Complications
Severe muscle weakness is a complication of significant hyperkalemia, commonly presenting as ascending paralysis. This process occurs as a function of depolarization blockade.[103] Muscle weakness secondary to hyperkalemia can be of sufficient severity to suppress respiratory effort. The effect of nondepolarizing muscle relaxants can be accentuated by concurrent hyperkalemia. Cardiac arrhythmias often, but not always, accompany muscle paralysis. Urgent reduction in serum potassium values is required to reverse this complication.
Hyperkalemia has several consequences for the myocardial action potential. The action potential shortens and the myocardium undergoes premature synchronous repolarization. Conduction velocity increases. These pro-excitatory changes may induce fibrillation or tachyarrhythmias.[97][98]
Life-threatening arrhythmias occur most commonly when factors impairing cellular uptake of potassium coexist. Presence of hyponatremia and/or hypocalcemia can intensify the cardiotoxicity of hyperkalemia.[69] ECG findings are usually progressive and include first-degree heart block (prolonged PR interval >0.2 s), flattened or absent P waves, tall peaked (tented) T waves (i.e., T wave larger than R wave in more than 1 lead), ST-segment depression, widened QRS (>0.12 s), ventricular tachycardia, bradycardia, and eventually cardiac arrest (pulseless electrical activity, ventricular fibrillation/paroxysmal ventricular tachycardia, asystole).[3] The presence of cardiotoxic ECG changes from hyperkalemia requires continuous monitoring until serum potassium values have been brought into a safe range and the ECG changes have been corrected.[1]
[Figure caption and citation for the preceding image starts]: ECG changes in people with hyperkalemiaBMJ 2009; 339:b4114. Copyright ©2009 by the BMJ Publishing Group [Citation ends].
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