Causes of hyperkalemia in children based on pathophysiology

Category	Cause
Increased potassium intake (rare cause of hyperkalemia, with the exception of children with chronic kidney disease)	Exposure to high potassium loads in intravenous fluids or medications Exposure to potassium-containing medications Massive transfusions of stored blood
Transcellular potassium movement	Structural cellular damage due to: Hemolysis Rhabdomyolysis Tumor lysis No structural cellular injury: Metabolic acidosis Diabetic ketoacidosis Hyperkalemia periodic paralysis
Abnormal renal potassium excretion	Decreased effective circulating volume Decreased RAAS activity: Congenital adrenal hyperplasia Adrenal insufficiency Drug effect (ACE inhibitor/ARB, eplerenone, spironolactone, or aliskiren) Significant kidney function impairment with either acute or chronic loss of GFR Impaired tubular potassium secretion: Reflux nephropathy Obstructive uropathy Sickle cell nephropathy Drug effect (amiloride, triamterene) Hypoaldosteronism (type IV renal tubular acidosis)
Pseudohyperkalemia	Hemolyzed specimen Leukocytosis or thrombocytosis

ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; GFR: glomerular filtration rate; RAAS: renin-angiotensin-aldosterone system.

Graphic 85965 Version 3.0