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Hyperkalemia is a common and potentially lethal clinical problem. It may be caused by several drugs, especially those which target the renin-angiotensin--aldosterone system, inability of kidney to excrete potassium, a shift of these ions into the extracellular fluid, or a combination of those mechanisms. It can be also spurious, caused by hemolysis after blood drawing. In the article the conditions associated with hyperkalemia, its diagnosis and the management are reviewed.

Background: Severe hyperkalaemia may be life-threatening, especially in patients with renal failure who are unable to excrete potassium. Various therapies including intravenous sodium bicarbonate, insulin/glucose infusion as well as several beta-2 agonists have been proposed for management of hyperkalaemia. However, if the potassium concentration increases rapidly and the situation becomes critical, haemodialysis may be used. External cardiac compressions can provide adequate blood flow., Case Report: We report a case of a 53-year-old male drunk, multiple trauma patient who was admitted after falling from the tree 40 h earlier. Patients was tetraplegic and anuric. His serum potassium concentration was 8.5 mmol L(-1). Shortly after admittance he arrested and standard CPR was commenced. Because of hyperkalaemia veno-venous haemodialysis was initiated via the internal jugular vein. Blood flow was adequate. After 40 min of resuscitation serum potassium decreased to 5.44 mmol L(-1) and spontaneous sinus rhythm returned. Patient regained consciousness and could move his limbs. After another four dialysis he recovered completely., Conclusion: Haemodialysis should be considered as a rescue method during hyperkalaemic cardiac arrest if standard CPR and treatment of hyperkalaemia is not effective, even if there is no spontaneous circulation present.

Patients with congestive heart failure are at increased risk of hyperkalemia due to coexisting morbidities and usage of multiple medications that impair potassium excretion--such as angiotensin-converting enzyme inhibitors or spironolactone. Because of the risk of this disturbance, knowledge of causation and prevention is mandatory. We described 3 patients with life threatening hyperkalemia (>8.5 mEq/t) caused by drugs. We showed the symptoms of increased potassium level, the list of medications and comorbidities predisposing to hyperkalemia. After a few days of medical treatment and dialysis, potasium level normalized in all of our patients.

Patients with congestive heart failure are at risk for hiperkaliemia because of coexisting comorbidities and use of multiple medications that impair potassium excretion--such as angiotensin-converting enzyme inhibitors or spironolactone. This is the case report about the patient with late drug-induced hyperkalemia. Causes and prevention methods used against development of this adverse event were explained.

Three elderly patients with severe symptomatic bradyarrhythmia due to iatrogenic hyperkalemia are presented. In all patients potassium - lowering therapy was effective; two patients required temporary pacing. The issue of iatrogenic hyperkalemia and treatment options are discussed.