Hyperkalaemia in a patient with hepatic cirrhosis

Haralampos J. Milionis and Moses S. Elisaf

Department of Internal Medicine, Medical School University of Ioannina, Greece

A 53-year-old man with cirrhotic ascites due to chronic hepatitis B infection was admitted because of malaise, fatigue and ascites deterioration. The patient was on frusemide 80 mg per o.s. and spironolactone 100 mg per o.s. daily. On physical examination, cachexia, ascites and flapping tremor were evident.

Biochemical parameters and arterial gas determination are shown in Table 1Go. Serum aldosterone was 800 pg/ml (normal range 7.5–150 pg/ml), and plasma renin activity was 18 ng/ml/h (normal range 0.2–2.8 ng/ml/h).

Answer to quiz on preceding page

Although hyperkalaemia may lead to clinical problems, hypokalaemia is probably more significant as it is a risk factor for the development of hepatic encephalopathy in cirrhotic patients. Hypokalaemia has been shown to increase tubular NH3 synthesis resulting in high serum ammonia levels. Therefore, cirrhotic patients must have their serum potassium levels regularly checked, aiming towards prevention of potassium depletion. In practice, Henle-loop diuretics (e.g. frusemide) in combination with potassium-sparing diuretics (e.g. spironolactone) should be carefully administered in order to maintain normal serum potassium levels [6].

Notes

The readers of our journal are encouraged to submit material suitable for this section. Submissions should be directed to the Section Editor, Dr T. J. Rabelink, University Hospital, Department of Nephrology, PO Box 85500, Fo 3.226, 3508 GA Utrecht, The Netherlands.

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