I Pseudohyperkalemia A. Cellular efflux; thrombocytosis, erythrocytosis, leukocytosis, in vitro hemolysis B. Hereditary defects in red cell membrane transpo II. Intra- to extracellular shift A. Acidosis B. Hyperosmolality; radiocontrast, hypeonic dextrose, mannitol C. b2-Adrenergic antagonists (noncardioselective agents) D. Digoxin and related glycosides (yellow oleander, foxglove, bufadienolide) E. Hyperkalemic periodic paralysis F. Lysine, arginine, and e-aminocaproic acid (structurally similar, positively charged) G. Succinylcholine; thermal trauma, neuromuscular injury, disuse atrophy, mucositis, or prolonged immobilization H. Rapid tumor lysis III. Inadequate excretion A. Inhibition of the renin-angiotensin-aldosterone axis; | risk of hyperkalemia when used in combination 1. Angiotensin-conveing enzyme (ACE) inhibitors 2. Renin inhibitors; aliskiren (in combination with ACE inhibitors or angiotensin receptor blockers ) 3. Angiotensin receptor blockers (ARBs) 4. Blockade of the mineralocoicoid receptor: spironolactone, eplerenone, drospirenone 5. Blockade of the epithelial sodium channel (ENaC): amiloride, triamterene, trimethoprim, pentamidine, nafamostat B. Decreased distal delivery 1. Congestive hea failure 2. Volume depletion C. Hyporeninemic hypoaldosteronism 1. Tubulointerstitial diseases: systemic lupus erythematosus (SLE), sickle cell anemia, obstructive uropathy 2. Diabetes, diabetic nephropathy 3. Drugs: nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 (COX2) inhibitors, b-blockers, cyclosporine, tacrolimus 4. Chronic kidney disease, advanced age 5. Pseudohypoaldosteronism type II: defects in WNK1 or WNK4 kinases, Kelch-like 3 (KLHL3), or Cullin 3 (CUL3) D. Renal resistance to mineralocoicoid 1. Tubulointerstitial diseases: SLE, amyloidosis, sickle cell anemia, obstructive uropathy, post-acute tubular necrosis 2. Hereditary: pseudohypoaldosteronism type I; defects in the mineralocoicoid receptor or the epithelial sodium channel (ENaC) E. Advanced renal insufficiency 1. Chronic kidney disease 2. End-stage renal disease 3. Acute oliguric kidney injury F. Primary adrenal insufficiency 1. Autoimmune: Addison's disease, polyglandular endocrinopathy 2. Infectious: HIV, cytomegalovirus, tuberculosis, disseminated fungal infection 3. Infiltrative: amyloidosis, malignancy, metastatic cancer 4. Drug-associated: heparin, low-molecular-weight heparin 5. Hereditary: adrenal hypoplasia congenita, congenital lipoid adrenal hyperplasia, aldosterone synthase deficiency 6. Adrenal hemorrhage or infarction, including in antiphospholipid syndrome