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Hyperkaliémie sévère ou menaçante : le diable est dans les détails

Acute and severe hyperkalemia: Pathophysiological approach

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Réanimation

Résumé

Une hyperkaliémie aiguë avec des signes électrocardiographiques (ECG) peut mettre en jeu le pronostic vital. Malgré une littérature importante, les différents mécanismes physiopathologiques menant à l’hyperkaliémie restent complexes et n’ont pas encore été complètement élucidés. Dans cette revue de la littérature, nous avons intégré de nombreux articles permettant de comprendre l’impact de l’hyperkaliémie sur les cellules musculaires, cardiaques et squelettiques. L’intégration physiopathologique par le clinicien des modifications engendrées par l’hyperkaliémie est indispensable à la bonne compréhension de ses manifestations cliniques, notamment ECG. Nous discutons aussi des traitements spécifiques de l’hyperkaliémie, en insistant sur l’utilisation du sodium. Nous espérons aussi que le lecteur sera en mesure de discuter, d’un point de vue physiopathologique, l’importance du contexte clinique face à une hyperkaliémie biologique. Cette approche est discutée notamment chez le patient insuffisant rénal chronique. Les situations cliniques d’hyperkaliémie, chez les patients porteurs d’un stimulateur cardiaque ou dans un contexte préopératoire, sont aussi détaillées.

Abstract

Acute hyperkalemia with electrocardiogram (EKG) changes can be a life-threatening situation. Despite a large body of literature, the complex pathophysiology of hyperkalemia is not fully described or even explained at the molecular level in many textbooks. In this review, we specifically integrated a large body of clinical and experimental works describing how hyperkalemia impacts differently the cellular membrane potential in heart and muscle tissues. Integrating this knowledge appears relevant to the understanding of peculiar hyperkalemia-induced EKG changes that clinicians should be aware of. We discuss how some specific therapeutics (sodium salt infusion, in particular) might be reappraised in today’s practice. We also challenge the clinical relevance of isolated biological hyperkalemia. From a pathophysiological standpoint, we believe that hyperkalemia should be treated in regard to a specific clinical context more than based on potassium levels alone. This approach should be debated, especially in chronic renal failure patients. Clinical situations such as hyperkalemia occurring in patients with pacemaker devices, and hyperkalemia in preoperative settings are also discussed here.

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Authors and Affiliations

  1. Urgences néphrologiques et transplantation rénale, hôpital Tenon, AP–HP, 4, rue de la Chine, F-75020, Paris, France

    T. Robert & L. Mesnard

  2. Université Pierre-et-Marie-Curie, Paris-VI, F-75005, Paris, France

    T. Robert & L. Mesnard

  3. Service de cardiologie, hôpital Antoine-Béclère, F-92140, Clamart, France

    V. Algalarrondo

Authors
  1. T. Robert
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  2. V. Algalarrondo
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  3. L. Mesnard
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Correspondence to L. Mesnard.

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Robert, T., Algalarrondo, V. & Mesnard, L. Hyperkaliémie sévère ou menaçante : le diable est dans les détails. Réanimation 24, 688–712 (2015). https://doi.org/10.1007/s13546-015-1125-8

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  • DOI: https://doi.org/10.1007/s13546-015-1125-8

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