Hyperkalemia

With hyperkalemia, hyper- means over and -kal- refers to potassium, and -emia refers to the blood, so hyperkalemia means higher than normal potassium levels in the blood, generally over 5.5 mEq/L.

Now, total body potassium can essentially be split into two components—intracellular and extracellular potassium, or potassium inside and outside cells, respectively.

The extracellular component includes both the intravascular space, which is the space within the blood and lymphatic vessels and the interstitial space, the space between cells where you typically find fibrous proteins and long chains of carbohydrates which are called glycosaminoglycans.

Now, the vast majority, around 98%, of all of the body’s potassium is intracellular, or inside of the cells.

In fact, the concentration of potassium inside the cells is about 150 mEq/L whereas outside the cells it’s only about 4.5 mEq/L.

Keep in mind that these potassium ions carry a charge, so the difference in concentration also leads to a difference in charge, which establishes an overall electrochemical gradient across the cell membrane. This is called the internal potassium balance.

This balance is maintained by the sodium-potassium pump, which pumps 2 potassium ions in for every 3 sodium ions out, as well as potassium leak channels and inward rectifier channels that are scattered throughout the membrane.

This concentration gradient is extremely important for setting the resting membrane potential of excitable cell membranes, which is needed for normal contraction of smooth, cardiac, and skeletal muscle.

Also, though, in addition to this internal potassium balance, there’s also an external potassium balance, which refers to the potassium you get externally through the diet every day.

On a daily basis the amount of potassium that typically gets taken in usually ranges between 50 mEq/L to 150 mEq/L, which is way higher than the extracellular potassium concentration of 4.5 mEq/L, so your body has to figure out a way to excrete most of what it takes in.

This external balancing act is largely taken care of by the kidneys, where excess potassium is secreted into a renal tubule and excreted in the urine.

Also though, a small amount dietary potassium is also lost via the gastrointestinal tract and sweat.