Because the kidney is responsible for 90 per cent of potassium excretion, most true hyperkalemia results from renal insufficiency. Hypertrophy of renal tubules usually maintains the ability to balance potassium until the glomerular filtration rate falls below 10 ml/min, provided that dietary intake is normal. An increased potassium intake or tissue release may lead to hyperkalemia at much higher glomerular filtration rates, as may the effects of drugs that modify renal handling of potassium. Hyperosmolar infusions may also produce hyperkalemia (Conte et al 1990) (Table 1).
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