Tang et al listed risk factors associated with hyperkalemia in a patient treated with a drug that inhibits the renin-angiotensin-aldosterone system such as an aldosterone receptor antagonist. A patient with one or more of these risk factors should be monitored for hyperkalemia during therapy with one of these agents.


Comorbid conditions:

(1) advanced age

(2) diabetes mellitus

(3) chronic renal insufficiency, especially when the GFR is < 30 mL per minute


Concurrent medications:

(1) beta-adrenergic blocker

(2) trimethoprim

(3) NSAID therapy

(4) COX-2 inhibitor

(5) potassium sparing diuretic (triamterene, amiloride)


Fluid and electrolytes:

(1) volume depletion from dehydration, diarrhea or overdiuresis

(2) potassium-based salt substitute

(3) potassium supplement or high potassium diet


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