Hyperkalemia can be caused by a deficiency of the salt-retaining hormone, aldosterone. As most readily seen in patients with adrenal insufficiency, the lack of salt-retaining hormone leads to decreased renal tubular reabsorption of sodium. Since potassium is excreted in exchange for sodium reabsorbed, potassium excretion is decreased, resulting in hyperkalemia. The deficiency of aldosterone may be selective. The first report of a patient with isolated aldosterone deficiency clearly defined the typical features of the syndrome: elderly patients with mild to moderate renal insufficiency in whom severe hyperkalemia develops, particularly when they are deprived or depleted of sodium, the hyperkalemia manifested.
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