Which electrolyte imbalance may worsen in patients with acute kidney injury?

Hyperkalemia is the most likely electrolyte imbalance to worsen in patients with acute kidney injury (AKI). In AKI, the kidneys' ability to excrete potassium is impaired, leading to its accumulation in the blood. This can have serious consequences, as high potassium levels can result in dangerous cardiac arrhythmias.

Due to the diminished renal function, potassium retention becomes pronounced, especially if there are additional factors at play, such as tissue breakdown from muscle injury or hemolysis, which releases potassium into the bloodstream. As a result, monitoring and managing potassium levels is crucial in patients with AKI to prevent further complications.

While other electrolyte imbalances, such as hypocalcemia, hyponatremia, and hyperchloremia, can occur in the context of AKI, hyperkalemia specifically stands out as a direct and critical consequence of the kidneys’ failure to excrete potassium. The prominence of hyperkalemia in this scenario highlights the importance of recognizing and addressing electrolyte disturbances in the management of acute kidney injury.