Which medications are associated with hyperkalemia?

• A. ACE inhibitors
• B. Spironolactone
• C. ACE inhibitors and Spironolactone
• D. Beta-blockers

Answer: (C)

When potassium balance is disrupted, it's usually from drugs that blunt aldosterone’s effect or mimic its action. Aldosterone promotes potassium excretion in the collecting ducts of the kidney; reducing its activity or action leads to potassium retention.

ACE inhibitors lower angiotensin II, which in turn reduces aldosterone secretion from the adrenal glands. With less aldosterone, the distal nephron excretes less potassium, so serum potassium can rise. Spironolactone directly blocks aldosterone receptors in the collecting ducts, acting as a potassium-sparing diuretic; this also reduces potassium excretion and increases potassium retention.

Because both drug types undermine the body’s ability to remove potassium, they are classically associated with hyperkalemia, and the risk is higher when kidney function is impaired or when other contributing factors (like NSAID use or potassium supplements) are present. Beta-blockers can cause mild hyperkalemia in some situations, but the strongest, most consistent associations are with ACE inhibitors and spironolactone, especially together.