Which of the following can lead to hyperkalemia?

Hyperkalemia, which refers to elevated potassium levels in the bloodstream, can indeed be caused by acute kidney injury. In this condition, the kidneys are unable to effectively filter waste products and maintain electrolyte balance, leading to the accumulation of potassium. The kidneys play a crucial role in regulating potassium levels by excreting excess amounts in urine. When their function is compromised, potassium levels can rise, resulting in hyperkalemia and potentially causing serious cardiac issues.

While other factors such as dehydration can influence potassium levels, they do not primarily lead to hyperkalemia in the same way. Dehydration might concentrate electrolytes in the blood, but it does not directly affect the kidneys’ ability to excrete potassium. Metabolic alkalosis can also influence potassium levels; however, it typically leads to a shift of potassium into cells, thereby lowering serum potassium concentration rather than raising it. Excess insulin might also lead to a transient drop in serum potassium as insulin promotes the uptake of potassium into cells. Thus, acute kidney injury is the key factor directly associated with hyperkalemia in this context.