The clinical signs of hyperkalemia usually are less evident than hypokalemia. Arrhythmia and bradycardia could be the first changes noticed. Most cases of persistent hyperkalemia are associated with renal retention of potassium. Common causes for hyperkalemia include hypoadrenocorticism, ruptured bladder, and urethral or bilateral ureteral obstruction. Drug such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, potassium-sparing diuretics, and nonsteroidal antiinflammatory drugs can also lead to hyperkalemia.