Hyperkalemia is the medical term for high potassium levels in the body. This condition (too much potassium) may not cause any symptoms, or it may cause mild, nonspecific symptoms that don’t feel serious. But hyperkalemia can sometimes cause serious symptoms and complications such as muscle weakness, muscle cramps, heart rhythm abnormalities, and heart attack.

Treatment of hyperkalemia (high serum potassium) depends on the cause and severity. Treatment options may consist of a low-potassium diet, medications such as diuretics and potassium binders to lower potassium levels, or dialysis for severe hyperkalemia. Please continue reading to learn more.

What role does potassium play in the body?

Potassium is an electrolyte (mineral) that dissolves in bodily fluids such as blood. The body obtains potassium from foods and drinks in diet. Potassium affects many organ systems and plays several important roles in the human body, such as nerve and muscle function and the movement of nutrients and waste products into and out of cells. Potassium also counteracts the effects of sodium (salt) on blood pressure.

When potassium homeostasis (balance) is disrupted, the body cannot maintain normal potassium levels. This results in potassium disorders (low or high potassium). These shifting potassium levels can cause various symptoms and complications.

What is the normal serum potassium level?

The normal serum potassium level is 3.5 to 5.0 mmol/L. Potassium levels above 5.5 mmol/L are called hyperkalemia. A potassium level above 6.5 mmol/L is dangerously high and requires immediate medical attention to prevent heart problems.

What causes hyperkalemia?

Chronic kidney disease

A common cause of hyperkalemia (high plasma potassium) is kidney disease or kidney failure. In healthy people, the kidneys remove excess potassium from the body in urine. This renal potassium excretion helps to maintain normal serum potassium levels. However, in people with chronic kidney disease (decreased kidney function), diabetic nephropathy, and renal failure, there is reduced renal excretion of potassium (the kidneys are unable to remove excess potassium), and high potassium in your blood (hyperkalemia) occurs as a result of this.

High-potassium diet

Eating a diet of high-potassium foods can lead to high serum potassium levels. Foods that are rich sources of potassium include fruits (bananas, cantaloupes, oranges), vegetables (tomatoes, potatoes, leafy green vegetables, broccoli, winter squash, beans), nuts (almonds, cashews), lean meats (chicken), fish (salmon), and dairy products.

Medications

A wide range of drugs can affect potassium metabolism and cause hyperkalemia, for example by impairing renal potassium excretion (potassium secretion in urine) or increasing how much potassium is absorbed from food. Examples of medications that can cause high potassium levels include blood pressure and heart medications such as beta blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin-II receptor blockers, potassium-sparing diuretics, aldosterone antagonists, and direct renin inhibitors. Other drugs, such as nonsteroidal anti-inflammatory drugs, suxamethonium, mannitol, calcineurin inhibitors, heparin, trimethoprim, pentamidine, and digoxin toxicity can also cause high serum potassium levels. In addition, potassium supplements and salt substitutes can be responsible for causing hyperkalemia.

Medical conditions

People with certain health conditions are at an increased risk of developing hyperkalemia (high potassium), for example, kidney disease, abnormal kidney structure, alcohol use disorder, diabetes, congestive heart failure, HIV infection, Addison’s disease (adrenal insufficiency), and large burns.

Genetic conditions

Rarely, certain genetic conditions such as pseudohypoaldosteronism type 1 and 2 can cause high potassium levels.

What are the symptoms of severe hyperkalemia?

Many people with hyperkalemia (high potassium levels) do not have any symptoms. Some people develop mild nonspecific symptoms for which they do not seek medical attention. The symptoms of hyperkalemia can come and go and may develop over several months. This makes it difficult to diagnose hyperkalemia (too much potassium).

When present, the symptoms of mild hyperkalemia may include gastrointestinal adverse events such as abdominal pain, nausea, vomiting, and diarrhea. Severe hyperkalemia can cause muscle weakness and cramps, numbness in the arms and legs, chest pain, palpitations, and specific heart rhythm abnormalities (fluttering, fast, or irregular heartbeat).

How do doctors diagnose hyperkalemia?

Doctors can diagnose hyperkalemia with a blood test to measure potassium levels. If a healthcare provider suspects that high potassium is having an effect on the heart, they may order an electrocardiogram (EKG). Specific changes in EKG are early signs of hyperkalemia.

How do you lower potassium in hyperkalemia?

The treatment of acute hyperkalemia consists of identifying the cause and treating it. For example, if a certain medication is causing high potassium, stopping it and changing to some other drug can help in reducing serum potassium. If renal disease is the cause, treatment for the kidney condition can help to lower serum potassium.

Your doctor may prescribe the following treatment options for lowering serum potassium if you have acute or chronic hyperkalemia:

Low potassium diet

You may be advised to limit your potassium intake by discontinuing potassium supplements and/or salt substitutes. Your doctor may also ask you to avoid or limit certain high-potassium foods (see above).

Diuretics or water pills

Thiazide diuretics such as chlorthalidone (Hygroton), chlorothiazide (Diuril), and hydrochlorothiazide (HydroDiuril, Esidrix, Microzide), and loop diuretics such as bumetanide (Bumex) and furosemide (Lasix) can help to lower the serum potassium concentration by helping the kidneys excrete potassium in urine.

Note: Potassium-sparing diuretics such as spironolactone (Aldactone), amiloride (Midamor), and eplerenone (Inspra) have the opposite effect and can cause high potassium levels.

Potassium binders

These medications help to restore potassium balance by removing excess potassium in the stool. They are used when dietary changes and other medications do not help with potassium lowering. Examples include calcium polystyrene sulfonate, sodium polystyrene sulfonate (Kayexalate, Kionex), sodium zirconium cyclosilicate (Lokelma), and patiromer (Veltassa).

Dialysis

Dialysis is a treatment used in patients with kidney failure. It helps the body remove extra fluid and waste products when the kidneys are unable to do so. If other measures are not able to lower potassium levels or if you have renal failure, your doctors may recommend dialysis to help your kidneys remove extra potassium from your blood.

What is the immediate treatment for hyperkalemia?

The immediate treatment for severe hyperkalemia (very high levels of potassium above 6.5 mmol/L or EKG changes) in hospitalized patients is intravenous calcium therapy which is given through a vein. This urgent treatment includes an IV infusion of calcium gluconate or calcium chloride to protect the heart. It is followed by intravenous insulin to help move extra potassium from the blood. An asthma medication, albuterol, may also be used as acute therapy to help lower blood potassium levels. In patients with severe hyperkalemia who have metabolic acidosis, sodium bicarbonate may be used in addition to insulin and albuterol for the management of hyperkalemia.

References:

https://my.clevelandclinic.org/health/diseases/15184-hyperkalemia-high-blood-potassium
https://www.hsph.harvard.edu/nutritionsource/potassium/
https://pubmed.ncbi.nlm.nih.gov/25047526/
https://www.health.harvard.edu/heart-health/tips-for-taking-diuretic-medications
https://my.clevelandclinic.org/health/treatments/24744-potassium-binder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5762976/#

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