Hyperkalemia is the medical term for when a person has higher than normal levels of potassium. Usually, people with hyperkalemia do not have any symptoms, which makes it challenging for a doctor to diagnose.

The leading causes of hyperkalemia are chronic kidney disease, uncontrolled diabetes, dehydration, an injury causing severe bleeding, consuming excessive dietary potassium, and some medications. A doctor will typically diagnose hyperkalemia when an individual’s potassium levels are greater than 5.0–5.5 milliequivalents per liter.

Treatment for hyperkalemia varies according to severity. In acute hyperkalemia, which often results from a particular event, such as trauma, doctors may use dialysis and intravenous medications to flush the potassium from the body. Chronic hyperkalemia usually means that a person’s kidneys are not functioning correctly, and doctors will offer treatment to manage the condition.

In this article, we will discuss the causes, symptoms, and treatment options for hyperkalemia.

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Hyperkalemia describes a medical condition in which a person has too much potassium in their blood. Typically, the body’s kidneys are able to regulate its serum concentration of potassium. However, if the kidneys are not functioning well, potassium can accumulate in the blood. Most sources suggest that normal potassium serum levels are between 3.6–5 millimoles per liter, and levels above 5 mmol/l indicate hyperkalemia.

Potassium is one of the seven essential macrominerals that people require for optimal health. It plays an important role in many bodily functions, such as helping the kidneys, heart, muscles, and the transmission of messages through the nervous system.

However, while it is important that people consume a sufficient amount of dietary potassium, having too much present in the blood can result in health complications. According to the Office of Dietary Supplements (ODS), the adequate intake level for potassium is roughly 2,600–3,400 milligrams for most adults and a daily value of 4,700 mg for adults and children age 4 years and older

There are different causes of high potassium levels, most of which affect the function of the kidneys. Possible causes of hyperkalemia may include:

  • Chronic kidney disease: A lower kidney capacity means that the kidneys may not be able to filter potassium out of the body adequately.
  • Uncontrolled or untreated diabetes: As a decrease in kidney function is a possible complication of diabetes, poorly managing the condition may result in hyperkalemia.
  • Taking certain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, potassium-sparing diuretics, cyclosporine, trimethoprim, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, succinylcholine, digoxin, heparin, and mannitol may also prevent the kidneys from eliminating excess potassium.
  • Heart disease: In people with congestive heart failure, lower kidney function combined with the medication to treat the disease can cause hyperkalemia.
  • Injury: Burns or other severe injuries can cause damage to tissues that results in the body releasing extra potassium into the blood.
  • Hypoaldosteronism: This rare condition results in a lack of aldosterone. This hormone helps regulate the amount of potassium the body excretes in the urine. People may also experience pseudohypoaldosteronism, which mimics the condition.
  • Congenital adrenal hyperplasia: A rare disease resulting from a gene mutation that can also cause lower levels of aldosterone.
  • Addison’s disease: This is a condition that occurs following damage to the adrenal glands. It can affect the production of hormones, such as aldosterone and cortisol, which can affect potassium levels.
  • Higher potassium intake: Consuming too much potassium through medications or diet can cause hyperkalemia. This is rare but may affect people whose kidneys do not function optimally.
  • Pseudohyperkalemia: This occurs when a person receives a falsely high potassium reading. This may happen when using a syringe or other methods that cause hemolysis, which is the breakdown of red blood cells.
  • Dehydration: Severe dehydration may lead to the body being unable to process potassium.

Typically, a person with hyperkalemia will experience very few, if any, symptoms. The symptoms they may experience are often mild and nonspecific, which means that doctors may overlook it until symptoms worsen.

Hyperkalemia occurs when the body is unable to remove excess potassium. As an electrolyte, it helps regulate fluid and blood levels, muscle contractions, and nerve impulses. As such, high levels of potassium may disrupt or affect many of these processes.

Acute hyperkalemia is when significant changes to potassium levels occur over a short time, and it is more serious than having chronic hyperkalemia, or regularly high potassium levels. However, both acute and chronically high potassium levels can be dangerous, potentially causing a heart attack or paralysis.

Chronic hyperkalemia often has fewer symptoms than acute hyperkalemia.

At higher potassium levels, symptoms of hyperkalemia can include:

  • muscle weakness
  • a general feeling of weakness or fatigue
  • nausea and vomiting
  • muscle pain or cramps
  • difficulty breathing
  • heart palpitations
  • chest pain

Hyperkalemia often presents with no symptoms. This means doctors often find it challenging to diagnose.

In people with cases of acute hyperkalemia, doctors will:

  • assess kidney, heart, and urinary tract function
  • check hydration levels
  • monitor the heartbeat using an electrocardiogram

In people with cases of chronic hyperkalemia, doctors follow up by ordering routine laboratory work, such as blood tests or urine samples. Additionally, they may check medications to ensure there are no interactions that may contribute to high potassium levels.

Doctors often use dialysis to treat people with cases of hyperkalemia that require urgent treatment. Dialysis involves filtering the blood to eliminate toxins, and it will reduce the body’s total potassium levels. People with kidney failure or urgent cases of hyperkalemia will benefit the most from dialysis.

In acute hyperkalemia, doctors may prescribe the following treatments to lower potassium levels:

  • Intravenous insulin and glucose: This is the most reliable method for reducing potassium levels as it forces potassium into the cells and out of the blood. In most cases, this option works within 10–20 minutes and the effect typically lasts 4–6 hours. The glucose helps prevent blood sugar levels from going too low.
  • Albuterol: This is only effective in some groups of people. Doctors often administer a much higher concentration than a typical albuterol inhaler, and they may use it alongside other treatments to help with potassium secretion.
  • Intravenous calcium: Injecting calcium into the blood helps to stabilize the cardiac membrane, which can help protect against damage to the heart.

Treatment options for chronic hyperkalemia may include stopping or adjusting medications, avoiding NSAIDs, and reducing the consumption of foods rich in potassium. Additionally, people may benefit from avoiding certain salt substitutes, herbal remedies, or supplements and taking diuretics and potassium binders.

If a person is at risk for developing hyperkalemia, they can make some dietary alterations that may help prevent their potassium levels from becoming too high. However, before making any changes, it is advisable to discuss them with a doctor.

For example, a doctor might recommend limiting foods that contain high levels of potassium. According to the Dietary Guidelines for Americans, the foods with the highest potassium per serving size are:

  • beet greens
  • fufu
  • lima beans
  • Swiss chard
  • potatoes, with skin
  • yams
  • durian
  • jackfruit
  • yogurt

Other high potassium foods include:

  • canned tomato products
  • juices, such as prune, carrot, and tomato
  • proteins, such as white beans, clams, halibut, soybeans, tuna, lima beans, and cod
  • stone fruits, particularly dried prunes, apricots, and peaches

In addition to limiting or avoiding certain foods, people can also:

  • check if any salt substitutes are high in potassium, such as those that list potassium chloride as an ingredient
  • drink sufficient amounts of water to avoid dehydration
  • avoid certain herbs that can raise potassium levels, such as alfalfa, nettle, and dandelion

Treatment for hyperkalemia varies according to whether it is acute or chronic. Acute hyperkalemia is more urgent and dangerous than chronic hyperkalemia and requires rapid treatment, such as dialysis.

Some groups of people are more likely to experience hyperkalemia. Being older or male can increase the risk of hyperkalemia. Having kidney disease, hypertension, diabetes, heart disease, or a past heart attack may also increase the risk of developing hyperkalemia.

Talking with a doctor is the first step to prevent hyperkalemia and find effective treatment.