High Potassium

What is hyperkalemia?

Potassium is an essential electrolyte, which is a mineral your body needs to function correctly. Potassium is especially important for your nerves and muscles, including your heart.
While potassium is important to your health, getting too much of the nutrient can be just as bad as, or worse than, not getting enough. Normally, your kidneys keep a healthy balance of potassium by flushing excess potassium out of your body. But for many reasons, the level of potassium in your blood can get too high. This is called hyperkalemia, or high potassium. 

According to the Mayo Clinic, a normal range of potassium is between 3.6 and 5.2 millimoles per liter (mmol/L) of blood. A potassium level higher than 5.5 mmol/L is critically high, and a potassium level over 6 mmol/L can be life-threatening. Small variations in ranges may be possible depending on the laboratory.
Whether you have mild or severe hyperkalemia, you should get prompt medical attention to prevent possible complications.

Causes

Several things can cause hyperkalemia, including health problems and use of certain medications.

Kidney failure

Kidney failure is the most common cause of high potassium. When your kidneys fail or don’t function properly, they can’t remove extra potassium from your body. This can lead to potassium buildup.

Other health conditions

High potassium can also be linked to certain health problems, such as:

• dehydration
• type 1 diabetes
• Addison's disease
• internal bleeding

Medications

Certain medications have been linked with high potassium levels. These include:

• certain chemotherapy drugs
• angiotensin-converting enzyme (ACE inhibitors)
• angiotensin-receptor blockers

Supplements

Overuse of potassium supplements can increase your potassium levels to a range that’s higher than normal or even dangerous.

Alcohol or drug use

Heavy alcohol or drug use can cause your muscles to break down. This breakdown can release a high amount of potassium from your muscle cells into your bloodstream.

Trauma

Certain kinds of trauma can raise your potassium levels as well. In these cases, extra potassium leaks from your body cells into your bloodstream. Burns or crush injuries where a large number of muscle cells are injured can cause these effects.

Symptoms of high potassium

The symptoms of high potassium depend on the level of the mineral in your blood. You may not have any symptoms at all. But if your potassium levels are high enough to cause symptoms, you may have:

• tiredness or weakness
• a feeling of numbness or tingling
• nausea or vomiting
• trouble breathing
• chest pain
• palpitations or irregular heartbeats

In extreme cases, high potassium can cause paralysis or heart failure. If left untreated, high potassium levels can cause your heart to stop.

When to call your doctor

Because the effects of high potassium can be serious, it’s important to address this condition right away. If you have any of the symptoms above and you’ve been diagnosed with high potassium or have reason to think you have it, call your doctor right away. If your symptoms are severe, call 911 or go to the nearest emergency room.
If you have extremely high potassium levels, you’ll need to be hospitalized until your levels return to normal.

How it’s diagnosed

A blood test or urine test can help your doctor diagnose hyperkalemia. Your doctor will routinely do blood tests during your annual checkup or if you’ve recently started a new medication. Any problems with your potassium levels will show up on these tests.
If you’re at risk of high potassium, it’s important to have regular checkups. This is because you may not be aware you have high potassium levels until you start developing symptoms.

Treatment

The typical goal of treatment for high potassium levels is to help your body get rid of the excess potassium quickly and to stabilize your heart.

Hemodialysis

If you have high potassium due to kidney failure hemodialysis,  is your best treatment option. Hemodialysis uses a machine to remove waste from your blood, including excess potassium, when your kidneys cannot filter your blood effectively.

Medications

Your doctor may also prescribe drugs to treat your high potassium levels. These may include:
Calcium gluconate: Calcium gluconate can help reduce the effect that potassium has on your heart until high potassium levels are stabilized.
Diuretics: Your doctor might also prescribe diuretics, which are pills that cause you to urinate more. Some diuretics increase the amount of potassium excreted by the kidneys while other diuretics do not increase potassium excretion. Depending on your potassium level, your doctor might recommend one or more of the following types of diuretics:

• loop diuretics
• potassium-sparing diuretics
• thiazide diuretics

Each type of diuretic targets a different part of the kidneys.
Resin: In some cases, you may be given a medication called a resin to take by mouth. Resin binds with potassium, allowing it to be removed from your body during your bowel movements.

Home remedies for reducing potassium

If your high potassium is severe, you must get treatment right away. But if you have mild high potassium, you may be able to help reduce your potassium levels at home. Be sure to follow your doctor’s instructions for treating your high potassium, and talk to your doctor before trying these methods.

Reduce your potassium intake

One of the easiest ways to lower your potassium levels naturally is to reduce the amount of potassium in your diet. This means limiting foods and supplements that are high in potassium.

• bananas
• nuts
• beans
• milk
• potatoes
• apricots
• cod
• beef

Talk to your doctor for suggestions about the best diet plan for you. You can also ask them for a referral to a dietitian or nutritionist.

Check your salt substitutes

Some salt substitutes are also high in potassium. When you buy a salt substitute, make sure to avoid any that list potassium chloride as an ingredient. Foods that are high in additives, such as commercial baked goods and sports drinks, are also usually high in potassium.

Drink more water

Dehydration can make high potassium levels worse. Try to drink more water.

Avoid certain herbs

If you take herbs for any reason, be aware that there are a few herbs you should not take if you have high potassium levels. Alfalfa, nettle, and dandelion can increase your potassium levels, so be sure to avoid them.

Outlook

Because symptoms of high potassium may not appear in the early stage, you should get regular blood tests if you’re at risk for this condition. 

If your blood tests show that you have high potassium levels, your doctor will choose the treatment plan that’s right for you. If your levels are dangerously high, your doctor may prescribe 
hospitalization or dialysis. But if your potassium levels are slightly elevated and you don’t have any other symptoms of hyperkalemia, your doctor may choose to monitor your condition and order a follow-up test. 

In either case, with prompt intervention, high potassium can be treated.

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How to Lower Your Potassium Levels

Hyperkalemia means that the potassium levels in your blood are too high.

High potassium occurs most often in people with chronic kidney disease (CKD). This is because the kidneys are responsible for getting rid of excess potassium and other electrolytes like salt.

Other causes of hyperkalemia include:
    metabolic acidosis
    trauma
    certain medications

Hyperkalemia usually doesn’t have any symptoms.

To find out your potassium levels, your healthcare provider will order a blood test. According to the National Kidney Foundation, a blood potassium level higher than 5 mmol/L indicates hyperkalemia.

Untreated hyperkalemia can be life threatening, resulting in irregular heartbeats and even heart failure.

It’s important to follow your healthcare provider’s advice and take steps to lower your potassium levels.

Your treatment will depend on:
    how severe your hyperkalemia is
    how quickly it’s come on
    what’s causing it

Here are several ways you can lower your blood potassium levels.
Acute hyperkalemia treatment

Acute hyperkalemia develops over the course of a few hours or a day. It’s a medical emergency that requires treatment in a hospital.

At the hospital, your doctors and nurses will run tests, including an electrocardiogram to monitor your heart.

Your treatment will depend on the cause and severity of your hyperkalemia. This may include removing potassium from your blood with potassium binders, diuretics, or in severe cases, dialysis.

Treatment may also include using a combination of intravenous insulin, plus glucose, albuterol, and sodium bicarbonate. This helps move potassium from your blood into your cells.

It can also treat metabolic acidosis, another common condition associated with CKD, which occurs when there’s too much acid in your blood.

Chronic hyperkalemia treatment
Chronic hyperkalemia, which develops over the course of weeks or months, can usually be managed outside of the hospital.

Treating chronic hyperkalemia usually involves changes to your diet, changes to your medication, or starting a medication such as potassium binders.

You and your healthcare provider will also carefully monitor your potassium levels.
Types of medications
Diuretics and potassium binders are two common types of medication that can treat hyperkalemia.
 
Diuretics

Diuretics increase the flow of water, sodium, and other electrolytes like potassium out of the body. They’re a common part of treatment for both acute and chronic hyperkalemia. Diuretics can reduce swelling and lower blood pressure, but they can also cause dehydration and other side effects.
Potassium binders

Potassium binders work to treat hyperkalemia by increasing the amount of potassium your body excretes through bowel movements.

There are several types of potassium binders that your doctor may prescribe, such as:

    sodium polystyrene sulfonate (SPS)
    calcium polystyrene sulfonate (CPS)
    patiromer (Veltassa)
    sodium zirconium cyclosilicate (Lokelma)

Patiromer and sodium zirconium cyclosilicate are two relatively new treatments for hyperkalemia. Both of these may be especially effective options for people with heart disease or diabetes, as they enable continued use of certain medications that can lead to hyperkalemia.

Changing medications

Certain medications can sometimes cause hyperkalemia. High blood pressure medications known as renin-angiotensin-aldosterone system (RAAS) inhibitors can sometimes lead to high potassium levels.

Other drugs associated with hyperkalemia include:
    nonsteroidal anti-inflammatory drugs (NSAIDs)
    beta-blockers for high blood pressure
    heparin, a blood thinner
    calcineurin inhibitors for immunosuppressive therapy

Taking potassium supplements can also lead to high potassium levels.

It’s important to talk with your healthcare providers about any and all medications and supplements you take to help determine the cause of your hyperkalemia.

This will also allow them to make the right recommendations for lowering your potassium.

If your hyperkalemia is caused by a medication you currently take, your healthcare provider may recommend changing or stopping that medication.

Or, they may recommend certain changes to your diet or the way you cook. If diet changes don’t help, they may prescribe a hyperkalemia medication, like potassium binders.
Dietary changes

Your healthcare provide may recommend a low potassium diet to manage your hyperkalemia.

There are two easy ways to naturally lower the amount of potassium you eat, which are:

    avoiding or limiting certain high potassium foods
    boiling certain foods before you eat them

High potassium foods to limit or avoid include:

    root vegetables such as beets and beet greens, parsnips, and potatoes, yams, and sweet potatoes (unless they’re boiled)
    bananas and plantains
    spinach
    avocado
    prunes and prune juice
    raisins
    dates
    sun-dried or pureed tomatoes, or tomato paste
    beans (like adzuki beans, kidney beans, chickpeas, soybeans, etc.)
    bran
    potato chips
    French fries
    chocolate
    nuts
    yogurt
    salt substitutes

High potassium drinks to limit or avoid include:

    coffee
    fruit or vegetable juice (especially passion fruit and carrot juices)
    wine
    beer
    cider
    milk

Boiling certain foods can lower the amount of potassium in them.
For example, potatoes, yams, sweet potatoes, and spinach can be boiled or partially boiled and drained. Then, you can prepare them how you normally would by frying, roasting, or baking them.

Boiling food removes some of the potassium. However, avoid consuming the water you’ve boiled the food in, where potassium will remain.

Your doctor or nutrition specialist will also likely recommend you avoid salt substitutes, which are made from potassium chloride. These can also increase your blood potassium levels.
Takeaway

Your healthcare provider will work with you to find the right treatment to manage your chronic hyperkalemia or help you avoid an acute episode.

Changing your medication, trying a new medication, or following a low potassium diet can all help.

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Early intervention in hyperkalemia can cut mortality by half

A new study has suggested that correcting high potassium levels immediately in patients suffering from hyperkalemia can cut the mortality rate in the population by half. The study was published in the journal called American Journal of Emergency Medicine.

In the study, researchers reviewed around 115000 patients and found that the mortality rate was significantly reduced in such patients. “Because of the increasing risk of hyperkalemia in this population, it is important, as our study showed, to develop protocols that help quickly identify and correct hyperkalemia while the patient is still in the emergency department,” said Dr Singer.

Tens of thousands of patients that suffer from diseases like heart failure, diabetes, renal failure, and hypertension have higher risks of developing hyperkalemia. In the future, many therapies that would be deduced to treat these conditions might also contain high potassium levels.

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Beware, too much potassium in your blood can give you hyperkalemia

Though the name may sound serious and exotic, hyperkalemia is actually a common condition. Most people are diagnosed with mild hyperkalemia. This is not life-threatening and can be easily treated. This is in fact essential because if it get too severe, it can give you a cardiac arrest. In severe cases, it can be fatal. This condition occurs when you have too much potassium in your bloodstream. Though potassium is essential for the proper functioning of the muscles, heart and nerves, too much can be dangerous. At the same time, low potassium is also not a good thing. You need to maintain a balance for good health.

Now, according to a new study in American Journal of Emergency Medicine, correcting high potassium levels immediately in patients suffering from hyperkalemia can cut the mortality rate in the population by half.  Researchers say that tens of thousands of patients who suffer from diseases like heart failure, diabetes, renal failure, and hypertension have higher risks of developing hyperkalemia. In the future, many therapies that would be deduced to treat these conditions might also contain high potassium levels.

Symptoms of hyperkalemia

In most cases hyperkalemia does not cause any symptoms. But usual  signs to look out for are nausea, extreme tiredness, muscle weakness and a tingling sensation. In severe cases, you may experience a slow heartbeat and a weak pulse. Acute hyperkalemia can cause cardiac arrest and even death.

Causes of hyperkalemia

The major causes of hyperkalemia are renal diseases and adrenal gland disorder. It happens when potassium shifts out of cells into the blood circulation. Sometimes, it may also be the result of certain medication.

Treatment and prevention measures

Your doctor will ask you to stop taking any potassium supplements, salt substitutes that contain potassium and other medications that may can cause hyperkalemia. He will also ask you to keep your kidneys healthy. Treatment for mild hyperkalemia varies from person to person depending on health status and severity of the condition. But in severe cases it may require emergency intervention with heart rhythm monitoring.

If you have this condition, you will have to follow a low potassium diet, stop taking medications that increase blood potassium levels, intravenous administration of glucose, insulin, calcium to promote movement of potassium from the extracellular space back into the cells and to protect the heart and muscles from the effects of hyperkalemia. In severe cases, you may have to go in for dialysis in the event of renal failure.

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