High potassium level

  • Definition
    • High potassium level is a problem in which the amount of potassium in the blood is higher than normal. The medical name of this condition is hyperkalemia.

  • Alternative Names
    • Hyperkalemia; Potassium - high; High blood potassium

  • Causes
    • Potassium is needed for cells to function properly. You get potassium through food. The kidneys remove excess potassium through the urine to keep a proper balance of this mineral in the body.

      If your kidneys are not working well, they may not be able to remove the proper amount of potassium. As a result, potassium can build up in the blood. This buildup can be due to:

      • Addison disease. Disease in which the adrenal glands do not make enough hormones.
      • Burns over large areas of the body
      • Certain blood pressure lowering drugs, most often angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
      • Damage to muscle and other cells from certain street drugs, alcohol abuse, untreated seizures, surgery, crush injuries and falls, certain chemotherapy, or certain infections.
      • Disorders that cause blood cells to burst (hemolytic anemia)
      • Severe bleeding from the stomach or intestines
      • Taking extra potassium, such as salt substitutes or supplements
      • Tumors
  • Symptoms
    • There are often no symptoms with a high level of potassium. When symptoms do occur, they may include:

      • Nausea
      • Slow, weak, or irregular pulse
      • Sudden collapse, when the heartbeat gets too slow or even stops
  • Exams and Tests
    • The health care provider will perform a physical exam and ask about your symptoms.

      Tests that may be ordered include:

      • Electrocardiogram (ECG)
      • Potassium level

      Your provider will likely check your blood potassium level and do kidney blood tests on a regular basis if you:

      • Have been prescribed extra potassium
      • Have chronic kidney disease
      • Take medicines to treat heart disease or high blood pressure
      • Use salt substitutes
  • Treatment
    • You will need emergency treatment if your potassium level is very high, or if you have danger signs, such as changes in an ECG.

      Emergency treatment may include:

      • Calcium given into your veins (IV) to treat the muscle and heart effects of high potassium levels
      • Glucose and insulin given into your veins (IV) to help lower potassium levels long enough to correct the cause
      • Kidney dialysis if your kidney function is poor
      • Medicines that help remove potassium from the intestines before it is absorbed
      • Sodium bicarbonate if the problem is caused by acidosis
      • Some water pills (diuretics)

      Changes in your diet can help both prevent and treat high potassium levels. You may be asked to:

      • Limit or avoid asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, and cooked spinach
      • Limit or avoid oranges and orange juice, nectarines, kiwifruit, raisins, or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines
      • Avoid taking salt substitutes if you are asked to eat a low-salt diet

      Your provider may make the following changes to your medicines:

      • Reduce or stop potassium supplements
      • Stop or change the doses of medicines you are taking, such as ones for heart disease and high blood pressure
      • Take a certain type of water pill to reduce potassium and fluid levels if you have chronic kidney failure

      Follow your provider's directions when taking your medicines:

      • DO NOT stop or start taking medicines without first talking to your provider
      • Take your medicines on time
      • Tell your provider about any other medicines, vitamins, or supplements you are taking
  • References
    • Kamel KS, Lin SH, Yang SS, Halperin M. Clinical disorders of hyperkalemia. In: Alpern RJ, Moe OW, Caplan M, eds. Seldin and Giebisch's The Kidney. 5th ed. Philadelphia, PA: Elsevier; 2013:chap 51.

      Seifter JL. Potassium disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 117.