Hyperkalemia (High Potassium)

Medications that have been linked to hyperkalemia include:

• Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors
• Blood pressure drugs called angiotensin-receptor blockers (ARBs)
• Blood pressure drugs called beta-blockers
• Herbal supplements, including milkweed, lily of the valley, Siberian ginseng, Hawthorn berries, or preparations from dried toad skin or venom (Bufo, Chan Su, Senso)
• Heparin, a blood thinner
• Nonsteroidal anti-inflammatory medications (NSAIDs)
• Potassium supplements
• Potassium-sparing diuretics including amiloride (Midamor), spironolactone (Aldactone, Carospir), and triamterene (Dyrenium)
• Antibiotics, including amoxicillin

Genetic conditions

Some people are born with mutations in their genes that can lead to hyperkalemia. Genetic conditions linked to high potassium include:

• Pseudohypoaldosteronism type 1 (PHA1), which affects how your body handles sodium
• Pseudohypoaldosteronism type 2 (PHA2), or Gordon's syndrome, which affects your blood pressure
• Fibronectin glomerulopathy (GFND), a genetic kidney condition
• Hyperkalemic periodic paralysis (HYPP), an inherited condition that causes muscle weakness
• Congenital hypoaldosteronism, which affects your body's adrenal glands
• Nephronophthisis, which causes scarring on your kidneys

What Is Pseudohyperkalemia?

Pseudohyperkalemia happens when your blood test doesn't accurately reflect the level of potassium in your body. You might get an artificially high reading for many reasons, including:

• Problems during blood draw, such as using a too-tight tourniquet or clenching your fist too hard
• Issues with the way the blood is delivered to the lab for testing
• Issues with how the test is performed

Any of these factors can cause blood cells in your sample to rupture, which lets extra potassium leak out. If your health care provider thinks you may have pseudohyperkalemia, they'll repeat the blood test.

Symptoms of Hyperkalemia

If your hyperkalemia is mild, you may not have any symptoms or only have them sometimes. If your hyperkalemia is severe, it can cause heart problems and other life-threatening complications.

Hyperkalemia Diagnosis

You may not have any symptoms of hyperkalemia, and you may not know you have it until your have an abnormal blood test. A specific test, called a serum potassium test, measures the level of potassium in your blood.

Hyperkalemia EKG

Your doctor might order this test to see whether your heart shows evidence of hyperkalemia.

For an electrocardiogram (EKG or ECG), you'll have electrodes placed on certain parts of your body. The electrodes are connected by wires called leads to the EKG machine. Your heart's electrical activity is measured and printed on a piece of paper. No electricity goes into your body.

Your doctor will study the T waves on the printout, which show your heart at rest after a beat. If your T waves are tall or peaked, that can be a sign of hyperkalemia.

Hyperkalemia Levels

Potassium levels are measured in millimoles per liter (mmol/L).

Hyperkalemia Treatment

Your potassium levels and symptoms will help decide how your hyperkalemia is treated.

Diuretics. You may have heard these medicines called "water pills." They make you pee more, helping flush potassium out of your system.

Adjusting your medicine. You may need to stop meds that are leading to hyperkalemia or switch to another type of drug.

Potassium binders. These drugs bind potassium to your poop, which helps remove it from your body.

Calcium gluconate for hyperkalemia. This is part of IV therapy for high potassium levels. These drugs protect your heart.

Insulin for hyperkalemia. Receiving insulin can be another step in IV therapy. It moves potassium into your blood cells.

Beta-2 adrenergic agents. These drugs push your cells to reabsorb extra potassium.

Dialysis. You may need treatment for underlying kidney disease, which can include dialysis. This process filters potassium from your blood.

Hyperkalemia Management 

Your health care provider will help you come up with a plan to manage your hyperkalemia.

You may need medicine to keep your hyperkalemia in check. Slower-acting potassium binders used for hyperkalemia management include:

• Patiromer sorbitex calcium (Veltassa)
• Sodium polystyrene sulfonate (Kayexalate), although there are safety precautions to follow with this drug
• Sodium zirconium cyclosilicate (Lokelma)

Dietary changes

You may need to follow a low-potassium diet. You might have to cut back on certain foods or avoid them completely. Foods on that list include:

• Dried fruits such as prunes, raisins, apricots and dates
• Fresh orange juice and canned juices such as prune, apricot, and grapefruit
• Fresh fruits such as bananas, strawberries, watermelon, cantaloupe, honeydew, oranges, and nectarines
• Fresh vegetables such as spinach, beets, spinach, tomatoes, mushrooms, squash, potatoes, sweet potatoes, avocados, and asparagus
• Tomato-based products such as ketchup and sauces
• Dried beans
• Meats such as beef, turkey, and fish
• Salt substitutes that contain potassium

Complications of Hyperkalemia

Hyperkalemia can cause life-threatening complications:

When to See a Doctor

You should talk to your doctor if you have unexplained symptoms such as:

• Diarrhea 
• Stomach pain
• Nausea and vomiting 
• Fatigue

This is especially important if you have kidney disease or have had hyperkalemia in the past.

Seek medical help right away if you have any of these symptoms:

• Extreme muscle weakness
• Trouble breathing
• Severe stomach pain 
• Any signs of heart attack, including chest pain or a weak pulse

Takeaways

When you have hyperkalemia, you have too much potassium in your body. This can happen because of your diet, medications you take, kidney disease, or a genetic condition. If your level is only slightly too high, you may not have symptoms. Signs of hyperkalemia include stomach pain, nausea, vomiting, and diarrhea. If your hyperkalemia is severe, you might have trouble with your heart rhythm or paralysis. In the hospital, several drugs can lower your potassium level quickly. If your condition is long-term, you may need to change your diet, take medications to manage your hyperkalemia, and treat underlying health issues.

Hyperkalemia FAQs

What are the symptoms of raised potassium levels?

Symptoms of mild hyperkalemia include stomach upset and muscle weakness. More severe symptoms include changes to your heartbeat, severe stomach pain, and paralysis.

How do you fix hyperkalemia?

In the hospital, you'll receive medicine that reduces the amount of potassium in your blood. You might need to change to a low-potassium diet or switch medicines you take for other conditions.

What brings potassium down quickly?

Certain medicines can make potassium leave your body quickly through your pee or poop. Other drugs push your cells to reabsorb potassium.

Do ACE inhibitors cause hyperkalemia?

Yes. ACE inhibitors prevent your body from releasing a substance called aldosterone. That interferes with how your body processes sodium, which can lead to high levels of potassium.