Hyperkalemia is a 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, having had severe bleeding, consuming excessive dietary potassium, and some medications. A doctor will typically diagnose hyperkalemia when levels of potassium are between 5.0–5.5 milliequivalents per liter (mEq/L).

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 potassium from the body. Chronic hyperkalemia usually means that a person's kidneys are not working correctly, and doctors will offer treatment to manage the condition.

Symptoms

Typically, a person with hyperkalemia does not experience any symptoms, which means that doctors may overlook it until symptoms worsen. Acute hyperkalemia, or significant changes to potassium levels over a short time, 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 heart attacks or paralysis.

Chronic hyperkalemia often has fewer symptoms than acute hyperkalemia. At higher levels, symptoms of hyperkalemia include:

• Muscle weakness
• A general feeling of weakness or fatigue
• Nausea
• Muscle pain or cramps
• Difficulty breathing
• Unusual heartbeat and chest pains

Causes

There are different causes of hyperkalemia:

• Chronic kidney disease: Lower kidney capacity means that the kidneys may not be able to filter potassium out of the body adequately
• Uncontrolled or untreated diabetes: A lack of insulin can cause hyperkalemia
• Taking certain medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, some diuretics, cyclosporine, trimethoprim, angiotensin inhibitors, beta blockers, calcium blockers, succinylcholine, digoxin, heparin, and mannitol may also cause high potassium levels
• Heart disease: In cases of congestive heart failure, lower kidney function and treatment medication can cause hyperkalemia
• Injury: Damage to tissues can cause potassium levels to shift and change
• Hypoaldosteronism or pseudohypoaldosteronism: Lack of the hormone aldosterone causes hyperkalemia
• Congenital adrenal hyperplasia: A rare disease resulting from a gene mutation causes lower levels of aldosterone
• Higher potassium intake: Consuming too much potassium through medications or diet can cause hyperkalemia. This is rare but may affect people who have kidney disease
• 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 breaking down of red blood cells

Prevention

If there is a risk that a person may develop hyperkalemia, a doctor might recommend limiting foods that contain high levels of potassium. According to the Dietary Guidelines for Americans, the highest-potassium foods per serving size are:

• Sweet potato
• Tomato paste
• Beet greens
• Potato
• White beans
• 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

Diagnosis

Hyperkalemia often has no symptoms. This means doctors often find it challenging to diagnose. In cases of acute hyperkalemia, doctors will:

• Assess kidney, heart, and urinary tract function
• Check hydration levels
• Monitor heartbeat using an electrocardiogram

In chronic hyperkalemia, doctors follow up by:

• Carrying out routine laboratory work, such as blood tests or urine samples
• Checking medications to ensure that they are not contributing to high potassium levels

Treatment

Doctors often use dialysis for hyperkalemia that requires urgent treatment. Dialysis involves filtering and purifying the blood to reduce total body potassium levels. People with kidney failure or urgent hyperkalemia will benefit the most from dialysis. In acute hyperkalemia, doctors prescribe the following treatments to lower potassium levels:

• Intravenous calcium: Injecting calcium into the blood helps lower potassium
• Intravenous insulin or glucose: This is the most reliable method for reducing potassium levels. In most cases, doctors give 10 units of insulin and 25 grams of glucose
• Albuterol: This is only effective in some groups of people. Doctors often administer albuterol alongside other treatments

Treatment options for chronic hyperkalemia include changing medications, avoiding NSAIDs, and reducing consumption of potassium. Loop diuretics may also be a useful treatment for some types of chronic hyperkalemia.

Takeaway

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 increases the risk of hyperkalemia. Having kidney disease, hypertension, diabetes, heart disease, or having had a heart attack in the past also increase the risk of developing hyperkalemia. Talking with a doctor is the first step to preventing hyperkalemia and finding effective treatment.