Hyperkalemia (High Potassium)

What is hyperkalemia?

Hyperkalemia is a condition in which the potassium levels in your blood get too high.

Potassium is a positively charged electrolyte. Electrolytes are minerals that have a natural positive or negative charge when they dissolve in water or other body fluids, such as blood. It helps carry an electric charge through your body, which helps your body function. Potassium helps:

• Muscles in your body expand and contract.
• Nerves send signals between your brain and the rest of your body.
• Move waste products out of your cells and nutrients into your cells.
• Offset sodium’s (salt’s) effects on your blood pressure.

What happens when potassium is high?

You get potassium through the foods and drinks you consume. Normally, your kidneys remove extra potassium, which leaves your body through your urine (pee). But if you have too much potassium in your body, your kidneys may not be able to remove all of it, and it can build up in your blood. Too much potassium in your blood can damage your heart, make you feel palpitations and even cause a heart attack. You can’t always tell when your potassium levels are high.

What is a safe or normal potassium level?

A typical potassium level for adults is between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia occurs when potassium levels go above 5.5 mmol/L. A potassium level above 6.5 mmol/L can cause heart problems that require immediate medical attention.

How common is hyperkalemia?

In the general U.S. population, hyperkalemia is rare. Medical experts estimate 2% to 3% of people have high potassium levels. However, you’re up to three times more likely to have hyperkalemia if you have chronic kidney disease (CKD). Over half of those who have CKD but don’t need dialysis eventually develop high potassium levels.

What are the signs of high potassium?

If you have mild hyperkalemia, you may not have any signs, or your signs might be easy to dismiss. Symptoms often come and go or may gradually develop over weeks or months. Mild hyperkalemia signs may include:

• Abdominal pain.
• Diarrhea.
• Nausea and vomiting.

Dangerously high potassium levels affect your heart and cause sudden, life-threatening problems. Severe hyperkalemia symptoms may include:

• Chest pain.
• Heart palpitations.
• Arrhythmia (irregular, fast or fluttering heartbeat).
• Muscle weakness or numbness in your limbs.

What is the major cause of hyperkalemia?

The most common cause of hyperkalemia is kidney disease. Kidney disease damages your kidneys, which means they don’t filter wastes (including excess potassium) from your blood as well as they should.

In addition to kidney disease, these factors also contribute to hyperkalemia:

• A high-potassium diet, including potassium supplements.
• Medications that block your kidneys’ ability to secrete potassium, including certain drugs that treat high blood pressure.

Is hyperkalemia contagious?

No, hyperkalemia isn’t contagious. You can’t spread hyperkalemia to another person.

In very rare cases, genetic disorders may cause high potassium levels. These include:

• Pseudohypoaldosteronism type 1 (PHA1). A genetic mutation that helps your body regulate sodium causes PHA1.
• Pseudohypoaldosteronism type 2 (PHA2). A genetic mutation that helps regulate your blood pressure causes PHA2. Another name for PHA2 is Gordon’s syndrome.

Who does hyperkalemia affect?

Anyone of any age can get hyperkalemia, including children. You may be at a higher risk of hyperkalemia if you have:

• Addison’s disease.
• Alcohol use disorder.
• Burns over a large part of your body.
• Congestive heart failure.
• Diabetes.
• Human immunodeficiency virus (HIV).
• Chronic kidney disease or a family history of CKD.
• Abnormal kidney structure.

What are the complications of hyperkalemia?

Severe hyperkalemia can come on suddenly. It can cause life-threatening changes to your heart that cause a heart attack. Without treatment, even mild hyperkalemia can damage your heart over time.

How is hyperkalemia diagnosed?

Most people don’t have hyperkalemia symptoms, so you might not know you have high potassium levels until a healthcare provider orders a blood test. A serum potassium test is a type of blood test that measures your potassium levels.

A provider may also order an electrocardiogram (EKG). An EKG shows changes in your heart rhythm. Tall (peaked) T waves are the earliest signs of hyperkalemia in an EKG. T waves show your heart at rest or recovering after beating.

How do you fix hyperkalemia?

Hyperkalemia treatment varies according to your potassium levels. Treatment options may include:

• Diuretics. Diuretics make you pee more electrolytes like sodium and potassium, which makes you pee more often. Another name for diuretics is water pills.
• Medication management. Blood pressure medications and certain other drugs can raise your potassium levels. Stopping or taking a different kind of medication can lower your levels. A healthcare provider can determine what medication changes to make.
• Potassium binders. Potassium binders help lower your potassium levels by attaching extra potassium to your stool (poop), which leaves your body when you use the bathroom. A provider may recommend potassium binders if other treatments don’t lower your levels.
• Intravenous (IV) therapy. A provider may order IV therapy (given through a vein) if you have extremely high potassium levels. They’ll give you an IV infusion of calcium gluconate, which helps protect your heart. Next, they’ll give you an infusion of insulin, which helps move potassium into the blood cells. They may also give you the asthma medication albuterol, which helps lower potassium levels.
• Dialysis. You may need dialysis if other treatments don’t lower your potassium levels or if you have kidney failure. Dialysis helps your kidneys remove excess potassium from your blood.

Can hyperkalemia be prevented?

The best way to prevent hyperkalemia is to be aware of your kidney health and to limit the amount of potassium you put in your body. If you’re at risk of hyperkalemia, talk to a healthcare provider. They may refer you to a nephrologist. A nephrologist is a doctor who specializes in conditions that affect your kidneys.

What can I expect if I have hyperkalemia?

Changes to your diet and taking medications often resolve mild cases of hyperkalemia. With the proper care, most people don’t have long-term complications due to high potassium levels. However, hyperkalemia increases your chances of developing other serious medical conditions, including heart attack and death. A healthcare provider may order regular blood tests to ensure your potassium levels stay in a healthy range.

How do I take care of myself if I have hyperkalemia?

A healthcare provider will work with you to develop a treatment plan. Your treatment plan may include making changes to your diet and taking medicines as prescribed by a healthcare provider.

What can I eat/drink with hyperkalemia?

If you have hyperkalemia or are at risk of developing it, adopting a low-potassium diet is the best way to protect your health. You may need to cut back on or completely stop eating certain high-potassium foods, including:

• Dry fruits (raisins, apricots, prunes, dates).
• Fresh fruits (bananas, strawberries, watermelon, cantaloupe, honeydew, oranges, nectarines).
• Dry vegetables (beans, peas).
• Fresh vegetables (spinach, beets, spinach, tomatoes, mushrooms, squash, potatoes, sweet potatoes, avocados, asparagus).
• Tomato-based products like sauces and ketchup.
• Meat (turkey, beef, fish).
• Fresh orange juice.
• Canned fruit juices (grapefruit, prune, apricot).
• Salt substitutes that contain potassium.

When should I see a healthcare provider?

If a healthcare provider diagnoses you with hyperkalemia, schedule regular follow-up appointments for blood testing. It’s also a good idea to talk to a provider if you have mild hyperkalemia symptoms, including:

• Stomachache.
• Diarrhea.
• Nausea and vomiting.
• Fatigue.

When should I go to the ER?

Go to the emergency room as quickly as possible if you have hyperkalemia and develop serious symptoms, including:

• Difficulty breathing.
• Extreme muscle weakness.
• Severe abdominal pain.
• Heart attack symptoms, including chest pain or a weak pulse.

What questions should I ask a healthcare provider?

• How do you know that I have hyperkalemia?
• How did I get hyperkalemia?
• What’s your recommended treatment option?
• What are the risks or side effects of your recommended treatment option?
• How often should I get blood tests to check for hyperkalemia?
• How much potassium should I get in my daily diet?
• What foods, drinks or supplements should I avoid?
• Can I use salt substitutes?
• What salt substitutes can I use?
• Should I see a dietitian who specializes in kidney disease (renal dietitian)?
• Am I at risk of kidney failure or other hyperkalemia problems?
• What follow-up care do I need after treatment?
• Should I look out for signs of complications?

What is the difference between hyperkalemia and hypokalemia?

Hyperkalemia is when the potassium levels in your blood are too high.

Hypokalemia is when the potassium levels in your blood are too low.

A note from Cleveland Clinic

Hyperkalemia is when you have too much potassium in your blood. It’s not a common condition found in most people. But it’s very common if you have kidney disease or kidney failure.

Hyperkalemia rarely causes symptoms, so it can be surprising if a blood test shows high potassium levels. A low-potassium diet can protect your health, and a healthcare provider can determine how much potassium you need. They’ll work with you to help create a meal plan to ensure you get the right amount of potassium in your diet and prescribe or change your medications.

You may feel anxious or overwhelmed during treatment, especially if you need dialysis. These feelings are normal. Be open with your healthcare providers about any concerns or questions you have. They’re here to answer your questions and provide support and advice.