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Hyperkalemia - Causes, Symptoms, and Treatment

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Hyperkalemia - Causes, Symptoms, and Treatment

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Hyperkalemia, a condition with excess potassium levels in the blood, might require emergency treatment, especially, in people with chronic diseases.

Medically reviewed by

Dr. Ankush Jairath

Published At August 24, 2021
Reviewed AtNovember 28, 2023

Introduction

Potassium is essential for numerous physiological processes of the human body. Potassium is rapidly and typically completely absorbed from the digestive tract. The typical daily intake can change depending on the diet. Fruits, potatoes, beans, and grains are common sources of potassium; in contrast, high-fat diets typically have low potassium intakes. The glomerulus filters potassium, which is then almost entirely reabsorbed in the proximal tubule and the loop of Henle and excreted through the collecting ducts of the kidneys. A rise in the potassium level due to an imbalance between intake and excretion, an abnormal distribution of the mineral between intracellular and extracellular space, or in people with healthy other regulatory systems and unimpaired renal function, or other factors is referred to as hyperkalemia. This article discusses the causes, symptoms, and treatment of hyperkalemia.

What Is Hyperkalemia?

A serum or plasma potassium level over the upper limits of normal, often more than 5.0 mEq/L to 5.5 mEq/L, is referred to as hyperkalemia. Even while mild hyperkalemia is often asymptomatic, it can cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Pseudohyperkalemia occurs when a syringe rather than a vacuum device is used to collect the sample, and is the most frequent cause of hyperkalemia. The normal range for blood potassium is 3.6 to 5.2 millimoles per liter (mmol/L). Blood potassium levels of more than 6.0 millimoles per liter can be dangerous and typically call for prompt medical attention.

What Are the Causes of Hyperkalemia?

The causes of hyperkalemia are as follows::

  • Acute Kidney Failure and Chronic Kidney Disease - Removing the excess potassium from the blood and excreting it in the urine is the function of the kidneys. A breach occurs in this function if there is some kidney disorder. In cases of mild kidney dysfunction, the potassium level is maintained by the kidneys. But, in severe diseases, the kidneys cannot remove the excess potassium, and it gets stored in the blood resulting in hyperkalemia.

  • Potassium-Rich Diet - Consumption of a diet that is rich in potassium also increases the risk of hyperkalemia, but is uncommon. The risk is much more increased in people who, in addition, have a renal disorder. Beans, bananas, cooked spinach, mushrooms, potatoes, sweet potatoes, cucumbers, oranges are high-potassium foods.

  • Medications - Certain medications like angiotensin II receptor blockers, angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers hamper the elimination of potassium from the kidney, therefore, increasing the potassium level in blood.

  • Burns- Hyperkalemia was thought to be a risk factor for patients who had electrical burns. Red blood cell apoptosis, rhabdomyolysis, metabolic acidosis, and the onset of renal failure are some of the causes of hyperkalemia.

  • Uncontrolled Diabetes- Poorly controlled diabetes directly affects kidney function, so it increases the chances of hyperkalemia.

What are the Symptoms of Hyperkalemia?

Usually, mild hyperkalemia does not manifest any symptoms. However, the hyperkalemia symptoms occur intermittently and gradually increase over time. Very high potassium levels cause severe complications, and immediate treatment is needed.

Signs and symptoms of hyperkalemia include:

  • Abdominal pain.

  • Nausea and vomiting.

  • Diarrhea.

  • Chest pain.

  • Palpitations.

  • Irregular heartbeat.

  • Fatigue and numbness in the muscles of extremities.

  • Paralysis.

  • Breathing difficulties.

  • Signs of a heart attack like a weak pulse, chest pain, etc.

  • Severe muscle fatigue.

  • Severe abdominal pain.

  • Nausea.

  • Vomiting.

When Is Emergency Treatment Needed for Hyperkalemia?

Hyperkalemia is diagnosed accidentally in routine blood tests since it exhibits no symptoms during the initial phases. Medical history, diet, and medications play an essential role in diagnosis. Therefore, it is necessary to inform the doctor about everything, even over-the-counter drugs, herbal medicines, or any other supplements. Any changes or abnormalities in the heart rhythm can be diagnosed with the help of an electrocardiogram.

Hyperkalemia and Electrocardiogram (ECG):

An electrocardiogram may show the following changes:

  • T waves attain the peak.

  • Short QT intervals.

  • ST-segment depression.

  • Widening of QRS complex.

  • Increase in the PR interval.

  • A decrease in the amplitude of the P wave.

These are the initial changes that can be reversed with treatment for hyperkalemia. If left untreated, it causes further widening of the QRS complex and the disappearance of the P wave. Ventricular fibrillation, a type of arrhythmia characterized by rapid and inadequate heartbeat, usually follows these changes. Though there is typically a correlation between the ECG changes and hyperkalemia, sometimes severe arrhythmias can occur at any stage of hyperkalemia without any distinct ECG changes.

How Can Hyperkalemia Be Treated?

Depending on the level of potassium in the blood, there are different treatment options which include:

  • Diuretics: As potassium excretion mainly happens through urine, diuretics or water pills help in increasing urine flow, which eventually reduces the potassium level in the blood.

  • Low-Potassium Diet: It is also advisable to follow a low-potassium diet and reduce the consumption of salt substitutes that are high in potassium. A dietitian will help in creating a specialized meal plan to follow in hyperkalemia.

  • Potassium Binders: It is a medication that must be taken daily, which binds with the excess potassium in the bowels and excretes it in feces. It is usually administered orally, but sometimes it can also be administered through the rectum as an enema. For oral administration, these are mixed with water. These are recommended when other treatments do not pave off. Also, caution should be taken not to take the potassium binders within six hours of taking any other drugs, and it is also not recommended in children.

  • Intravenous Therapy: It is the suggested treatment modality in patients who require emergency treatment, during which an intravenous infusion of Calcium is done to protect the heart from further damage. In addition, Insulin is infused, which helps in moving potassium into the blood cells. Also, Albuterol inhalation is needed, which is an asthmatic drug that helps in decreasing potassium levels.

  • Managing the Medications: Drug-induced hyperkalemia can be reversed by withdrawing anti-hypertensive medications and other drugs, which cause a significant rise in the potassium level. It is suggested to consult with the physician and make changes to the medications taken.

  • Dialysis: Suppose the potassium levels continue to rise despite the treatment, or in case of complete renal failure, it is advisable to do dialysis to lower the potassium levels in the blood.

How Can Hyperkalemia Be Prevented?

In hyperkalemic patients or high-risk patients with known renal dysfunctions, the best way to prevent hyperkalemia is to limit potassium intake in food.

Conclusion

Due to the risk of cardiac arrest and severe weakness, the therapy of hyperkalemia is carried out by an interdisciplinary team. In most cases of hyperkalemia, the prognosis is good with an adequate diet and medications. It does not result in any long-term complications. However, people with chronic disorders like end-stage renal failure might need routine blood tests to check their potassium levels. In conclusion, it is clinically relevant and potentially life-saving to recognize and treat hyperkalemia as soon as possible, especially if renal function is compromised.

Frequently Asked Questions

1.

What Are the Effects of High Levels of Potassium?

Potassium is a vital nutrient essential for properly functioning nerves and muscles. However, high potassium levels [above 5.5 millimoles per liter (mmol/L) can be dangerous and affect the heart and kidneys; it can cause life-threatening problems. Some of the symptoms of hyperkalemia include:
- Diarrhea.
- Nausea and vomiting.
- Heart palpitations (irregular heartbeat).
- Abdominal pain.
- Chest pain.
- Muscle weakness.
- Numbness in the limbs.

2.

Can Hyperkalemia Be Cured?

Hyperkalemia can be cured, and the treatment is based on potassium levels. Some of the treatment options include:
- In case of severe potassium levels, an intravenous infusion (IV infusion) of calcium is done to protect the heart, or dialysis may be advised.
- Medications such as diuretics or potassium binders help to excrete potassium in the urine or stools.
- Modifications in the drugs that increase potassium levels, such as blood pressure medications, etc.

3.

What Are Some of the Causes of Hyperkalemia?

Some of the causes of hyperkalemia include:
- Consumption of a high potassium diet or potassium supplements.
- Medications containing potassium include blood pressure medications, angiotensin-converting enzyme inhibitors (ACE inhibitors), beta-blockers, etc.
- Patients with advanced kidney diseases, Addison’s disease, type I diabetes, etc.
- Destruction of red blood cells (RBCs) due to severe burns or injuries.

4.

What Are Some Foods With High Potassium Levels To Be Avoided?

Some of the foods to be avoided in hyperkalemia include:
- Bananas.
- Potato, tomato.
- Dairy products.
- Salty and junk foods.
- Beans and legumes.
- Nuts and apricots.
- Squash, yam, and zucchini.
- Fish, chicken breast.

5.

What Are Some of the Fluids That Decrease Potassium Levels?

A variety of foods help maintain the balance of potassium levels in the body; some of the fluids that may help during hyperkalemia include:
- Tea and coffee.
- Sparkling water.
- Herbal tea.
- Rice milk.
- Apple sauce or apple juice.
- Cranberry juice.
- Pineapple juice.

6.

Does Drinking Water Help During Hyperkalemia?

Drinking plenty of water can help during hyperkalemia, as dehydration may worsen it. Low fluid intake can hamper potassium excretion from the body and cause its accumulation, leading to hyperkalemia.

7.

When Is Hyperkalemia Considered an Emergency?

Severe hyperkalemia can be life-threatening due to the extracellular potassium shift, as the kidneys cannot excrete the potassium. It may cause chest pain, improper functioning of nerves and muscles, heart palpitations, and shortness of breath and require immediate care and management. Prompt detection and appropriate treatment can prevent lethal outcomes due to hyperkalemia.

8.

How Long Does It Take To Cure Hyperkalemia?

Hyperkalemia can be treated through acute and long-term therapy and depends on the potassium levels and the presence or absence of electrocardiogram (ECG) changes. Acute hyperkalemia management requires hospitalization if ECG changes occur or potassium levels exceed 6.5 mmol/L. It includes medications such as diuretics, potassium binders, or dialysis. In some cases, an intravenous infusion of insulin, glucose, albuterol, and sodium bicarbonate is advised. Long-term therapy for chronic hyperkalemia includes diet and modifications in the medicines taken for other conditions.

9.

What Are Some of the Drugs That Cause Hyperkalemia?

Some of the drugs that cause hyperkalemia include:
- Non-steroidal anti-inflammatory drugs like Ibuprofen, Naproxen, etc.
- Angiotensin-converting enzyme inhibitors like Ramipril, Enalapril, etc.
- Angiotensin-II receptor blockers like Losartan, Telmisartan, etc.
- Immunosuppressants like Cyclosporine, Tacrolimus, etc.
- Heparin and its derivatives.
- Aldosterone antagonists.

10.

Do Low Levels of Vitamin D Cause Hyperkalemia?

Vitamin D can affect the absorption and metabolism of both sodium and potassium, leading to increased retention; however, potassium imbalance may not be associated with disturbances in the metabolism of vitamin D.

11.

Can Potassium Levels Be Checked at Home?

Potassium levels cannot be monitored at home as no home-test kits are available. A 24-hour urine sample can be collected by the patient at home and sent to the lab, determining the total amount of potassium excreted during the specified duration.

12.

What Are the Organs Affected by Hyperkalemia?

Potassium is an essential nutrient required for the proper functioning of the nerves and muscles, bone health, and a healthy digestive system. Hyperkalemia can damage the heart and can cause excessive load on the kidneys. It can be a life-threatening condition if not managed appropriately.

13.

Who Is at Risk for Hyperkalemia?

Patients with chronic kidney diseases, congestive cardiac failure, diabetes, human immunodeficiency virus infections (HIV), Addison’s disease, and individuals who are frequent alcoholics or have burns over a large part of the body.
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Dr. Ankush Jairath
Dr. Ankush Jairath

Urology

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