Hyperkalemia - Causes, Symptoms, and Treatment

What Is Hyperkalemia?

Potassium is a mineral needed for the proper functioning of the heart, nerves, and muscles. The amount of potassium required by the body can be obtained from the daily diet itself. Kidneys help in excreting the excessive potassium present in the blood. However, in the presence of any kidney disorders, excess potassium is not eliminated, and it stays in the blood, thereby producing hyperkalemia. Excessively increased potassium is a life-threatening condition and requires immediate medical intervention.

What Is the Normal Level of Potassium in Blood?

The normal level of potassium in the blood for adults: 3.5 to 5.0 mmol/L.

Level of potassium in the blood, which indicates hyperkalemia: above 5.5 mmol/L.

Potassium level in the blood that can cause heart problems and need emergency treatment: 6.5 mmol/L.

What Are the Causes of Hyperkalemia?

• Kidney Dysfunctions - Removing the excess potassium from the blood and excreting it in the urine is the function of 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. The trouble is much more increased in people who, in addition, have a renal disorder. Beans, bananas, cooked spinach, mushrooms, potatoes, sweet potatoes, cucumbers, oranges, etc., 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, increase the potassium level in blood.

• Burns or Severe Injuries-Excess potassium is released into the blood following severe burns or injuries and results in hyperkalemia.

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

• Addison's disease.

• Congestive heart failure.

• Human immunodeficiency virus (HIV).

• Potassium supplements.

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Symptoms of Hyperkalemia:

Usually, mild hyperkalemia does not manifest any symptoms. However, the 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.

• 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 does not exhibit any 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 the 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 taken in the oral route, 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.

How Is the Prognosis in Hyperkalemia?

In most cases of hyperkalemia, the prognosis is good with an adequate diet and medications. It does not result in any long-term complications.

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