Hyperkalemia

Hyperkalemia is a condition in which you have too much potassium in your blood. Most potassium in the body (98%) is found within cells and organs. Only a small amount circulates in the bloodstream. Potassium helps nerve and muscle cells, including those in the heart, function properly. Your kidneys usually maintain levels of potassium in the blood. But if you have kidney disease, the most common cause of hyperkalemia, potassium levels can build up.

Medications or diet may also affect the amount of potassium in the blood. Hyperkalemia can be life threatening and must be treated promptly.

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Signs and Symptoms

Sometimes hyperkalemia has no symptoms. Other times you may experience symptoms such as:

• Irregular heartbeat
• Fatigue
• Weakness
• Tingling, numbness, or other unusual sensations
• Paralysis
• Difficulty breathing
• Nausea and vomiting

What Causes It?

Hyperkalemia has many causes, including:

• Kidney disease
• Too much acid in the blood, as is sometimes seen in diabetes
• Established cardiovascular disease
• Diet high in potassium (from bananas, oranges, tomatoes, high protein diets, salt substitutes, or potassium supplements)
• Trauma, especially crush injuries or burns
• Addison disease
• Certain medications, including anti-hypertensive medications and certain nonsteroidal anti-inflammatory drugs (NSAIDs)

What to Expect at Your Doctor's Office

You may not be feeling any effects of hyperkalemia. Your health care provider may discover it during a routine blood test or electrocardiogram. Hyperkalemia can cause life-threatening complications without warning. If you experience symptoms of hyperkalemia, you should call 911 or get to an emergency room. If you have severe hyperkalemia, you will be admitted to the hospital to stabilize your condition, and for further tests.

Your doctor will prescribe medications to take care of the immediate problem, but more tests may be needed to determine the underlying cause. If the medications do not lower the potassium level in your blood, your provider may recommend dialysis.

Treatment Options

Medications used to treat hyperkalemia are meant to stabilize heart function, promote the movement of potassium from the bloodstream back into the cells, and encourage the excretion of excess potassium. Hemodialysis is the most reliable tool for removing potassium from the body in patients with kidney failure.

Drug Therapies

• Calcium chloride or gluconate. Minimizes the effects of hyperkalemia on the heart.
• Insulin. Promotes potassium shift from blood to cells.
• Sodium bicarbonate. Promotes potassium shift from blood to cells.
• Beta agonists. Promote potassium shift from blood to cells.
• Diuretics. Cause potassium excretion from kidneys.
• Binding resins. Promote potassium and sodium exchange in the gastrointestinal system.

Complementary and Alternative Therapies

Alternative therapies can help treat the underlying cause once your condition has been stabilized. Make sure to tell your medical providers about any alternative therapies or supplements you may be using. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Nutrition

Following these nutritional tips may help reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Avoid foods that contain high amounts of potassium, including bananas, lentils, nuts, peaches, potatoes, salmon, tomatoes, and watermelon.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, or beans for protein. Limit the intake of processed meats, such as fast foods and lunch meats.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol and tobacco. Talk to your doctor before using products that contain caffeine products, such as teas and soft drinks. Caffeine impacts several conditions and medications.
• Drink more water. Dehydration can make hyperkalemia worse.
• Exercise, if possible, 30 minutes daily, 5 days a week. However, only begin this regimen after your condition has stabilized and a physician has cleared you for exercise.
• Avoid noni (Morinda citrifolia) juice, which is high in potassium.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted. If you are pregnant or nursing, speak to your doctor before taking any herbal products.

Hyperkalemia should only be treated by trained medical specialists. If a patient wishes to use herbal therapies, they must first consult with a medical herbalist and all of their providers. DO NOT use herbs on your own to treat hyperkalemia.

Avoid herbs that can increase potassium levels. Below are a few of the most common potassium-containing herbs:

• Alfalfa (Medicago sativa)
• Dandelion (Taraxacum officinale)
• Horsetail (Equisetum arvense)
• Nettle (Urtica dioca)

Homeopathy

Homeopathy may be useful as a supportive therapy.

Acupuncture

Acupuncture may help support normal kidney function.

Massage

Swedish massage may help to stimulate the kidneys.

Following Up

Your doctor will probably ask to see you 2 to 3 days after you are discharged from the hospital to repeat the potassium tests, electrocardiogram, and check your kidney function. Your doctor will review all the medications you are taking, and may recommend changes.

Special Considerations

If you are on regular dialysis, keep strictly to your schedule to avoid hyperkalemia and other serious problems.

Supporting Research

Adams MG, Pelter MM. Electrolyte imbalances. Am J Crit Care. 2004;13(1):85-6.

Skorecki K, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 8th ed. Philadelphia, PA: Elsevier Saunders; 2007.

Cheng TO. Herbal interactions with cardiac drugs. Arch Intern Med. 2000;160:870-1.

El-Hennawy AS, Nesa M, Mahmood AK. Thyrotoxic hypokalemic periodic paralysis triggered by high carbohydrate diet. Am J Ther. 2007;14(5):499-501.

Elliott MJ, Ronksley PE, Clase CM, et al. Management of patients with acute hyperkalemia. CMAJ. 2010:182(15):1631-5.

García NH, Baigorria ST, Juncos LI. Hyperkalemia, renal failure, and converting-enzyme inhibition: an overrated connection. Hypertension. 2001;38(3 Pt 2):639-44.

Gennari FJ, Segal AS. Hyperkalemia: An adaptive response in chronic renal insufficiency. Kidney Int. 2002;62(1):1-9.

Haden M, Marshall DA, Murphy B. Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia. Scott Med J. 2011;56(4):236.

Jain N, Kotla S, Little BB, et al. Predictors of hyperkalemia and death in patients with cardiac and renal disease. Am J Cardiol. 2012;109(10):1510-3.

John SK, Rangan Y, Block CA, et al. Life-threatening hyperkalemia from nutritional supplements: uncommon or undiagnosed? Am J Emerg Med. 2011;29(9):1237.e1-e2.

Lafrance JP, Miller DR. Dispensed selective and nonselective nonsteroidal anti-inflammatory drugs and the risk of moderate to severe hyperkalemia: a nested case-controlled study. Am J Kidney Dis. 2012;60(1):82-9.

Lim S. Approach to hyperkalemia. Acta Med Indones. 2007;39(2):99-103.

Marx J, Hockberger R, Walls R, eds. Rosen's Emergency Medicine. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014.

Miller RD, Eriksson LI, Fleisher L, et al., eds. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders, 2015.

Mueller BA, Scott MK, Sowinski KM, et al. Noni juice (Morinda citrifolia): hidden potential for hyperkalemia? Am J Kidney Dis. 2000;35:310-2.

Pantanowitz L. Drug-induced hyperkalemia. Am J Med. 2002;112:334-5.

Puccini JP, Nilsson KR. The Osler Medical Handbook. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2006;Ch 74.

Sarafidis PA, Georgianos PI, Bakris GL. Advances in treatment of hyperkalemia in chronic kidney disease. Expert Opin Pharmacother. 2015;16(14):2205-15.

Sood MM, Sood AR, Richardson R. Emergency management and commonly encountered outpatient scenarios in patients with hyperkalemia. Mayo Clin Proc. 2007;82(12):1553-61.

Thoms E. The DASH diet--is it a realistic option for people with kidney disease? CANNT J. 2005;15(2):58-9.

Weisberg L, Dellinger RP. Management of severe hyperkalemia. Critical Care Medicine. 2008;36(12).

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Review Date: 4/1/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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