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A.D.A.M. Medical Encyclopedia.

High potassium levels

Hyperkalemia; Potassium - high

Last reviewed: November 16, 2011.

Hyperkalemia is higher-than-normal levels of potassium in the blood.

Causes, incidence, and risk factors

The kidneys normally remove excess potassium from the body. High potassium levels are more likely to occur when the kidneys are not working properly and are less able to get rid of potassium.

If your kidneys are not working well enough, taking extra potassium (for example from using salt substitutes that contain potassium or taking potassium supplements prescribed by your health care provider) could lead to problems.

Certain medicines may cause potassium levels to build up because of their effect on the kidneys, including water pills (diuretics) and blood pressure medicines.

Any time potassium is released from the cells, it may build up in body fluids, including the bloodstream. Acidosis leads to the movement of potassium from inside the cells to the fluid outside the cells. Such injury includes:

  • Burns over large areas of the body
  • Damage to muscle and other cells from drugs, alcohol abuse, coma, surgery, injury, or certain infections
  • Disorders that cause blood cells to burst (hemolytic anemia)
  • Severe bleeding from the stomach or intestines
  • Tumors

Addison's disease is a disorder that causes an increase in total potassium.

Symptoms

There are often no symptoms with high levels of potassium. Symptoms that may occur include:

  • Nausea
  • Slow, weak, or irregular pulse
  • Sudden collapse, when the heartbeat gets too slow or even stops

Signs and tests

An ECG may show dangerous and abnormal rhythms such as:

  • Heart block, when the electrical impulse through the heart gets slower or stops
  • Slower than normal heartbeat
  • Ventricular tachycardia or fibrillation

Your doctor should check your serum potassium and do kidney blood tests on a regular basis if you:

Treatment

You will need emergency treatment if your potassium level is very high, or if you have danger signs, such as changes in an ECG.

Emergency treatment may include:

  • Calcium given into your veins (IV) to treat the muscle and heart effects of high potassium levels
  • Glucose and insulin given into your veins (IV) to help lower potassium levels long enough to correct the cause
  • Kidney dialysis if your kidney function is poor
  • Medications that help remove potassium from the intestines before it is absorbed
  • Sodium bicarbonate if the problem is caused by acidosis
  • Water pills (diuretics) to decrease total potassium

Changes in your diet can help both prevent and treat high potassium levels. You may be asked to:

  • Limit or avoid asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, and cooked spinach
  • Limit or avoid oranges and orange juice, nectarines, Kiwis, raisins, or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines
  • Avoid taking salt substitutes if you are asked to eat a low-salt diet

Your doctor may make the following changes to your medicines:

  • Reducing or stopping potassium supplements
  • Stopping or changing the doses of medicines you are taking, such as ACE inhibitors, angiotensin receptor blockers, spironolactone (Aldactone), amiloride (Midamor), or triamterene (Dyrenium)
  • Taking "loop diuretics" to reduce potassium and fluid levels if you have chronic kidney failure

It is important to follow your health care provider's directions when taking your medicines:

  • Do not stop or start taking medicines without first talking to your health care provider
  • Follow your prescribed schedule as closely as possible
  • Always tell your health care provider about any other medicines, vitamins, or supplements you are taking

References

  1. Seifter JL. Potassium disorders. In: Goldman L, Schafer, AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 119.

Review Date: 11/16/2011.

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Drugs that aim to prevent the loss of protein or albumin through urine in people with sickle cell disease
    Sickle cell disease is a group of inherited disorders that often lead to kidney damage. High protein or albumin levels in urine is a strong predictor of subsequent kidney failure. It is common practice to give angiotensin‐converting enzyme (ACE) inhibitors to reduce the level of protein or albumin in urine, thus protecting the kidneys from damage. However, little is known about how effective and safe these are in patients with sickle cell disease. This review included one study comparing captopril (an ACE inhibitor) to placebo. There were 22 participants in this study and the results were not convincing, with minor analysis changes leading to very different study conclusions. This study did not show that ACE inhibitors could reduce the level of protein or albumin in the urine. The level of creatinine and potassium in the blood were reported constant throughout the study. No serious adverse events were noted, although the potential for causing low blood pressure should be highlighted. More long‐term studies involving multiple centers and larger numbers of participants are warranted.
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