Hyperkalemia

1 What Is Hyperkalemia?

Hyperkalemia is a common medical problem. It refers to abnormally high levels of potassium in the blood.

The human body requires a fine balance of this ion in the blood for the proper functioning of the heart and muscles. For normal functioning of the muscle, nerves, and heart, potassium is essential; the activity of smooth muscles, skeletal muscles, and the heart muscle is regulated by the element. For normal electrical signals in the nervous system and normal electrical rhythm of the heart, potassium is critical. Normally, flushing excess potassium out of the body from the kidneys maintains a healthy balance of potassium. But sometimes, the levels might grow too high and cause hyperkalemia.

Elevated levels of potassium in the blood may lead to life-threatening changes in heart rhythm. Most patients with elevated levels of potassium have only mild hyperkalemia.

Conditions leading to mild hyperkalemia should also be treated to prevent the disease’s progression to a more severe form.

Hyperkalemia occurs due to electrolyte disturbance and, in the majority of cases, the condition is mild, so symptoms may not appear at all. Until the potassium levels are very high, the symptoms do not become apparent. If the potassium levels in the blood become extremely high, it can cause cardiac arrest and even death.

Normal levels of potassium in the blood are 3.5–5.0 milliequivalents per liter (mEq/L). Mild hyperkalemia refers to the presence of 5.1mEq/L to 6.0mEq/L, while potassium levels ranging from 6.1mEq/L to 7.0mEq/L fall under moderate hyperkalemia, and levels above 7.0mEq/L are considered severe hyperkalemia.

What Are the Main Causes of Hyperkalemia?

There are various reasons that could result in an excessive build-up of potassium in the bloodstream, which in turn causes hyperkalemia. Some of the most common causes associated with this medical condition are:

  • Loss of kidney function: Inability of the kidneys to filter out potassium from the body and excrete it through urine is one of the primary causes behind potassium build-up in the body. This can occur either due to kidney failure or if the kidneys are unable to function at their optimum levels. Conditions such as acute or chronic renal failure, obstructions within the urinary tract, and glomerulonephritis can cause potassium levels to rise.
  • Other medical conditions: Hyperkalemia is not usually a disease in itself, but rather a symptom of a serious health issue. Various disorders like dehydration, diabetes, Addison’s disease, and hemorrhage could result in excessive potassium build-up in the bloodstream, resulting in hyperkalemia.
  • Potassium moving out of cells: 98% of potassium is in the cells and only 2% is in the bloodstream. Many conditions can cause the potassium to move out of its usual location into the blood stream, thus elevating the potassium level. People with type 1 diabetes may develop a condition called diabetes ketoacidosis, in which the potassium is drawn into the bloodstream.
  • Addison’s disease: Aldosterone secreted by the adrenal gland maintains the electrolytes by excreting potassium in the urine and retaining sodium in the kidneys. Addison’s disease is an affliction of the adrenal gland in which kidney function is reduced, resulting in excess potassium levels.
  • Tissue destruction: Massive tissue destruction due to burns, trauma, rhabdomyolysis, destruction of tumor cells, destruction of red blood cells, and surgical procedures can cause potassium levels to rise.
  • Medicines: Some medicines used to treat various diseases can also cause hyperkalemia. There are various chemotherapy drugs, ACE inhibitors, and other kinds of medications that could produce side effects in the body. The various medications associated with hyperkalemia are:
    • Antibiotics, such as penicillin G and trimethoprim
    • Azole antifungals, which are used to treat fungal infections
    • Angiotensin-receptor blockers are blood pressure drugs, but they are less potent than ACE inhibitors
    • Beta blockers
    • Blood thinners like heparin
    • Potassium sparing diuretics, including amiloride, spironolactone, and triamterene
    • Nonsteroidal anti-inflammatory medications
  • Supplements: Consuming too many potassium supplements can also increase potassium levels in the bloodstream, which could have serious repercussions. These include:
    • Herbal supplements, such as Siberian ginseng, milkweed, lily of the valley, preparations from dried toad skin or venom, and hawthorn berries
    • Potassium supplements
  • Excessive alcohol consumption: Excessive consumption of alcohol or drug abuse could result in muscle breakdown in the body. This breakdown can lead to high amounts of potassium settling in the bloodstream, causing hyperkalemia.
  • Trauma: Some kinds of trauma can cause potassium levels to rise in the body, resulting in hyperkalemia. In such cases, the injury causes some of the potassium to leak into the bloodstream, which can eventually lead to its build-up. Burns or accidents can cause such a condition to occur.
  • Diet high in potassium: Hyperkalemia can be caused by eating too much food high in potassium, such as cantaloupe, orange juice, banana, and honeydew melon. This is particularly important in people with advanced kidney disease.

Symptoms Associated With Hyperkalemia

Excessive potassium in the bloodstream often causes problems associated with the heart. This largely produces symptoms of heart dysfunction, some of which include:

  • Severe fatigue or tiredness
  • A general feeling of numbness or tingling sensation in various parts of the body
  • Severe nausea or vomiting
  • Breathing problems
  • Pain or discomfort in the chest
  • Irregular heartbeats or palpitations; arrhythmia is an abnormal heart rhythm and is a life-threatening condition.

Severe symptoms are a slow heartbeat and weak pulse. This reflects the effect of the potassium levels on the heart’s electrical activity. The effect of mild hyperkalemia is limited when the condition is moderate, but can still cause changes in the electrocardiogram. If the condition is severe, it may stop the heart from beating entirely. Sudden hyperkalemia along with muscle paralysis is called hyperkalemic periodic paralysis, which is a rare, inherited disorder.

The body can tolerate a slow rise in potassium levels, but not an abrupt increase. Unless the rise is too high, the symptoms are not apparent. Also, sometimes the symptoms of hyperkalemia are due to some other underlying medical condition.

Diagnosing Hyperkalemia

Hyperkalemia can often be hard to diagnose in a person. The symptoms are similar to those of other medical conditions and, in most cases, are so mild that the patient may not even realize their presence. As a diagnostic measure, the treating doctor conducts a physical examination of the patient and listens to the heartbeat to determine if there is any abnormality. The doctor may also ask questions pertaining to the patient’s condition, medical history, and diet. It is extremely important that all information is given to the doctor, including information about the medications one is consuming, over-the-counter products like herbal remedies and supplements, and so on. Certain lab tests may also be a part of the diagnosis by determining the level of potassium in the blood and urine. These tests indicate the patient’s vital organ functioning; if potassium levels are high, the doctor may suggest repeating blood tests; an ECG may be suggested to check for issues directly related to heart functionality, including the breathing pattern. This test gives a better view of the heart’s activity. An ECG may not show significant changes due to hyperkalemia and, in certain cases, the changes may also be mistaken for another underlying health condition.

Treating Hyperkalemia

Based upon the severity of the symptoms, the overall health of the patient, and the underlying cause of hyperkalemia, options for treatment can be determined. Treatment for hyperkalemia is more of a holistic approach that includes both medication and better diet management:

  • Eating a low-potassium diet is a must; ideal potassium consumption should be about 2,000 milligrams to 3,000 milligrams per day.
  • Reviewing the medications consumed by the patient, which means completely stopping or changing medications that could be the cause of higher potassium levels in the blood.
  • Consuming supplementary medication to help regulate potassium levels. Medications such as albuterol and epinephrine stimulate beta-2 adrenergic receptors, which promote the movement of potassium back into the cell.
  • The patient may be prescribed diuretics that can significantly help eliminate excess potassium in the body through the urinary tract. Some diuretics help exert potassium from the kidneys while some do not. The doctor may recommend diuretics such as potassium-sparing diuretics, loop diuretics, or thiazide diuretics.
  • Taking potassium binders, which excrete potassium through the gastrointestinal tract by binding with them. Such medications include cation-exchange resins. These medications are available in powdered form and are mixed with food. The powder is taken orally, whereas some are taken through the rectum. Follow the instructions given on the label. Sodium polystyrene HYPERLINK "https://www.findatopdoc.com/Medical-Library/Drugs-and-Supplements/Sodium-Polystyrene-Sulfonate"sulfonate (Kayexalate) can remove potassium via the digestive tract. 
  • In patients suffering from kidney disease, procedures like dialysis may be required to reduce potassium levels in the blood, as it externally filters wastes from the body.
  • If you are suffering from very high potassium levels, you may also require admission to the hospital, with medications being administered through an IV.
  • Calcium is given intravenously to protect the muscle and heart from the damaging effects of hyperkalemia.
  • The condition in which the blood becomes acidic is called acidosis. It releases potassium into the bloodstream from within the cells. Sodium bicarbonate decreases the acidity and promotes the movement of potassium back into the cells from the blood.
  • Sometimes, the underlying medical condition causing hyperkalemia, such as kidney disease, adrenal disease, or tissue destruction, needs to be treated first.

Home Remedies for Reducing Potassium Levels

  • Check your level of salt consumption, since it could cause a sudden rise in potassium levels in the body. Foods rich in additives and preservatives should also be avoided, as these are usually high in potassium. Limit foods and supplements high in potassium. These include nuts, beans, bananas, milk, apricots, beef, and cod. Foods low in potassium include cucumber, white rice, brown rice, spaghetti, macaroni, blueberries, and raspberries.
  • Avoid salt substitutes that have potassium chloride in the ingredients list. Sports drinks and commercially baked goods are high in potassium as well.
  • Dehydration often causes greater potassium retention in the body. Hence, one needs to drink large quantities of water to eliminate wastes like excess potassium from the body.
  • Certain herbal supplements can also cause potassium retention in the body, which results in hyperkalemia. Alfalfa, nettle, and dandelion are a few such herbs that should be avoided by patients suffering from excessive potassium levels.

If you suffer from diseases like diabetes or blood pressure, it is important to keep your pressure and sugar levels in check. It is also important to have periodic blood tests to keep an eye on the levels and to avoid a sudden rise in potassium. 

Safety Concerns

Follow a low-potassium diet if you have hyperkalemia or if you are at risk. Talk to your healthcare provider or dietitian, as eating too little or too much can be harmful for you. Foods such as meat, fish, and chicken contain potassium and are high in proteins. In order to stay healthy, there should be a balance of high-protein foods, too. Dietitians will help you get the right amount of protein and potassium for your body by creating a meal plan for you.

Complications

Hyperkalemia can cause cardiac arrhythmia or changes in heart rhythm. It can cause ventricular fibrillation, which is an emergency condition. Extreme cases in which hyperkalemia is not treated properly or is left untreated may cause death.

Long-Term Management

In people with CKD, kidney function continuously deteriorates, and hyperkalemia tends to recur. Potassium levels increase without any warning signs, so, managing such a condition can be challenging. One way to manage hyperkalemia is through dietary restriction of potassium, but this can be problematic since many healthy foods, such as steak, avocadoes, cantaloupe, milk, banana, potatoes, tomato paste and juice, squash, and raisins, contain potassium. Treatment to lower potassium levels is available, but managing the chronic risk of high blood potassium on a daily basis is challenging.

Outlook 

Get regular blood tests if you feel you are at risk of hyperkalemia. Sometimes, the symptoms of hyperkalemia are not visible in the early stage. If your levels are high, the doctor will start a treatment plan, and if the levels are too high, emergency treatment may be needed. If the levels are mild, the doctor may only monitor your condition. The doctor will order a follow-up if you are diagnosed with hyperkalemia. The frequency of follow-ups depends on the patient’s condition. A key part of your treatment and safety is the follow-up. Go for all appointments, and if you experience any symptoms, go to the doctor. Keep a list of all medications and supplements you are taking and keep all test results. 

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