Published: 18 Jun 2025

ICD9: 276.7      ICD10: E87.5      ICD11: 5C76

Hyperkalemia refers to a condition where the potassium level in your blood is higher than normal.
Potassium is an essential electrolyte that helps your nerves and muscles function properly. The normal range for potassium is typically between 3.5 and 5.0 milliequivalents per liter (mEq/L). Hyperkalemia is usually defined as a potassium level above 5.5 mEq/L. Levels significantly above 6.0 mEq/L can be dangerous and require immediate treatment.

Here's a breakdown of what's important to know about hyperkalemia:

Causes:

Kidney problems: This is the most common cause. Kidneys are responsible for filtering and excreting excess potassium. If they aren't working properly, potassium can build up. Conditions like chronic kidney disease (CKD) and acute kidney injury are major culprits.
Medications: Certain medications can impair potassium excretion or promote potassium release from cells. Common examples include:
ACE inhibitors and ARBs (used for blood pressure)
Potassium-sparing diuretics (e.g., spironolactone, eplerenone)
NSAIDs (nonsteroidal anti-inflammatory drugs)
Heparin
Trimethoprim (an antibiotic)
Cyclosporine and tacrolimus (immunosuppressants)
Digoxin
Beta-blockers
Potassium supplements: Taking too many potassium supplements can obviously raise potassium levels.
Diet: A very high-potassium diet alone is rarely the cause of hyperkalemia in people with healthy kidneys, but it can contribute if kidney function is already compromised.
Cell breakdown: Conditions that cause rapid cell damage or breakdown can release potassium from inside the cells into the bloodstream. This can occur in:
Trauma (crush injuries, burns)
Rhabdomyolysis (muscle breakdown)
Tumor lysis syndrome (after cancer treatment)
Severe infections
Endocrine disorders:
Adrenal insufficiency (Addison's disease) can lead to hyperkalemia because the adrenal glands produce hormones that regulate potassium.
Hypoaldosteronism (low aldosterone) also leads to decreased potassium excretion.
Acidosis: Acidosis (too much acid in the blood) can cause potassium to move from inside cells to outside, increasing blood potassium levels.
Dehydration: Severe dehydration can concentrate the potassium in the blood.
Pseudohyperkalemia: This is a false elevation of potassium levels that occurs because of the way the blood sample was handled. For example, potassium can be released from blood cells if the blood sits too long before being processed or if the blood sample is hemolyzed (red blood cells are broken).

Symptoms:

Many people with mild hyperkalemia have no symptoms. When symptoms do occur, they can be vague and include:

Muscle weakness or paralysis: This is a common and potentially serious symptom.
Fatigue
Numbness or tingling (paresthesias)
Nausea or vomiting
Slow or irregular heartbeat (arrhythmia): This is the most dangerous symptom. Severe hyperkalemia can cause life-threatening arrhythmias, including ventricular fibrillation and cardiac arrest.
Shortness of breath
Chest pain

Diagnosis:

Blood test: A blood test to measure potassium levels is the primary way to diagnose hyperkalemia. It's important to rule out pseudohyperkalemia by ensuring proper blood sample handling.
Electrocardiogram (ECG or EKG): An ECG can detect changes in heart rhythm and electrical activity caused by hyperkalemia. Specific ECG findings include peaked T waves, prolonged PR interval, widened QRS complex, and eventually loss of P waves.
Evaluation for underlying causes: The doctor will investigate the underlying cause of hyperkalemia by reviewing the patient's medical history, medications, diet, and performing other tests as needed (e.g., kidney function tests, adrenal function tests).

Treatment:

Treatment for hyperkalemia depends on the severity of the condition, the patient's symptoms, and the underlying cause. The goals of treatment are to:

Stabilize the heart: This is the priority in severe hyperkalemia.
Calcium gluconate or calcium chloride: These medications do not lower potassium levels but help stabilize the heart muscle and protect it from the effects of hyperkalemia. Calcium counters the effects of potassium on cardiac cell membranes.
Shift potassium from the bloodstream into cells:
Insulin and glucose: Insulin promotes the movement of potassium into cells. Glucose is given along with insulin to prevent hypoglycemia (low blood sugar).
Sodium bicarbonate: Sodium bicarbonate can also shift potassium into cells, especially if the patient has acidosis.
Beta-agonists (e.g., albuterol): These medications, often used for asthma, can also cause potassium to move into cells.
Remove potassium from the body:
Diuretics (e.g., furosemide): These medications help the kidneys excrete potassium in the urine. They are only effective if the kidneys are functioning adequately.
Potassium binders: These medications bind to potassium in the digestive tract and prevent it from being absorbed into the bloodstream. Examples include:
Sodium polystyrene sulfonate (Kayexalate): Traditional potassium binder, but can have side effects.
Patiromer (Veltassa): Newer potassium binder.
Sodium zirconium cyclosilicate (Lokelma): Newer potassium binder.
Hemodialysis: Hemodialysis is the most effective way to remove potassium from the body and is used in severe cases of hyperkalemia, especially when kidney function is severely impaired.
Address the underlying cause: Treatment should also focus on addressing the underlying cause of hyperkalemia, such as adjusting medications, treating kidney disease, or managing endocrine disorders.

Prevention:

Monitor potassium levels: People with kidney disease, diabetes, heart failure, or those taking medications that can raise potassium levels should have their potassium levels checked regularly.
Dietary modifications: People at risk for hyperkalemia may need to limit their intake of high-potassium foods, such as bananas, oranges, potatoes, tomatoes, spinach, and avocados. A registered dietitian can help with this.
Medication review: Regularly review medications with a doctor or pharmacist to identify any drugs that could be contributing to hyperkalemia.
Avoid potassium supplements: Unless specifically prescribed by a doctor, avoid taking potassium supplements.

In summary, hyperkalemia is a potentially dangerous condition characterized by high potassium levels in the blood. It is important to be aware of the risk factors, symptoms, and treatment options. If you suspect you may have hyperkalemia, seek medical attention immediately.

Disclaimer: This information is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.*