Hyperkalemia: Symptoms, Causes, Treatment, Cost, and Side Effects

Hyperkalemia is a medical condition that can cause harm to nerves and muscle function, causing a heart attack in extreme cases. Hyperkalemia is caused by excess quantities of potassium in the blood. A healthy person typically has potassium levels between 3.5 and 5.0 millimoles per liter (mmol/L) in their blood. Anyone with potassium levels above 5.0 mmol/L can be at high risk for Hyperkalemia, and patients with potassium level above 6.5 mmol/L are at high risk of heart problems that demand immediate medical intervention. Stastically, Nearly 1 to 10 percent of hyperkalemia patients require hospitalization.

Despite the fatal dangers of high levels of potassium, symptoms of Hyperkalemia are not as obvious as one might think. A patient suffering from Hyperkalemia may experience nausea or vomiting, numbness in their body, tingling sensation, and muscle weakness. In more severe cases where the patient may be in danger of heart failure, they might experience heart palpitations, chest pain, shortness of breath and vomiting.

Hyperkalemia is a disease caused by excess of potassium in blood, so the leading causes can range from a high-potassium diet to renal diseases. Patients with adrenal mineralocorticoid deficiency, acidosis, and chronic or acute renal failure are also at high risk for hyperkalemia. Other factors contributing to high potassium levels in one’s body include:

• Type 1 diabetes
• Addison's disease (adrenal insufficiency)
• Destruction of red blood cells post rhabdomyolysis (crush injury, convulsion, infection)
• Excessive intake of potassium supplements
• Dehydration
• Medications for chemotherapy, K-sparing diuretic, ACE inhibitors, beta blockers, succinylcholine, etc.

Preventive measures for hyperkalemia depend on the severity of the issues. If a patient has mild hyperkalemia which can be managed by medical treatment, then they are given diuretics and potassium binders. But if the patient has extreme renal failure and the patient is at high-risk of heart failure, they may require dialysis treatment. If you have mild symptoms of hyperkalemia and you are yet to receive the dietary changes, follow these.

Two common types of medication for hyperkalemia treatment are Diuretics and DOs and DONTs:

Dos

1. Follow a low potassium diet
2. Avoid salt substitutes which are high in potassium
3. Avoid herbal supplements like alfalfa, milkweed, Bufo, Chan’su, or Senso, etc.
4. Take potassium binders or water pills as directed by the healthcare provider

Don’ts

1. Eating foods with potassium levels over 200 mg per serving
2. Taking salt substitutes which are high in potassium
3. Consuming herbal remedies or supplements
4. Taking medications that contain potassium

In most cases, hyperkalemia, which is usually indicated by high levels of potassium in the blood, usually crops up during a routine blood test, or in extreme cases, when the patients complain of chest pain, nausea and heart palpitations.

What tests are done for Hyperkalemia?

If the doctor suspects that you may be at high-risk for hyperkalemia, they may recommend a serum potassium test to measure potassium levels in your blood. If your pre-diagnosis symptoms include heart palpitations and chest pain, the doctor may also recommend an electrocardiogram (EKG) which shows if there’s a change in the heart rhythm due to excess potassium levels in your blood.

How do you check for Hyperkalemia at home?

Currently there are no at-home testing kits available for people to test for hyperkalemia by themselves. Usually, a routine blood test will tell you the potassium levels in your blood, and if they are high, the doctor might suggest additional screening for hyperkalemia. If you experience warning symptoms such as heart palpitations, chest pain, shortness of breath, muscle weakness, dehydration, and nausea or vomiting, seek immediate medical attention, as severe hyperkalemia may cause heart failure.

Furthermore if you have Type 1 diabetes, Addison's disease, or are taking any type of hormonal inhibitors or potassium supplements, pay close attention to your potassium levels by taking routine blood tests.

Hyperkalemia cannot be remedied at home right away, but in the case of mild cases, once the doctor has prescribed relevant medications, one needs to make sure that they are limiting their intake of high potassium foods and boiling certain foods before eating them.

No, unless the potassium levels are slightly above the normal level and can be lowered by dietary changes, hyperkalemia requires medical management, and in some cases mild surgical intervention.

Patients of hyperkalemia should eat foods with potassium levels below the 200 milligrams (mg) mark in every serving. Some of the low-potassium foods you can include are:

• Fruits such as apples, pineapple, grapefruit, cranberries and cranberry juice, and berries, such as strawberries and blueberries
• Vegetable such as cauliflower, broccoli, eggplant, and green beans
• White rice and white pasta
• White bread and egg whites
• Canned tuna in water

Foods with potassium levels above the 200 mg per serving mark should be avoided at all costs by the patients of hyperkalemia. Some of the foods that fit into this category are:

• Fruits such as bananas, avocados, prunes or prune juice, and oranges or orange Juice
• Beans like kidney beans, chickpeas, adzuki beans, soybeans, etc.
• Raisins, dates, dried apricots and nuts
• Tomatoes, tomato juice, and tomato sauce
• Lentils
• Spinach
• Brussels sprouts
• Potatoes (regular and sweet)
• Pumpkin
• Milk
• Bran products
• French fries
• Chocolate
• Yogurt
• Low-sodium cheese
• Meats such as beef and chicken

Hyperkalemia treatment options vary patient to patient, depending on the severity of the issues. Mild cases of hyperkalemia where the potassium levels in the blood are slightly high above the normal range, can be treated with dietary and lifestyle changes, and medical management. Medicines for mild hyperkalemia cases include water pills, IV infusion of calcium, and potassium binders. However, in the case of severe hyperkalemia where the patient is at high risk of heart failure or has pre-existing renal failure, dialysis treatment is one of the common treatments.

To test for high potassium levels in the body, take a routine blood test. A spot urine test for potassium, creatinine, and osmoles is another test used by healthcare providers to detect hyperkalemia.

Hyperkalemia patients should seek immediate care if the serum potassium is less than or equal to 6.5 mmol/L or if high potassium content in blood is accompanied by ECG changes - even in the case of mild hyperkalemia ([K+] 5.5 – 5.9 mmol/L).

Hyperkalemia patients who experience changes in the electrocardiography (ECG), a quick spike of serum potassium, acidosis or decreased renal function, should seek urgent care.

Since most hyperkalemia cases usually result from some kidney disorder, your GP may refer you to a nephrologist. In addition, if it's a mild case of hyperkalemia which can be remedied with dietary changes, then you may have to consult a nutritionist along with a nephrologist.

If you are diagnosed with high potassium content in blood tests, don’t panic. Ask your healthcare provider to educate you on preventive measures. Some of the questions, you may ask are:

• What caused your hyperkalemia?
• How frequently should I get blood tests for hyperkalemia assessment?
• How much potassium should I intake in my daily diet?
• Any foods or supplements that I should avoid?
• What, if any, salt substitutes can I use?
• Any treatment risks and side effects I should know about?
• Am I at risk for kidney failure or other problems due to hyperkalemia?
• What follow-up care do I need after the treatment procedure?
• Any signs of complications that I need to watch out for?

Sodium zirconium cyclosilicate (Lokelma) is one of the best medicines for hyperkalemia in adults which is a FDA approved treatment. Lokelma is a potassium binder that binds itself to potassium in the small and large intestines and exchanges it for hydrogen and sodium, reducing the potassium levels in the lumen of the GI tract.

Surgical intervention is only required for patients with severe cases of hyperkalemia where the patients may have a pre-existing renal failure or if the patient requires immediate treatment. In mild cases, potassium levels are brought back to normal with medical management, where the patient takes diuretics or potassium binders orally, and makes dietary changes.

Two treatment therapies for hyperkalemia that do not require surgery are:

1. Diuretic therapy: Chronic diuretic therapy may be used in patients with CKD and mild hyperkalemia. In this treatment procedure, loop diuretics, such as furosemide 40–80 mg IV, and saline combined together are infused into the patient's body to deliver sodium to the distal nephron and activate renal potassium excretion.
2. Cation-exchange resins: Patients may take Sodium-polystyrene sulfonate (SPS) which can be taken either orally or through retention enema which causes an exchange of sodium for potassium ions in the large intestine.

Hemodialysis, a therapy choice for life-threatening hyperkalemia, is used to treat patients with compromised renal function, severe rhabdomyolysis, and patients who are not healing from prescribed medications. There are three types of dialysis treatments: in-center hemodialysis, at-home hemodialysis, and peritoneal dialysis.

In the hemodialysis treatment procedure, a dialysis machine and a dialyzer (a special filter called an artificial kidney), are used to clean your blood. The doctor will do a minor surgery, usually on your arm, to make an entrance into your blood vessels, to allow passage of blood into the artificial kidney.

Slightly high levels of potassium levels can be managed with lifestyle changes and medical management. However, if the potassium levels remain high or the patient has kidney failure, one might need a dialysis treatment. A single Dialysis treatment in India can take an average sum of Rs. 2,700 to 27,000.

Recovery from hyperkalemia depends on the severity of the diseases, and the treatment options may range from dietary changes and medical management to surgical treatment. The three levels of potassium content are:

• Safe zone: 3.5 to 5.0 mmol/L
• Caution zone: 5.1 to 6.0 mmol/L
• Danger zone: 6.0 mmol/L or higher

Patients in the caution zone should take 10 U of regular insulin and 50 mL of dextrose 50% in water (D50W). The insulin starts working within 20-30 minutes and may take between two to six hours. In the case of patients in the danger zone who require hemodialysis (TIRD), Dialysis recovery time (DRT) may take anywhere between 2 to 6 hours.

Mild cases of hyperkalemia can be treated permanently without any long-term complications with the right care. Your doctor may increase the frequency of blood tests to monitor your potassium levels once you are treated. In the case of kidney failure, a patient undergoing dialysis treatment for hyperkalemia requires a kidney transplant for permanent recovery.

A patient may no longer need to continue potassium-lowering therapy once the potassium levels are restored back to normal. Two key practises recommended post-treatment of hyperkalemia include:

• Avoid eating potassium rich foods, potassium supplements and salt substitutes.
• Regular blood tests to check potassium levels

The doctors at Pristyn Care will be able to guide you on what you need to do to heal quickly.

Depending on the potassium content in the blood vessels, patients may be categorized into Safe zone, Caution zone, and Danger zone. Depending on the severity of the issue, the healthcare specialist then recommends preventive measures which may include certain medications and lifestyle changes to manage the high potassium content in the blood. But, if the patient’s potassium levels still remain higher than 6.5 mmol/L or if pathological ECG symptoms persist, then haemodialysis is the most effective method in treating hyperkalemia.

Patients with hyperkalemia who experience ECG changes, along with decreased renal function, spike in serum potassium, or significant acidosis should consult a health specialist as soon as possible. Also, even if the patient has mild hyperkalemia, one should not drink fruit juice or eat fruits, potatoes, fruit gums, coffee, chocolates, or eat biscuits.

According to several medical papers on hyperkalemia, renal failure was the biggest cause of hyperkalemia, followed by potassium inducing drugs, and hyperglycemia, contributing to most episodes. Most people who were diagnosed with Hyperkalemia were taking angiotensin converting enzyme inhibitors (ACE) or angiotensin II receptor blockers (ARBs) while taking spironolactone for renal failure. Some of the popular treatment methods used for hyperkalemia include:

1. Administering calcium to stabilize electrically excitable membranes.
2. Use of sodium bicarbonate, insulin, or albuterol to transfer the potassium content from the extracellular to the intracellular compartment
3. Use of sodium polystyrene exchange resins or dialysis to remove potassium from the body.