Hyperkalemia is a metabolic disorder in which there is an elevated concentration of potassium in the blood. Potassium is necessary for proper functioning of nerves and muscles, including heart muscle, but an excess level of potassium may disrupt the proper functioning of cells.  Severe hyperkalemia can be life threatening.

The kidneys regulate potassium levels by excreting excess potassium into the urine. Patients with kidney disease often are unable to excrete all the excess potassium in the blood, particularly if they are taking certain medications like ACE inhibitors or angiotensin II receptor blockers, or if they are eating high potassium foods. 

Causes of Hyperkalemia

While kidney disease is the most common cause of hyperkalemia, there are several other possible causes, including:

  • Diseases of the adrenal glands
  • Hormonal disorders
  • Lupus
  • Diabetes
  • Excessive potassium in the diet
  • Certain medications
  • Blood transfusions
  • Alcohol or drug use
  • Traumatic injury
  • Tumors

Symptoms of Hyperkalemia

Mild hyperkalemia usually has no symptoms. Severe hyperkalemia may be associated with symptoms listed below, though many patients continue to have no symptoms whatsoever.  If any of these symptoms arise, patients need to seek evaluation and treatment as soon as possible because severe hyperkalemia can lead to cardiac arrest and death if not treated immediately.

  • Palpitations caused by heart arrhythmia
  • Slow heart rate or weak pulse
  • Muscle weakness or fatigue
  • Tingling or numbness of the skin
  • Nausea
  • Breathing disturbances
  • Paralysis

Diagnosis of Hyperkalemia

Hyperkalemia may be difficult to diagnose because of the nonspecific nature of the presenting symptoms. After obtaining a detailed history and performing a physical examination, a healthcare professional usually will order blood testing to determine potassium levels. In addition, the doctor may order an electrocardiogram, or EKG, to check the electrical activity of the heart. 

Treatment of Hyperkalemia

Hyperkalemia can be treated in several ways, depending on its severity. Treatment for severe cases may include hospitalization and one or more of the following:

  • Discontinuation of medications that increase blood potassium levels
  • Calcium, sodium bicarbonate or other medications administered intravenously
  • Insulin and glucose to move the potassium out of the bloodstream temporarily
  • Diuretics
  • Medications to bind potassium in the GI tract
  • Dialysis in severe cases

Additional Resources