How to Recognize and Treat Hyperkalemia? | Risks of Untreated Hyperkalemia

What is Hyperkalemia, and How Do You Recognize It?

Hyperkalemia is caused by high potassium levels in the blood.(1,2) Most people seldom experience any symptoms of hyperkalemia, making it difficult to recognize the condition.(3) If symptoms do appear, they are typically mild and non-specific in nature. If you have high potassium levels in the blood, you may feel some numbness, tingling or pins and needles sensation in your hands and feet, muscle weakness, abdominal cramping, or loose stools.(4) The symptoms of hyperkalemia do not develop overnight. They take time to develop, usually over several weeks or even months and tend to be mild even then. However, these symptoms tend to be persistent in nature.(5,6)

In some cases, if hyperkalemia comes on suddenly, and you have severely high levels of potassium, you are likely to feel shortness of breath, chest pain, heart palpitations, nausea or vomiting. Severe or sudden hyperkalemia is a life-threatening condition that should never be ignored. If you experience any of the symptoms discussed here or suspect you may have a sudden or severe onset of hyperkalemia, it is essential that you seek immediate medical assistance.(7)

Are there any warning signs of hyperkalemia? There are usually no warning signs of hyperkalemia. People with mild to moderate hyperkalemia usually do not even have any signs or symptoms of the condition. However, if you have a high enough or a sudden change in your potassium levels, you may experience nausea, fatigue, and muscle weakness. Some people also experience changes in a cardiac EKG or ECG (electrocardiogram) scan that shown an irregular heartbeat, a condition known as arrhythmia.(8,9)

But how to recognize severe hyperkalemia? If you have severe hyperkalemia, you may experience symptoms such as severe muscle weakness or even paralysis. You may also feel a decrease in your tendon reflexes. Hyperkalemia can also cause cardiac changes, especially in your heart rhythm. If you experience any cardiac changes, you will need to seek immediate medical assistance to avoid cardiac arrest.

What are the Causes of Hyperkalemia?

There are several causes of hyperkalemia. The most common causes of the condition include:

Chronic Kidney Disease: Hyperkalemia is known to happen if your kidneys are not functioning properly. The kidneys have the job of filtering out the excess potassium through urine. You get potassium through the foods you eat and beverages you drink. During the early onset of kidney disease, the kidneys are able to continue filtering out the excess potassium. However, as the kidney function worsens, they are unable to remove the extra potassium from the blood. This can lead to hyperkalemia.(10)

High Potassium Diet: Eating too many foods that are high in potassium can cause hyperkalemia, especially in people who have advanced kidney disease. You must avoid having high-potassium foods like orange, nectarines, bananas, cantaloupe, and honeydew melon.(11)

Certain Medications: Certain types of drugs can prevent the kidneys from removing the excess potassium. These drugs include ACE inhibitors and beta-blockers that are often prescribed in the treatment of heart disease and high blood pressure.(12)

Some of the other lesser common causes of hyperkalemia include:

Poorly Managed Diabetes: When diabetes is not controlled, it can impact the kidneys directly, thus impairing the balance of potassium in the blood.

Burns or Other Serious Injuries: This can cause hyperkalemia because the body, in response to speed up healing of the severe burns or wounds, releases excess potassium in the bloodstream.

Taking excess potassium in the form of supplements or salt substitutes.

Addison’s Disease: This can happen if the body does not make a sufficient amount of specific hormones. This presents the kidneys from triggering certain responses in the body, thus leading to a build-up of potassium in the bloodstream.

Shifts in potassium levels due to dehydration or severe blood loss.

Sometimes, false elevations of potassium can also be observed in lab results. This is known as pseudohyperkalemia. In order to be certain of the high potassium reading, your doctor is going to recheck the potassium reading to ensure it is an accurate reading.(13)

What is the Treatment for Hyperkalemia?

There are many treatment options for hyperkalemia. First of all, your doctor will determine that there are no cardiac changes brought on by the high potassium in the blood. You will need to undergo an EKG test for this. If you have developed an irregular or unstable heart rhythm due to the high levels of potassium in the bloodstream, your doctor will then recommend calcium therapy to stabilize your heartbeat.(14)

If there are no cardiac changes, your doctor may administer insulin, followed by a glucose infusion. This helps in lowering the potassium levels quickly.

After this, your doctor is likely to recommend a medication for removing the excess potassium from the blood. Some medicines that are prescribed include a thiazide diuretic or loop medication, or a cation exchange medicine.(15) The cation exchangers that are typically prescribed include sodium zirconium cyclosilicate (brand name Lokelma) or patiromer (brand name Veltassa).(16)

Are There Any Risks Of Untreated Hyperkalemia?

If hyperkalemia is left untreated, it can lead to severe heart arrhythmia. This can cause various cardiovascular problems and even death. If your doctor tells you that your lab tests indicate high potassium levels, you should immediately start taking preventive actions. Your doctors will again check your potassium levels to rule out the condition of pseudohyperkalemia. If you do have hyperkalemia, there is nothing to worry about, but you must proceed with starting the treatments to lower your potassium levels.

Conclusion

There is overall a low occurrence rate of hyperkalemia. Most people do not experience hyperkalemia even after having foods rich in potassium or being on medications like ACE inhibitors or beta-blockers. People who are at a risk of developing hyperkalemia are usually the ones who have acute or chronic kidney disease.

It is possible to prevent kidney disease by following a healthy lifestyle. This includes regular exercising, avoiding smoking, restricting the intake of alcohol, controlling your blood sugar and blood pressure, and watching your weight.

References:

  1. Parham, W.A., Mehdirad, A.A., Biermann, K.M. and Fredman, C.S., 2006. Hyperkalemia revisited. Texas Heart Institute Journal, 33(1), p.40.
  2. Evans, K.J. and Greenberg, A., 2005. Hyperkalemia: a review. Journal of Intensive Care Medicine, 20(5), pp.272-290.
  3. Weisberg, L.S., 2008. Management of severe hyperkalemia. Critical care medicine, 36(12), pp.3246-3251.
  4. Einhorn, L.M., Zhan, M., Walker, L.D., Moen, M.F., Seliger, S.L., Weir, M.R. and Fink, J.C., 2009. The frequency of hyperkalemia and its significance in chronic kidney disease. Archives of internal medicine, 169(12), pp.1156-1162.
  5. Lehnhardt, A. and Kemper, M.J., 2011. Pathogenesis, diagnosis and management of hyperkalemia. Pediatric nephrology, 26(3), pp.377-384.
  6. Pfortmüller, C.A., Leichtle, A.B., Fiedler, G.M., Exadaktylos, A.K. and Lindner, G., 2013. Hyperkalemia in the emergency department: etiology, symptoms and outcome of a life threatening electrolyte disorder. European journal of internal medicine, 24(5), pp.e59-e60.
  7. An, J.N., Lee, J.P., Jeon, H.J., Kim, D.H., Oh, Y.K., Kim, Y.S. and Lim, C.S., 2012. Severe hyperkalemia requiring hospitalization: predictors of mortality. Critical Care, 16(6), p.R225.
  8. Campese, V.M. and Adenuga, G., 2016. Electrophysiological and clinical consequences of hyperkalemia. Kidney International Supplements, 6(1), pp.16-19.
  9. Ronny, C., Rhadames, R., Christine A, G., Sohail, M., Yoojin, P., Anthony, D. and Brooks, M., 2012. Electrocardiogram manifestations in hyperkalemia. World Journal of Cardiovascular Diseases, 2012.
  10. Miller, R.D., Way, W.L., Hamilton, W.K. and Layzer, R.B., 1972. Succinylcholine-induced hyperkalemia in patients with renal failure?. Anesthesiology: The Journal of the American Society of Anesthesiologists, 36(2), pp.138-141.
  11. Adamson, R.T., 2015. The burden of hyperkalemia in patients with cardiovascular and renal disease. Am J Manag Care, 21, pp.S307-S315.
  12. Chang, A.R., Sang, Y., Leddy, J., Yahya, T., Kirchner, H.L., Inker, L.A., Matsushita, K., Ballew, S.H., Coresh, J. and Grams, M.E., 2016. Antihypertensive medications and the prevalence of hyperkalemia in a large health system. Hypertension, 67(6), pp.1181-1188.
  13. Don, B.R., Sebastian, A., Cheitlin, M., Christiansen, M. and Schambelan, M., 1990. Pseudohyperkalemia caused by fist clenching during phlebotomy. New England Journal of Medicine, 322(18), pp.1290-1292.
  14. Kim, H.J. and Han, S.W., 2002. Therapeutic approach to hyperkalemia. Nephron, 92(Suppl. 1), pp.33-40.
  15. Allon, M. and Copkney, C., 1990. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney international, 38(5), pp.869-872.
  16. Packham, D.K., Rasmussen, H.S., Lavin, P.T., El-Shahawy, M.A., Roger, S.D., Block, G., Qunibi, W., Pergola, P. and Singh, B., 2015. Sodium zirconium cyclosilicate in hyperkalemia. New England Journal of Medicine, 372(3), pp.222-231.