Hyperkalemia: Treatment, Diet, Prevention of High Potassium
Amongst the various electrolytes or rather minerals that plays a significant role in keeping the body healthy and help the organs to function properly, potassium is one such important mineral that helps the heart beat properly, control the function of the skeletal muscles i.e., the muscles that are found around the skeleton and torso, as well as the smooth muscles which are found in the digestive tracts. Potassium also lets the nerves work properly while transmitting the electrical signals across the nervous system and maintains the body fluid levels.
This mineral (potassium) is acquired from the daily diets and only a moderate amount of potassium in the body, rather blood is enough. With an abnormal level of potassium in blood, the rhythm of heart differs, because potassium controls the normal electrical heart rhythm. When the potassium level in blood is increased, it leads to the condition that is commonly called hyperkalemia. Diet plays a vital role in treatment and management of Hyperkalemia or High Potassium but before we get to know more about the diet and treatment, let us get familiar with its symptoms, complications and causes.
Definition of Hyperkalemia or High Potassium:
The condition in which there is high potassium content in the blood is known as hyperkalemia.
The normal range of potassium in blood is 3.5 to 5 meq/L; that is milliequivalents per litre or millimoles per litre.
Signs and Symptoms of Hyperkalemia or High Potassium:
Hyperkalemia can be asymptomatic. When hyperkalemia occurs, it can be absolutely nonspecific and may vary largely from person to person. Generally the following symptoms are associated with cardiac and muscular function:
- Nausea and vomiting
- Fatigue and weakness
- Chest pain
- Frank muscle paralysis
- Muscle weakness
- Absent or depressed tendon reflexes.
Complications Associated with Hyperkalemia or High Potassium:
When the potassium level in the blood exceeds the required amount, it can be dangerous for the body. While mild hyperkalemia or mild increase in potassium levels affects the heart rhythm with a limited impact, moderate hyperkalemia or moderate increase in potassium levels brings changes in the EKG reports, which is the electrical reading of heart muscles. However, with severe hyperkalemia or high potassium levels in blood, the electrical activity of the heart is suppressed, causing heart arrest. In some rare cases, this condition leads to muscle dysfunction, known as hyperkalemic periodic paralysis.
Causes of Hyperkalemia or High Potassium:
There are many causes of Hyperkalemia or High Potassium. The general pathophysiological mechanism that leads to this condition is excessive intake, very low excretion and the shift of the potassium from intracellular to extracellular space. The most common causes that are associated with these pathophysiological conditions are –
Hyperkalemia or High Potassium Caused Due to Kidney failure:
The proper levels of potassium in the body is controlled and maintained by the kidneys. When the kidneys fail to remove the excess potassium from the body, it leads to the deposition of potassium in the blood and body. Hence, when the kidney fails, it is the roots cause Hyperkalemia or High Potassium. Whether the patient has a chronic kidney disease or an acute kidney failure, this condition is very likely to be caused.
Hyperkalemia or High Potassium Caused Due to Alcoholism:
The other possible cause that leads to hyperkalemia or high potassium is excessive drinking of alcohol. Heavy alcohol intake can cause the muscles to break down and high amount of potassium is therefore released into the blood. The syndrome that is associated with this muscle breakdown due to alcoholism is known as rhabdomyolysis.
Hyperkalemia or High Potassium Caused Due To Drugs and Medications:
Certain drugs such as chemotherapy drugs, as well as potassium supplements can also cause this condition. If you take these drugs for a prolonged period, it will lead to Hyperkalemia or High Potassium. Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) can also cause this condition.
The other causes of Hyperkalemia or High Potassium are –
- Severe injury or burn leading to destruction of red blood cells
- Adrenal failure or Addison's disease.
Pathophysiology of Hyperkalemia or High Potassium:
95-98% of the total store of body potassium is found primarily in the intracellular space in muscles. The serum potassium level is maintained by the normal homeostatic mechanisms. These mechanisms include the buffering of extracellular potassium against a large intracellular potassium pool and for this task the sodium-potassium pump is used. With the help of this sodium-potassium pump the excess potassium is excreted through urinary tracts. 90% of the total potassium is excreted through urine and 10% is excreted through stool and sweat.
The Cortical Collecting Duct (CCD) and the Distal Convoluted Tubule (DCT) play the most significant role in the excretion of potassium within kidneys and their functions are controlled by aldosterone and other adrenal corticosteroids. The apical membrane of cortical collecting tubule cells has Epithelial Sodium Channels (ENaC) in them. These channels reabsorb the sodium. A negative electrical potential is generated by the aldosterone in this entire procedure and the renal outer medullary potassium (ROMK) is secreted. These sodium and potassium are transported to distal nephrons with the help of WNK (with no K [lysine]) kinases, which are a family of signalling molecules. Finally the sodium and potassium are excreted through urine. With healthy renal activity, the kidneys can still perform the task of potassium excretion, even if the potassium intake is high. But with kidney failure, this ability is destroyed.
Diagnosis of Hyperkalemia or High Potassium:
Only regular checkups and blood tests can potentially make you aware of this condition. Otherwise, in most cases, Hyperkalemia or High Potassium is left undiagnosed. If you have started a new medication that has the potential of increasing the potassium levels in the blood, then seeing the doctor regularly to check the potassium level is a must.
Treatment for Hyperkalemia or High Potassium:
The treatment of Hyperkalemia or High Potassium has two basic lines of goals and these are to stabilize the heart and to get rid of the excessive potassium in the body. If kidney failure is the cause of hyperkalemia, then hemodialysis is the best treatment option. In the process of dialysis, a machine is used to remove the wastes from the body and blood that the kidney cannot filter. Additional drugs are given to reduce the potassium levels in the blood and Gluconate is given to reduce the impact of potassium on heart. At times, the doctor prescribes diuretics that will make the patient urinate more, in order to remove more potassium through urine. Oral resins are also given to make the potassium get bound and be removed in the form of bowel.
Diet for Hyperkalemia or High Potassium:
Since the main potassium intake is done through diets, it is very important that dietary changes are done in order to limit further potassium intake. Here are some dietary instructions that the patient must follow as home remedy for Hyperkalemia or High Potassium. The purpose is to limit the potassium intake to 2,000mg to 3,000mg potassium per day.
Foods to Avoid in Hyperkalemia or High Potassium:
Fruits like avocados, apricots, bananas, peaches, figs, orange; raisins, prunes and kiwis are rich sources of potassium. These fruits must be avoided as much as possible. Milk and other dairy products like yoghurt, buttermilk and cottage cheese are also rich in potassium. Hence, these must be avoided completely from the diet. Fish like salmon, tuna, seeds like flax seeds, pumpkin seeds, almonds, pistachios and sunflower seeds are also bad for hyperkalemia patients as they are rich in potassium. Raisins, dates and tomatoes, as well as beets and chocolates should also be eliminated from the diet.
Foods to Take in Hyperkalemia or High Potassium:
Fruits like grapefruit, blackberries, grapes, plums, lemons, pears, tangerines and strawberries are low in potassium and hence, are good choices for hyperkalemia patients. Carrots, cabbage, onion, ladies' finger, rice, pasta, alfalfa sprouts are good for regular diet as they are very low in potassium content.
When you follow this diet, you can sometimes eat the things that you must avoid, yet you like a lot as it will not make you sick after a single serving. However, maintaining the quantity is your responsibility.
Prevention for Hyperkalemia or High Potassium:
Hyperkalemia is a condition that is solely dependent on potassium intake control and kidney functioning. To prevent Hyperkalemia or High Potassium, making sure that your kidney is working properly is the best idea. However, eating low potassium diet to maintain the balance of potassium in the body is also not a bad idea.
With proper treatment, Hyperkalemia or High Potassium can well be treated and managed. You only have to make sure that the diagnosis is early.