Ways to Lower Your Potassium Levels

Everyone needs a certain amount of potassium in the body. Potassium is an essential nutrient that keeps our heart healthy, and our muscles working just right. However, while some amount of potassium is necessary, too much potassium or too little potassium can be dangerous, especially if you have an underlying medical condition like kidney disease. This can cause a condition known as hyperkalemia, which occurs due to high potassium levels in the blood. To find out your potassium levels, your doctor will order a blood test. Untreated hyperkalemia can prove to be a life-threatening condition, which is why taking steps to lower your potassium levels is necessary. Here are some ways in which you can learn how to lower your potassium levels.

Overview of Hyperkalemia

Hyperkalemia is a condition where your potassium levels in the blood are above average. High potassium levels tend to occur most commonly in people who have chronic kidney disease.(1,2) This is because the kidneys work to get rid of the extra potassium and other excess electrolytes like salt from the body.(3,4) In people with kidney disease, since the kidneys are no longer able to function correctly, the levels of potassium start building up, and over time can develop into hyperkalemia.(5)

Some of the other common causes of hyperkalemia include:

  • Certain medications
  • High-potassium diet
  • Metabolic acidosis
  • Trauma or severe burns

People with high potassium levels seldom come to realize they are having hyperkalemia because the condition does not usually have any symptoms.

To determine your blood potassium levels, your doctor is going to prescribe a blood test. According to the National Kidney Foundation, having a blood potassium level greater than 5 millimoles per liter (mmol/L) is an indication of hyperkalemia.(6)

It is essential for everyone to realize that hyperkalemia if left untreated, can prove to be life-threatening. It can cause irregularities in heartbeats and even lead to heart failure. This is why it is necessary to follow your doctor’s heed and take the required steps to lower your potassium levels.

The steps to lower your potassium levels, though, will depend on certain factors. These include:

  • What is the underlying cause of high potassium?
  • How quickly has it gone up?
  • How severe is your hyperkalemia?

Here are some ways to lower your potassium levels.

Lowering Potassium Levels in Acute or Sudden Hyperkalemia

Acute hyperkalemia is a term used to describe high blood potassium levels that develop over a few days or just a few hours.(7,8) This is a medical emergency that requires immediate medical assistance and treatment in a hospital. High potassium levels in the case of acute hyperkalemia can only be brought down with proper treatment in a hospital.

Once you are at the hospital, your doctor will order various diagnostic tests, including an electrocardiogram (ECG or EKG) to monitor your heart.(9,10)

The treatment of acute hyperkalemia will depend on the severity and cause of your high potassium levels. Steps to lower your potassium levels may involve removing the excess potassium from the bloodstream with diuretics and potassium binders. In severe cases of hyperkalemia, dialysis might be needed.(11)

Bringing down potassium levels in acute cases of hyperkalemia can also include administering a combination of insulin with glucose, sodium bicarbonate, and albuterol. This concoction helps move the excess potassium away from the bloodstream and into the cells.(12) Such type of treatment is also used in the treatment of metabolic acidosis, which is another common condition observed in people with chronic kidney disease.

Metabolic acidosis occurs when there is a high level of acid present in your bloodstream. This can also be a life-threatening condition and requires immediate medical assistance.(13)

Lowering Potassium Levels in Chronic Hyperkalemia

Chronic hyperkalemia is a condition of high blood potassium levels that takes weeks or months to develop. This type of high potassium can be managed outside of the hospital.

The primary way of lowering potassium levels in chronic hyperkalemia is by modifying your diet, changing your medication or the dosage of your medication, and/or starting a medication to lower the potassium levels such as potassium binders or diuretics.(14,15)

While you carry out the steps to lower your potassium levels, your doctor will continue to carefully monitor the blood potassium levels from time to time to ensure they are going down to a healthy range.

Lowering Potassium Levels with Medications

The most common types of medications used to lower potassium levels are potassium binders and diuretics.

Potassium Binders

This class of medications works on treating the condition of hyperkalemia by binding to the excess potassium present in the digestive system and then excreting this extra potassium through bowel movements.

There are many types of potassium binders that your doctor may choose to prescribe for lowering high potassium levels. These include:

  • Calcium polystyrene sulfonate (CPS)
  • Sodium polystyrene sulfonate (SPS)
  • Sodium zirconium cyclosilicate (brand name Lokelma)(16)
  • Patiromer (brand name Veltassa)(17)

Patiromer and sodium zirconium cyclosilicate are the two newer forms of potassium binders for treating hyperkalemia. Both of these medicines are known to be especially useful in people with diabetes or heart disease who have hyperkalemia. This is because people with heart disease or diabetes are usually taking certain medications that can increase the levels of blood potassium.

Diuretics

Diuretics are a class of drugs that helps flush out excess potassium and other electrolytes like sodium out of the body through urination. They are commonly used for treating both chronic and acute hyperkalemia. Diuretics can also decrease blood pressure and reduce inflammation in the body. However, one has to be careful while being on diuretics as it can cause side effects like dehydration.(18)

Lowering Potassium Levels by Changing your Diet

Your doctor is also going to recommend that you follow a low potassium diet for bringing down your blood potassium levels. There are two easy ways of naturally cutting back on the amount of potassium you consume. These are:

  • Restricting or avoiding high-potassium foods
  • Boiling certain foods to leach out the potassium from them before consuming them

Here are some high potassium foods you should restrict or avoid to lower your potassium levels:

  • Cooked spinach
  • Avocado
  • Bananas
  • Plantains
  • Root vegetables such as beets, beet greens, parsnips, taro, potatoes, yams, sweet potatoes (potatoes and sweet potatoes can be had after boiling)
  • Dates
  • Raisins
  • Prunes and prune juice
  • French fries
  • Potato chips
  • Bran
  • Chocolate
  • Nuts
  • Seeds
  • Tomato paste, tomato puree, or sun-dried tomatoes
  • Yogurt
  • Salt substitutes

Here are some high potassium beverages you should avoid or restrict:

  • Beer
  • Wine
  • Coffee
  • Cider
  • Milk
  • Fruit or vegetable juice (especially carrot and passion fruit juices)

Food like potatoes, sweet potatoes, spinach, and yams, can be consumed after boiling or partially boiling. After boiling, you can prepare them in whichever manner you want, be it roasting, baking, or frying them. The boiling process removes a lot of potassium from these foods. However, keep in mind that you should not have the water in which these foods have been boiled as the potassium would have leached out into this water.

Your doctor is also likely to tell you to avoid having salt substitutes, which are made from potassium chloride and can increase your blood potassium levels quite rapidly.(19)

Lowering Potassium Levels by Changing Medications

There are many medications that may, in some cases, cause hyperkalemia. These include medications for managing high blood pressure known as the renin-angiotensin-aldosterone system (RAAS) inhibitors.(20) Other medications that may cause an increase in your potassium levels include:

If you are diagnosed with hyperkalemia, it is essential to let your doctor know about all the medications and supplements you are taking to help them determine the exact cause of your high potassium levels. This is also required for your doctor to determine the right treatment for lowering your potassium.

Conclusion

If you are diagnosed with hyperkalemia, your doctor will work with you to determine the correct way of managing your high potassium levels and to help you avoid an acute hyperkalemia episode. Trying a new medication, changing the dosage of your medication, and following a low-potassium diet are some of the common ways of lowering high blood potassium levels.

References:

  1. Evans, K.J. and Greenberg, A., 2005. Hyperkalemia: a review. Journal of Intensive Care Medicine, 20(5), pp.272-290.
  2. DeFronzo, R.A., 1980. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney international, 17(1), pp.118-134.
  3. Parham, W.A., Mehdirad, A.A., Biermann, K.M. and Fredman, C.S., 2006. Hyperkalemia revisited. Texas Heart Institute Journal, 33(1), p.40.
  4. Ponce, S.P., Jennings, A.E., Madias, N.E. and Harrington, J.T., 1985. Drug-induced hyperkalemia. Medicine, 64(6), pp.357-370.
  5. 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.
  6. National Kidney Foundation. 2020. High Potassium (Hyperkalemia). [online] Available at: <https://www.kidney.org/atoz/content/hyperkalemia> [Accessed 30 October 2020].
  7. Elliott, M.J., Ronksley, P.E., Clase, C.M., Ahmed, S.B. and Hemmelgarn, B.R., 2010. Management of patients with acute hyperkalemia. Cmaj, 182(15), pp.1631-1635.
  8. GOLDFARB, S., COX, M., SINGER, I. and GOLDBERG, M., 1976. Acute hyperkalemia induced by hyperglycemia: hormonal mechanisms. Annals of internal medicine, 84(4), pp.426-432.
  9. Dittrich, K.L. and Walls, R.M., 1986. Hyperkalemia: ECG manifestations and clinical considerations. Journal of Emergency Medicine, 4(6), pp.449-455.
  10. Wrenn, K.D., Slovis, C.M. and Slovis, B.S., 1991. The ability of physicians to predict hyperkalemia from the ECG. Annals of emergency medicine, 20(11), pp.1229-1232.
  11. Weisberg, L.S., 2008. Management of severe hyperkalemia. Critical care medicine, 36(12), pp.3246-3251.
  12. Allon, M. and Copkney, C., 1990. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney international, 38(5), pp.869-872.
  13. Kraut, J.A. and Madias, N.E., 2010. Metabolic acidosis: pathophysiology, diagnosis and management. Nature Reviews Nephrology, 6(5), p.274.
  14. 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.
  15. DuBose, T.D. and Good, D.W., 1992. Chronic hyperkalemia impairs ammonium transport and accumulation in the inner medulla of the rat. The Journal of clinical investigation, 90(4), pp.1443-1449.
  16. Takkar, C., Nassar, T. and Qunibi, W., 2020. An evaluation of sodium zirconium cyclosilicate as a treatment option for hyperkalemia. Expert Opinion on Pharmacotherapy, pp.1-10.
  17. Weir, M.R., Bakris, G.L., Bushinsky, D.A., Mayo, M.R., Garza, D., Stasiv, Y., Wittes, J., Christ-Schmidt, H., Berman, L. and Pitt, B., 2015.
  18. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. New England Journal of Medicine, 372(3), pp.211-221.
  19. Greenberg, A., 2000. Diuretic complications. The American journal of the medical sciences, 319(1), pp.10-24.
  20. Hoyt, R.E., 1986. Hyperkalemia due to salt substitutes. Jama, 256(13), pp.1726-1726.
  21. Schrier, R.W., 2010. Hyperkalemia: a threat to RAAS inhibition?. Nature Reviews Nephrology, 6(5), pp.245-246.
  22. Rimmer, J.M., Horn, J.F. and Gennari, F.J., 1987. Hyperkalemia as a complication of drug therapy. Archives of internal medicine, 147(5), pp.867-869.
  23. Nash, D.M., Markle-Reid, M., Brimble, K.S., McArthur, E., Roshanov, P.S., Fink, J.C., Weir, M.A. and Garg, A.X., 2019. Nonsteroidal anti-inflammatory drug use and risk of acute kidney injury and hyperkalemia in older adults: a population-based study. Nephrology Dialysis Transplantation, 34(7), pp.1145-1154.
  24. Lin, W., Mou, L., Tu, H., Zhu, L., Wang, J., Chen, J. and Hu, Y., 2017. Clinical analysis of hyperkalemic renal tubular acidosis caused by calcineurin inhibitors in solid organ transplant recipients. Journal of clinical pharmacy and therapeutics, 42(1), pp.122-124.

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