Bay Area Medical Information (BAMI.us)
Hyperkalemia (High Potassium)

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Potassium is an electrolyte...

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Potassium is measured by a blood test Electrolytes are minerals in your blood and other body fluids and can be measured by a blood test. Potassium is an electrolyte that is critical to the function of nerve and muscles cells, including those in your heart. The level of potassium in the blood must be maintained within a narrow range. When potassium levels are too high or too low, it can increase the risk of an abnormal heartbeat and have serious consequences, such as a life-threatening rhythm disturbance or even cardiac arrest.

Our body naturally maintains it's own potassium balance within the normal range. 98% of the body's potassium is located inside the cells. Only 2% is located in the blood, outside the cells, which is the part that we measure by a blood test. The potassium stored within the cells can be used by the body to help maintain a constant level of potassium in the blood.

Potassium balance is achieved by matching the amount of potassium taken in with the amount lost. Potassium is taken in through food and electrolyte-containing drinks and lost primarily in urine, although some potassium is also lost through the digestive tract and in sweat. Healthy kidneys are able to adjust the excretion of potassium to match changes in dietary intake. Some drugs and certain conditions affect the movement of potassium into and out of cells, which greatly influences the potassium level in the blood.

Potassium levels, along with other electrolyte levels, are often part of routine blood work, but may be ordered at regular intervals to monitor therapy with certain drugs and in patients with certain chronic diseases. Normal potassium values may vary from lab to lab. In general normal values fall within the following ranges:

Normal Potassium Lab Values
Adults: 3.5–5.0 milliequivalents per liter (mEq/L); Children: 3.4–4.7 mEq/L (Infants and newborns have different normal ranges)
Note: Lab errors can occur with potassium levels--if the result is unexpectedly high, the doctor might repeat the blood test to confirm accuracy.

Our body naturally maintains it's own potassium balance within the normal range

98% of the body's potassium is located inside the cells. Only 2% is located in the blood, outside the cells, which is the part that we measure by a blood test. The potassium stored within the cells can be used by the body to help maintain a constant level of potassium in the blood.

Potassium balance is achieved by matching the amount of potassium taken in with the amount lost. Potassium is taken in through food and electrolyte-containing drinks and lost primarily in urine, although some potassium is also lost through the digestive tract and in sweat. Healthy kidneys are able to adjust the excretion of potassium to match changes in dietary intake. Some drugs and certain conditions affect the movement of potassium into and out of cells, which greatly influences the potassium level in the blood.

Causes of Hyperkalemia (Elevated Potassium)

Abnormally high levels of potassium in the blood is caused by:

  • Acute or chronic kidney failure (This is the most common cause of hyperkalemia--the kidneys regulate potassium levels, thus impaired function of the kidneys cause potassium levels to rise)
  • Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics (such as triamterene, amiloride, and spironolactone) can result in high potassium levels
  • Excessive use of potassium supplements
  • Other diseases (Addison's Disease, Hypoaldosteronism)
  • High blood potassium levels can also be caused by conditions that release potassium from the body's cells into the blood. These conditions include severe burns, crushing injuries, heart attack, diabetic ketoacidosis, and overdoses of crack cocaine. (4)
  • Certain cancer therapies that rapidly destroy cancer cells can increase blood levels of potassium.
  • Dehydration
Symptoms of Hyperkalemia (Elevated Potassium)

Mild hyperkalemia causes few, if any, symptoms. Usually, hyperkalemia is first detected when routine blood tests are performed or when a doctor notices changes on an electrocardiogram. A high level of potassium in the blood is dangerous. It can cause the heart rhythm to become abnormal. If the level is very high, the heart can stop beating.(3)

Treatment of Hyperkalemia (Elevated Potassium)
For mild hyperkalemia, reducing the potassium intake or discontinuing drugs that prevent the kidneys from excreting potassium may be the only treatment that is needed. If the kidneys are functioning, a diuretic may be given to increase potassium excretion.

For severe hyperkalemia, immediate treatment is essential. A resin that absorbs potassium from the digestive tract and passes out of the body in the stool can be given by mouth or enema. When more rapid treatment is needed, the person may be given an intravenous solution. If these measures do not work or if a person has kidney failure, dialysis may be necessary to remove the excess potassium.(3)

Potassium-Restricted Diets
  • Look on labels for symbols listed as KCL, K+ or potassium and avoid these foods. Potassium may be used in some foods as a preservative or a salt substitute.
  • Foods and food additives that are high in potassium should be avoided (above)
  • Soaking or boiling vegetables and fruits in water helps reduce the potassium content.
Foods high in potassium
Milk
All milk, skim, whole, buttermilk, yogurt (1 cup)*
Chocolate milk, low fat 1 cup 425 mg
Vegetables Fruits
Artichokes (1 whole)*
Asparagus (1 cup)*
Beans, dried (1/3 cup)*
Beet greens (1 cup)*
Bamboo shoots (1/2 cup)*
Broccoli (2 stalks)*
Brussel sprouts (1/2 cup)*
Celery (1 cup)*
Chard (1/2 cup)*
Chinese cabbage (2 cups)*
Lettuce (2 cups)*
Mushrooms (1 cup)*
Parsnips (1/2 cup)*
Pinto beans 1 cup 583 mg
Potato, baked 1 medium 610 mg
Pumpkin (1/2 cup)*
Spinach 1 cup, cooked 574 mg
Squash (Acorn) 1 cup, cubed 896 mg
Squash (summer) (1 cup)*
Squash (winter) (3/4 cup)*
Sweet Potato (1 cup) baked 950 milligrams (mg)
Tomato (1 medium)*
Tomato juice 8 ounces (oz.) 556 mg
Apricots, dried 1/3 cup 734 mg
Avocado (1/3 whole)*
Banana 1 medium 422 mg
Cantaloupe 1 cup, balls 473 mg
Dates (5 medium)*
Figs, dried (3 medium)*
Grapefruit juice (1 cup)*
Honeydew melon (2" wide slice of 6" diameter melon)*
Orange (1 medium or 3/4 cup sections)*
Orange juice, fresh squeezed 8 oz. 496 mg
Papaya 1 medium 781 mg
Peaches, dried (1/2 cup)*
Prune juice (1/2 cup)*
Prunes (5 large)*
Raisins (1/3 cup)*
Other--these foods and food additives are generally high in potassium
  • Salt substitutes (listed as KCl on labels)
  • Lite salts,
  • Coffee,
  • Sport drinks,
  • Iced tea sold in cans
  • Granola bars,
  • Ovaltine,
  • Chocolate and
  • Fig cookies
  • Molasses (Blackstrap) 1 tablespoon 498 mg
*The following foods, in listed portion sizes, have greater than 275 mg (7mEq) potassium per serving.
References
1) Potassium from the American Heart Association
2) Dietary Reference Intakes from the Institute of Medicine
3 ) Potassium from MerckSource.com
--Written by N Thompson, ARNP and Michael Thompson, MD, February 2009

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