Potassium plays a major role in muscle function and regulating blood pressure in the body. The recommended potassium levels for adults is 3-5 millimoles per liter (mmol/L). When the level exceeds 5 mmol/L it causes Hyperkalemia or high potassium levels. Mostly a comorbid condition in people with kidney issues, hyperkalemia increases the risk of cardiovascular complications.
In contrast, the deficiency of potassium due to severely low levels of potassium (hypokalemia) in the body (lower than 3.5 mmol/L) is also a reality for many.
According to National Kidney foundation, US the estimated prevalence of Hyperkalemia is 2-3 % in the general population. However, it adds that more than half of those in pre-dialysis CKD condition develop hyperkalemia.
High potassium levels: Who’s at risk
“Not all are at risk of hyperkalemia. Those with kidney issues such as chronic kidney disease (CKD) are at higher risk of hyperkalemia,” explains Dr Raman Malik, consultant nephrologist, Dr LH Hiranandani Hospital, Mumbai.
A 62-year-old businessman from Mangalore was diagnosed with kidney dysfunction in 2018 and managed it with medications and diet. In 2022, when kidneys further deteriorated, he was recommended for dialysis. He was advised to maintain a low potassium and low phosphorus diet to ensure the kidney responds to kidney dialysis well. Speaking to Happiest Health, he explained how he avoids potassium rich food in everyday diet.
“I avoid fruits and fruit juices. I limit my water intake to 1.5 litres per day,” he said. Six months ago when he suddenly experienced a lag in his movement, he rushed for a clinical examination. Currently, due to a mild spike in the potassium levels, he is on medications.
Those with healthy kidneys can also develop high potassium levels, explains Dr Anil Kumar BT, HOD, senior consultant nephrologist & chief transplant physician, Gleneagles BGS Hospitals, Kengeri, Bangalore. In these individuals’ hyperkalemia is caused by:
- Potassium-retaining drugs such as blood pressure medications
- Excessive or strenuous physical activity
Hyperkalemia and kidney disease: The connect
“Kidneys play a key role in maintaining the electrolyte balance in the body. Individuals with kidney conditions fail to filter the toxins, including excess potassium, from the body due to kidney dysfunction,” explains Dr Kumar. When kidneys end up retaining potassium, it can eventually cause high potassium levels in the blood.
Can excess exercise cause high potassium?
“Yes, any form of strenuous or excessive exercising—excessive weightlifting, high-intensity exercises, walking, or running—can injure the muscles,” warns Dr Kumar. This can cause the potassium —that resides within the cell- to spill outside the cell (intercellular leakage) and consequently increase the potassium levels in the blood, he adds.
Signs of high potassium in the body:
Mild to moderate increase in potassium levels can be indicated by nausea, constipation, loss of appetite, low blood pressure, and slowed down heart rate, explains Dr Malik. However, early identification is a challenge, he adds.
If the potassium levels rise beyond 6.5 mmol/L, it can be risky. Severe hyperkalemia can cause an increased risk of Quadriparesis (muscle weakness in the legs and arms) and paraparesis (weakness in the legs), warns Dr Malik. If the heart rate goes below 40 beats per minute it can increase the risk of cardiac complications, he warns. “The cardiovascular complications include arrhythmia (irregular heartbeat), heart blocked or AV block (when the electric signals that manage the heartbeat are partially or completely blocked), and cardiac arrest,” adds Dr Kumar.
Tests to identify hyperkalemia:
Dr Kumar explains that hyperkalemia is checked in the following ways:
- Serum potassium test: A blood test that measures potassium levels in the blood
- Echocardiogram (ECG): A test for heart health to assess the heart rate and rhythm changes of the heart
Treatment for hyperkalemia:
Dr Malik explains the various treatment methods that are adopted to treat high potassium levels:
Medications: The first line of treatment for high potassium levels is medications. For those individuals who have high potassium levels due to drugs, these drugs need to be replaced with those that do not retain potassium in the body.
Also, glucose-insulin (GI) drip and bicarbonate are administered in the Intravenous (IV) form to reduce the serum potassium levels by moving the excess potassium from outside within the cell. Another method is salbutamol nebulization through IV. Diuretics or water pills are also administered, in some cases, where excess potassium is removed from the body through urine. Potassium binders, edible powders that are mixed in water, are another method of removing the excess potassium from the bowels through excretion.
During this treatment, calcium gluconate is given to avoid the risk of cardiac arrhythmia and heart-related complications.
Dialysis: When medications fail, and/or there is low blood pressure, muscle weakness, and heartbeat is < 40 per minute (you mean bpm), experts recommend kidney dialysis.
Preventive measures
Low potassium diet: In cases of hyperkalemia caused by kidney diseases, a low potassium diet plays a key role. One must avoid potassium rich fruits and nuts such as bananas, oranges, mangoes, avocados, raisins, apricots, cashew nuts, almonds and fruit juices.
Limit water intake: People with some kidney conditions must restrict water intake to one liter a day to avoid fluid overload, water retention, and a spike in potassium levels.
Takeaways
- Those with CKD are at risk of developing high potassium levels.
- Potassium-retaining drugs or overexercising can also cause hyperkalemia.
- Nausea, constipation, and loss of appetite are the early signs. Muscle weakness indicates severe hyperkalemia.
- Medications are the first line of treatment. If all else fails, dialysis is recommended.
