The Analyst™

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  Hyperkalemia (Elevated Serum Potassium)  
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations


Hyperkalemia is an excess of serum potassium. Most potassium in the body (98%) is found within cells; only a small amount usually circulates in the bloodstream. The balance of potassium between the cells and the blood is critical. It affects the way the cell membranes work and governs the action of the heart and the pathways between the brain and the muscles. If you have excess potassium in the blood, it is usually excreted by the kidneys. However, the levels can get too high if your kidneys aren't working right, which is the most common cause of hyperkalemia. Another cause is damaged cells' releasing potassium into the bloodstream faster than even normal kidneys can clear it. Medications or diet may also affect the amount of potassium in the blood. Hyperkalemia is a serious condition that must be treated promptly!

Hyperkalemia has many causes, including the following.

  • Kidney problems
  • Too much acid in the blood, as sometimes seen in diabetes
  • Diet high in potassium (bananas, oranges, tomatoes, high protein diets, salt substitutes, potassium supplements)
  • Trauma, especially crush injuries or burns
  • Addison's disease
  • Certain medications
You may not be feeling any effects of the hyperkalemia; your health care provider may discover it during a routine blood test or electrocardiogram. Hyperkalemia can cause life-threatening effects without warning. If you experience the symptoms of hyperkalemia, you should call 911 or get to an emergency room. You should expect to be admitted to the hospital for further tests and so that your condition can be stabilized. You will be given medications to take care of the immediate problem, but more tests may need to be done to determine the underlying cause. If the medications are not successful in lowering the potassium level in your blood, dialysis may be recommended.


Signs, symptoms & indicators of Hyperkalemia (Elevated Serum Potassium):
Symptoms - Cardiovascular  Heart racing/palpitations

Symptoms - General

  Constant fatigue

Symptoms - Respiratory

  (Possible) difficulty breathing

Conditions that suggest Hyperkalemia (Elevated Serum Potassium):
Musculo-Skeletal  General Weakness

Nervous System


Risk factors for Hyperkalemia (Elevated Serum Potassium):
Hormones  Low Adrenal Function / Adrenal Insufficiency

Lab Values - Chemistries

  (Very) low serum K or normal serum K

Organ Health

  Kidney Weakness / Disease

Hyperkalemia (Elevated Serum Potassium) suggests the following may be present:
Autoimmune  Addison's Disease

Emergency Care

  A Potentially Urgent Medical Need

Recommendations for Hyperkalemia (Elevated Serum Potassium):
Action  See a Doctor at Earliest Opportunity
 An elevated serum potassium should be confirmed by repeat testing and the casue investigated.


  Increased Water Consumption
 Dehydration can make hyperkalemia worse.

Not recommended:
  Increased Fruit/Vegetable Consumption
 Patients on potassium-restricted diets should avoid these foods, or eat them sparingly, as advised by their nutritionist / doctor.

HIGH potassium (more than 225 milligrams per 1/2 c. serving)
All meats, poultry and fish are high in potassium.
Apricots (fresh more so than canned)
Lima beans
Oranges and orange juice
Potatoes (can be reduced to moderate by soaking peeled, sliced potatoes overnight before cooking)
Vegetable juice
Winter squash

Persons restricting their potassium might be cautioned to include no more than one or two servings from this list per day, depending on their medical restrictions.

Moderate potassium (125 - 225 mg per serving)
Apple juice
Green peas
Loose-leaf lettuce
Mushrooms, fresh
Summer squash, including zucchini


 Magnesium (200mg two to three times per day) helps regulate potassium levels.

Weak or unproven link
Strong or generally accepted link
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
Reasonably likely to cause problems


Addison's Disease:  Characterized by the chronic destruction of the adrenal cortex, which leads to an increased loss of sodium and water in the urine, muscle weakness and low blood pressure. The bronze color of the skin is due to the increased production of the skin pigment, melanin.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Dialysis:  The artificial process of cleaning wastes from the blood when kidneys fail.

Electrocardiogram:  A test that shows a tracing of the electrical conduction of the heart.

Potassium:  A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.