Kidney disease guidelines to manage and treat high potassium (hyperkalemia)

1. Talk to your provider about high potassium

Potassium is a mineral and an electrolyte that mostly comes from the food you eat. It helps your nerves and muscles work right, especially your heart. 

The only way to know if you have high potassium is to have a blood test. You will need to monitor this closely with your healthcare team through routine lab work and a treatment plan.

Ask your provider these questions:

• What is my potassium level?
• What should my potassium level be?
• How often should I have a blood test to check my potassium level?
• Why do I have high potassium?
• What caused it?
• What changes can I make to manage high potassium? Do I need to take any medicines to treat high potassium?
  • What are the possible side effects of these medicines?
  • How long will I need to take these medicines?
• What should I do if I have symptoms of high potassium?

2. Know your potassium numbers

Your provider will check your potassium numbers regularly through a blood test. The test is often part of a group of routine blood tests called an electrolyte panel.

Your provider will recommend what your potassium level should be
based on your other lab values, current medicines, medical history and overall health goals.

What do my potassium blood test results mean? 

• Healthy potassium levels typically range between 3.5-5.0 mmol/L
• High potassium levels are over 5.0 mmol/L
• Mild to moderate high potassium is 5.0-5.9 mmol/L
• Severe high potassium is 6.0-6.4 mmol/L 
• If your potassium is 5.0 mmol/L or higher, talk with your provider about a treatment plan to help lower your potassium levels.

3. Understand why it's important to keep potassium at a healthy level

Having too much potassium in your blood can be dangerous. It can cause your heart to beat irregularly, which can cause a heart attack. You may not feel symptoms of high potassium, which is why regular blood tests are so important.

Common symptoms of high potassium may include:

• Feeling tired or weak
• Feeling sick to the stomach (nausea)
• Muscle pains or cramps
• Trouble breathing, unusual heartbeat or chest pain

Common signs of heart attack are:

• Feelings of pressure, pain or squeezing in your chest or arms
• Stomach pain or nausea
• Shortness of breath
• Breaking into a cold sweat
• Sudden feelings of dizziness

If you have trouble breathing or think there could be a problem with your heart, call 911 for emergency help.

4. If you have high potassium, your provider will create a personalized treatment plan. Your treatment plan may include:

Your provider reviews all your medicines with you

Your provider may tell you to stop taking certain medicines that can raise your potassium level, such as nonsteroidal anti-inflammatory drugs like ibuprofen.

Your provider has you limit the amount of potassium you eat

Your provider may have you see a dietitian to create a food and fluid plan that is lower in potassium.

Your provider may have you take medicines to lower your potassium levels

These medicines may include: 

• A diuretic (water pill), which will help your kidneys make more urine to remove potassium – your provider may recommend this if you have high blood pressure.
• Sodium bicarbonate, which puts salt in your body to help move potassium from your blood into your cells – your provider may recommend this if you have metabolic acidosis (buildup of acid in your body).

If your potassium level is still high, your provider may have you take a medicine called a potassium binder. It sticks to the potassium in your body to prevent it from getting into your blood. If you take potassium binders, you may have more freedom to eat higher potassium and heart-healthy foods you enjoy.

Your provider may lower or pause your ACEi or ARB medicine

If you take an ACEi or ARB and your potassium level is still high after taking the above steps, your provider may lower your dose or pause your medicine. This is typically the last step your provider will take to lower your potassium level because these medicines play a large role in controlling your blood pressure and keeping your kidneys healthy.