Hyperkalemia: High Potassium, Medicines That Raise It and Kidney Disease

Urgent: when to get help now

There are often no symptoms with a high potassium level. [1] When symptoms do occur, they can include chest pain, difficulty breathing, nausea or vomiting, palpitations, a slow, weak or irregular pulse, and sudden collapse. [1] MedlinePlus says to contact your provider right away if you have vomiting, palpitations, weakness or difficulty breathing. [1] A very high level can stop the heart. [1] For chest pain, collapse or severe breathlessness, call emergency services (911 in the US).

This page is information only. Treatment is decided by a clinician, and it should not delay care.

What hyperkalemia is

Hyperkalemia means a higher-than-normal potassium level in the blood. [1] MedlinePlus gives a usual blood range of 3.5 to 5.1 mEq/L, and ranges differ between laboratories. [2] The kidneys remove extra potassium in urine, so kidney function matters most. [1] This is an established medical condition; the causes and tests below come from clinical reference pages, not from trials.

Common causes

MedlinePlus lists:

• kidneys that are not working well; [1]
• certain blood pressure medicines, most often ACE inhibitors, angiotensin receptor blockers (ARBs) and spironolactone-type medicines; [1]
• taking extra potassium, such as salt substitutes or supplements; [1]
• Addison disease, large burns, severe stomach or intestinal bleeding, and muscle or cell damage from several causes. [1]

NIDDK explains that in chronic kidney disease (CKD) potassium levels in the blood can become very high. [3] Taking certain medicines, or skipping dialysis treatments, can also raise it. [3]

Medicines that can raise potassium

The NHS says foods such as bananas and avocados, or potassium salt substitutes, can raise potassium further with spironolactone. It advises asking a doctor or dietitian. [5] Do not stop or start any medicine without first talking to your provider. [1] A pharmacist can check your list; see Medication interactions.

Kidney disease and food

People with kidney problems, particularly those on dialysis, should not eat too many potassium-rich foods. [4] NIDDK says that if potassium is high, a health professional may recommend using spices and herbs instead of salt substitutes, limiting foods with potassium chloride on the label and draining canned fruits and vegetables. [3] Your own limits come from your kidney team. Food lists are on Foods high in potassium and Minerals, supplements and kidney disease.

Tests and treatment overview

Tests may include a basic metabolic panel, an electrocardiogram (ECG) and a serum potassium level. [1] MedlinePlus says a provider will likely check potassium and kidney blood tests regularly if you have been prescribed extra potassium, have chronic kidney disease, take heart or blood pressure medicines, or use salt substitutes. [1] Emergency treatment is needed for a very high level or danger signs such as ECG changes. [1] Providers may reduce or stop potassium supplements, change medicines, or prescribe a potassium binder. [1][3] Those are clinician decisions.

What trials say about salt substitutes

In a trial of 20,995 people with prior stroke or aged 60+ with high blood pressure, serious events attributed to hyperkalemia were not significantly higher with a 75% sodium chloride / 25% potassium chloride substitute than with regular salt. [7] WHO says such products can help people not at risk of hyperkalemia. [8] The result does not transfer to people with advanced kidney disease or other groups, and the sources we read did not report on them.

Who should be especially careful

Older adults: the NHS says their kidneys may be less able to remove potassium and they should not take potassium supplements unless a doctor advises it. [9] Pregnancy, breastfeeding and young children were not covered for hyperkalemia in the sources we read; ask a clinician. For supplement quality, see Quality testing and certifications. Related: Potassium and Hypokalemia.