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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is hyperkalemia?
• How does hyperkalemia affect the body?
• What are the symptoms of hyperkalemia?
• What causes hyperkalemia?
• Kidney dysfunction
• Diseases of the adrenal gland
• Potassium shifts
• Medications
• How is hyperkalemia diagnosed?
• How is hyperkalemia treated?
• Patient Comments: Hyperkalemia - Symptoms
• Patient Comments: Hyperkalemia - Treatment
• Patient Comments: Hyperkalemia - Diagnosis
• Find a local Internist in your town
• Hyperkalemia Index

Hyperkalemia can be asymptomatic, meaning that it causes no symptoms. Sometimes, patients with hyperkalemia report vague symptoms including:

• nausea,
  
  
• fatigue,
  
  
• muscle weakness, or
  
  
• tingling sensations.
  
  

More serious symptoms of hyperkalemia include slow heartbeat and weak pulse. Severe hyperkalemia can result in fatal cardiac standstill (heart stoppage). Generally, a slowly rising potassium level (such as with chronic kidney failure) is better tolerated than an abrupt rise in potassium levels. Unless the rise in potassium has been very rapid, symptoms of hyperkalemia are usually not apparent until potassium levels are very high (typically 7.0 mEq/l or higher).

Symptoms may also be present that reflect the underlying medical conditions that are causing the hyperkalemia.

The major causes of hyperkalemia are kidney dysfunction, diseases of the adrenal gland, potassium sifting out of cells into the blood circulation, and medications.

Potassium is normally excreted by the kidneys, so disorders that decrease the function of the kidneys can result in hyperkalemia. These include:

• acute and chronic renal failure,
  
  
• glomerulonephritis,
  
  
• lupus nephritis,
  
  
• transplant rejection, and
  
  
• obstructive diseases of the urinary tract, such as urolithiasis (stones in the urinary tract).
  
  

Furthermore, patients with kidney dysfunctions are especially sensitive to medications that can increase blood potassium levels. For example, patients with kidney dysfunctions can develop worsening hyperkalemia when given salt substitutes that contain potassium, when given potassium supplements (either orally or intravenously), or medications that can increase blood potassium levels. Examples of medications that can increase blood potassium levels include:

• ACE inhibitors,
  
  
• nonsteroidal anti-inflammatory drugs (NSAIDs),
  
  
• Angiotensin II Receptor Blockers (ARBs), and
  
  
• potassium-sparing diuretics (see below).