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How is hyperkalemia treated?

Treatment of hyperkalemia must be individualized based upon the underlying cause of the hyperkalemia, the severity of symptoms or appearance of ECG changes, and the overall health status of the patient. Mild hyperkalemia is usually treated without hospitalization especially if the patient is otherwise healthy, the ECG is normal, and there are no other associated conditions such as acidosis and worsening kidney function. Emergency treatment is necessary if hyperkalemia is severe and has caused changes in the ECG. Severe hyperkalemia is best treated in the hospital, oftentimes in the intensive care unit, under continuous heart rhythm monitoring.

Treatment of hyperkalemia may include any of the following measures, either singly or in combination:

  • A diet low in potassium (for mild cases).
  • Discontinue medications that increase blood potassium levels.
  • Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells.
  • Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia.
  • Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells.
  • Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium.
  • Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells.
  • Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract.
  • Dialysis, particularly if other measures have failed or if renal failure is present.

Treatment of hyperkalemia naturally also includes treatment of any underlying causes (for example, kidney disease, adrenal disease, tissue destruction) of hyperkalemia.

Return to Hyperkalemia (High Blood Potassium)

See what others are saying

Comment from: mj, 55-64 Female (Patient) Published: July 12

I had muscle weakness, and was out of breath walking across the apartment. I was taking Dyazide diuretic, and the doctor had me taking too much potassium supplement to correct what was lost through diuretic. The doctor had me go back to original dose of potassium and I was okay. Some people are very sensitive to elevated potassium and develop symptoms of hyperkalemia when it is even a little too high. I thought I was having a heart attack! But no, I was okay after a few days of decreased potassium supplement.

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Comment from: jb, 55-64 Female (Patient) Published: February 10

I have had 3 blood tests in the last 2 months. Potassium blood levels are high. I am fearful. I have read all about hyperkalemia. What I cannot find is a diet plan, a list of foods I can eat, only what I cannot have! I also have high cholesterol, so the foods I can eat for good cholesterol are high in potassium. My doctor does not want to add any more drugs to my am and pm cocktails of medicines.

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Comment from: vilaskotekar, 45-54 Male (Caregiver) Published: April 17

My brother is suffering from cirrhosis of the liver, portal hypertension, and ascites. He is taking Ursomax and Aldactone. Now he is taking Indian Noni Gold juice. I don't know whether this improves his health condition or causes side effects. It is supposed to increase potassium levels in the body.

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