Hyperkalemia and Hypokalemia:
DID YOU KNOW... this refers to whether you have too little or too much Potassium?

Prepared by John. A. Sawdon M.Sc. Public Education & Special Projects Director,
Cardiac Health Foundation of Canada

What do we mean by Potassium?

Potassium is a mineral that is found in many of the foods we eat. It is the eighth or ninth most common element by mass within the human body so that a 60 kg adult contains 120g of potassium. 1 Potassium helps balance fluids and minerals in your body. Potassium ions are present in a wide variety of proteins and enzymes. It is also an electrolyte. Electrolytes conduct electrical impulses throughout the body. It plays a role in keeping your heart beat regular and your muscles working right. They assist with a range of essential body functions including:

  • Maintain a normal blood pressure
  • Normal water balance
  • Muscle contractions
  • Nerve impulses
  • Digestion
  • Heart rhythm
  • Ph balance (acidity and alkalinity)2
  • Glucose and insulin metabolism
  • Renal concentrating ability
  • Vascular tone

Potassium is not produced naturally by the body but is found in most foods we eat. It is the job of healthy kidneys to regulate the correct amount of potassium in your body. If your kidneys are not healthy then you need to regulate or limit the foods that can increase your potassium to dangerous levels within your body. Hypokalemia and Hyperkalemia are common electrolyte disorders caused by changes in potassium intake, excretion or trans cellular shifts.3 Diuretic use and gastrointestinal losses ( vomiting, diarrhea) are common causes of hypokalemia. Kidney disease, hyperglycemia and medication use are common causes of hyperkalemia.

Sources of protein which normally are derived from food include:

  • Fruits such as apricots, oranges, bananas, kiwi and pineapples
  • Vegetables including leafy greens, avocadoes, tomatoes, baked potatoes, and sweet potatoes
  • Lean meats
  • Whole grains
  • Beans and nuts especially pistachios, almonds

Potassium Deficiency

Some conditions can lead to potassium deficiencies or hypokalemia. A temporary loss of potassium may not cause any symptoms. This can occur from a really hard workout whereby you sweat profusely resulting in a loss of potassium. This loss is quickly reversed through drinking of fluids that restore the electrolytes in your body. More severe losses can occur as a result of the following:

  • Overuse of diuretics
  • Excess sweating, diarrhea, and or vomiting
  • Magnesium deficiency
  • Use of some antibiotics including penicillin

Severe symptoms of hypokalemia which can be life threatening includes 4:

  • Extreme fatigue
  • Irregular heart rate including cardiac arrhythmias and electrocardiogram abnormalities such as ventricular tachycardia or ventricular fibrillation, paroxysmal atrial or junctional tachycardia, premature atrial or ventricular beats, sinus bradycardia and atrioventricular block.
  • Muscle weakness and rhabdomyolysis
  • Renal abnormalities including hypokalemic nephropathy
  • elevated blood pressure
  • constipation, nausea and vomiting

Having Too Much Potassium

If not monitored carefully, too much potassium can lead to hyperkalemia. 4 Hyperkalemia occurs when there is impaired excretion of potassium due to acute/chronic kidney disease, or disorders, and drugs that inhibit the rennin-angiotensin-aldosterone axis. Risk factors that can lead to too much potassium or hyperkalemia can include:

  • taking too many potassium supplements
  • kidney disease
  • prolonged exercise
  • cocaine overdose
  • potassium conserving diuretics
  • chemotherapy
  • diabetes
  • severe burns

Symptoms of potassium overdose may include cardiac conduction problems, cardiac arrhythmias, muscle weakness and paralysis.

Treatments that are available from Hospitals and your Doctors may include:

Hypokalemia:
The most important and quickest treatments address the root causes of the lack of potassium such as improving diet, stopping diarrhea or vomiting or the offending medication. Potassium supplements are usually the first course of action. For more severe cases especially those experiencing abnormal heartbeats intravenous treatments may be required. If you have healthy kidneys potassium sparring diuretics may be used to rid the body of sodium while normalizing electrolyte levels. Because some diuretics and potassium supplements can be harsh on your stomach, or digestive tract, you might consider asking your doctor for coated medication. 5

Hyperkalemia:
Preventing reoccurrence of hyperkalemia usually involves reduction of dietary intake of potassium, removal of medications potentially causing potassium increases and or addition of a diuretic or an enema. For severe cases treatments will differ. Kidney dialysis is used for excretion for those suffering from kidney failure. Doses of insulin and glucose are utilized to transport potassium from the blood to cells for their removal. Calcium gluconate may be used to temporarily stabilize the heart while reducing heart complications from hyperkalemia. 6

Being Aware of Blood Potassium Levels that are Safe is Important

Remember blood tests are conducted to identify your blood potassium levels

Safe Zone is 3.5mmol/L to 5mmol/L

For Hyperkalemia
Caution Zone is 5.1 mmol/L to 6.0 mmol/L
Danger Zone is 6.0 mmol/L or higher

For Hypokalemia
Caution Zone is 2.5 mmol/L to 3.5mmol/L
Danger Zone is 2.5mmol/L or less.

The National Kidney Foundation in the United States of America suggest that a healthy American normally consumes 3500 to 4500 milligrams of potassium a day and those with a restricted diet are usually reduced to 2000 milligrams of potassium a day. Your Doctor and possibly a kidney dietitian will assist you to establish your intake limits. Within the section which follows we are providing a list of foods that are high or low potassium sources. This list plus information on reducing potassium levels within food/vegetables through leaching is intended to empower you to maintain healthy blood potassium levels.

High Potassium Foods

Banana avocado sweet potato
Papaya dates pumpkin
Prune juice figs spinach
Raisins nectarine rutabagas
Mango pomegranate okra
Kiwi juices –prune grapefruit- broccoli
Oranges and orange juice dried beans brussels sprouts
Cantaloupe kale beets
Honeydew white mushrooms carrots
Pears parsnips butternut squash
Apricots white potatoes bamboo shoots
Artichoke acorn squash baked beans
Clams turkey French fries
Fish haddock potato chips milk
Ground beef lentils tomatoes
Chocolate granola yogurt
Chewing tobacco molasses bran products

Low Potassium Foods

Peach apple canned peaches
Fresh strawberries watermelon canned pineapple
Applesauce apricots canned blackberries
Blueberries cherries grapes
Mandarin oranges tangerine raspberries
Cranberries plums fruit cocktail
Zucchini squash yellow lettuce
Corn cauliflower cucumber
Celery asparagus broccoli
Mixed vegetables alfalfa sprouts cabbage
Eggplant lettuce white mushrooms
Rice noodles pasta
Bread angel food cake coffee
Tea rhubarb radish
Onions peas water chestnuts
Cookies without nuts or chocolate cheese waffle
Brown rice flour or corn tortilla

Reducing the Potassium Level within your Foods

One of the ways to reduce the amount of potassium in vegetables and foods is to leach them. Please remember however that leaching does not get all of the Potassium out of your foods, it only reduces it.

  • Peel and place vegetables in cold water
  • Slice the vegetable into strips approximately 1 quarter inch
  • Rinse in warm water
  • Soak a minimum of two hours. For white potatoes soak overnight for best results.
  • Cook vegetables with 5 times the amount of water normally called for. This will work for most vegetables 7

Conclusion

My intention with this article was to introduce you to the blood Potassium within your bodies and to explore hypokalemia and hyperkalemia. Both of these diagnoses can have deadly consequences if not managed. They tend to occur for a variety of reasons all related to the level of potassium within the body. Both hypokalemia and hyperkalemia is more prevalent for individuals who are hospitalized. We encourage you to manage your numbers and to ask your Doctor about your potassium levels especially for those individuals suffering from Heart Failure or High Blood Pressure.

Let us know if this article was helpful for you. Also if there is a topic related to heart disease that you wish to know more about let us know. Send your comments to jsawdon@cardiachealth.ca.

References:

  1. Potassium from the free encyclopedia Wikipedia https://en.wikipedia.org/wiki/Potassium
  2. Cherney, Kristeen; Healthline Potassium http://www.healthline.com/health/potassium?print=tru
  3. Vera, Anthony J MD, MPH, & Wouk Nooah MD University of Chapel Hill School of Medicine Potassium Disorders: Hypokalemia and Hyperkalemia American Family Physician Journal September 15, 2015:92(6): 487-495 http://www.aafp.org/afp/2015/0915/p487.html
  4. ACLS Certification Institute Hypokalemia and Hyperkalemia https://acls.com/free-resources/knowledge-base/pea-asystole/hypokalemia-and-hyperkalemia
  5. Hypokalemia from the free encyclopedia Wikipedia https://en.wikipedia.org/wiki/Hypokalemia
  6. Hyperkalemia from the free encyclopedia Wikipedia https://en.wikipedia.org/wiki/Hyperkalemia
  7. National Kidney Foundation Potassium and your CKD Diet https://www.kidney.org/atoz/content/potassium
  8. Drugs.com Know more be sure “High Potassium Food List –Foods Rich in Potassium (https://www.drugs.com/cg/potassium-content-of-foods-list.html.
  9. Web MD High-Potassium Foods, Topic Overview http://www.webmd.com/food-recipes/tc/high-potassium-food-topic-overview

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advice. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.