Hyperkalaemia awareness

Overview

Hyperkalemia (high potassium) is when the amount of potassium in your blood is too high. Potassium is a mineral that helps your nerves and muscles work properly, but too much can be dangerous, especially for your heart.

Hyperkalemia is fairly common, especially among people with chronic kidney disease, heart failure, or those taking certain medications that affect potassium balance.

It mostly affects people with reduced kidney function, those with diabetes or heart failure, and people taking medicines such as ACE inhibitors, angiotensin receptor blockers, or potassium-sparing diuretics. It can also affect people who eat a very high-potassium diet or have uncontrolled adrenal gland problems.

Symptoms

Common symptoms

• Feeling tired or weak
• Nausea or vomiting
• Muscle cramps or tingling
• Palpitations (feeling like your heart is pounding or skipping a beat)

Symptoms in children

• Irritability or fussiness
• Poor feeding
• Unusual tiredness
• Weak cry or muscle weakness

Symptoms in older adults

• Non-specific symptoms like confusion or falls
• Increased weakness or fatigue
• Dizziness or lightheadedness
• Irregular heartbeat (may feel skipped beats or fluttering)

Causes

Main causes

• Chronic kidney disease (most common cause)
• Medicines that increase potassium, such as some blood pressure drugs (ACE inhibitors, ARBs), NSAIDs (like ibuprofen), or potassium-sparing diuretics
• A diet very high in potassium, especially if kidney function is reduced
• Adrenal gland conditions (e.g., Addison's disease)
• Type 1 diabetes, especially with poor blood sugar control
• Severe injury, burns, or bleeding (tissue damage releases potassium)

Risk factors

• Chronic kidney disease
• Heart failure
• Diabetes (especially if poorly controlled)
• Taking potassium supplements or salt substitutes that contain potassium
• Use of certain medicines (ACE inhibitors, ARBs, NSAIDs, diuretics that spare potassium)
• Adrenal gland disorders
• Older age (kidney function often declines with age)

When to see a doctor

See a doctor urgently if:

• If you have any symptoms of irregular heartbeat, chest pain, or severe muscle weakness, call emergency services immediately.
• If you have kidney disease and notice new or worsening symptoms like nausea, weakness, or palpitations, seek same-day medical advice.

Book a routine appointment if:

• If you have a condition that puts you at risk (like kidney disease or taking certain medicines), ask your doctor how often you should have your potassium checked.
• If you are starting a new medicine that can raise potassium, follow up with blood tests as advised.

Diagnosis

Hyperkalemia is diagnosed with a simple blood test that measures your potassium level. Your doctor will also review your medical history, symptoms, and any medicines you take.

Tests that may be done

• Blood test for potassium level (part of a basic metabolic panel or comprehensive metabolic panel)
• Electrocardiogram (ECG) – a test that checks your heart's electrical activity, because high potassium can change the heart rhythm
• Urine test – to see how your kidneys are handling potassium
• Additional blood tests – to check kidney function (creatinine, eGFR), blood sugar, and hormone levels if an adrenal problem is suspected

What to expect at your appointment

Your doctor will explain the test results and what they mean. If your potassium is only slightly high, you may be asked to change your diet or adjust medications. If it is high or you have symptoms, you may need treatment in a hospital or clinic to lower potassium quickly. The ECG can show if your heart is affected, which helps decide how urgent treatment is.

Treatment

Treatment for hyperkalemia aims to lower potassium levels to a safe range and address the underlying cause. The approach depends on how high the potassium is and whether you have symptoms. Mild cases may be managed with diet changes and medication adjustments, while severe cases require emergency treatments to protect the heart.

Self-care at home

• Follow a low-potassium diet – avoid foods like bananas, oranges, potatoes, tomatoes, spinach, and salt substitutes that contain potassium. Your doctor or dietitian can give you a full list.
• Stay well-hydrated (unless you have fluid restrictions due to kidney or heart problems).
• Avoid over-the-counter medicines like ibuprofen or naproxen unless your doctor says they are safe.
• Take all prescribed medicines exactly as instructed – do not stop or change them without talking to your doctor.

Medical treatments

If your potassium is moderately high or you have symptoms, your doctor may prescribe medicines that help your body get rid of potassium (like certain diuretics) or that lower potassium by moving it into cells. In emergency situations with very high potassium or dangerous heart changes, treatment may include intravenous calcium to protect the heart, followed by medications to shift potassium into cells, and sometimes dialysis (a machine that filters the blood) if kidney function is very poor.

When is surgery considered?

Surgery is not a treatment for hyperkalemia. In rare cases, surgery may be needed for an underlying cause, such as a tumour of the adrenal gland, but this is not related to treating the high potassium itself.

Living with this condition

Hyperkalemia often becomes a chronic condition if you have kidney disease or take certain medicines. With good management, most people can keep their potassium levels in a safe range. You will need regular blood tests and may need to see your kidney specialist (nephrologist) or heart doctor (cardiologist).

Lifestyle tips

• Follow a low-potassium diet as advised by your doctor or dietitian.
• Read food labels to check for potassium content, especially in processed foods and salt substitutes.
• Avoid taking any additional potassium supplements or herbal remedies without medical approval.
• Keep a list of all your medicines (including over-the-counter ones) and show it to every doctor you see.

Diet and exercise

Diet is very important. Your doctor or a dietitian can help you plan meals that are low in potassium. Exercise is generally safe if you feel well, but check with your doctor first – regular activity helps your overall health, but avoid overexertion if you feel weak or tired.

Mental health and emotional wellbeing

Living with a chronic condition like hyperkalemia can cause stress or anxiety, especially if you have to watch your diet closely or worry about heart problems. It can help to talk to your doctor or a counsellor. You are not alone – many people manage this condition successfully.

Prevention

Not all cases can be prevented, but you can reduce your risk by managing chronic conditions like kidney disease and diabetes, taking medicines as prescribed, avoiding high-potassium foods if your kidneys are not working well, and not taking potassium supplements unless your doctor tells you to. Regular blood tests can catch high potassium early.

Vaccines

There are no vaccines to prevent hyperkalemia.

Screening programmes

Screening is done with a simple blood test. If you have kidney disease, heart failure, diabetes, or take medicines that affect potassium, your doctor will likely check your potassium level periodically.

Complications

If left untreated

• Serious heart rhythm problems (arrhythmias) that can lead to cardiac arrest or death
• Muscle weakness or paralysis
• Damage to the heart muscle over time
• Worsening of kidney function

Long-term outlook

With early detection and proper management, most people with hyperkalemia can keep their potassium under control and avoid serious complications. Treatment is very effective, and many people live full, healthy lives. Staying in close contact with your healthcare team is the key to good outcomes.

Find support

International organisations

• National Kidney Foundation (USA)
• Kidney Care UK
• World Heart Federation

Local organisations

• Your local hospital or kidney unit · Global
• NHS (UK) – Health A-Z · UK

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