Do you sometimes feel tired, lightheaded, or have a pounding in your chest for no reason? Sometimes we think these are normal and dismiss them. But this could be a sign of a small chemical change inside your body. That is, the level of potassium in your blood has increased more than necessary. In medicine, we call this condition hyperkalemia. Don't worry, even if this name sounds like a big deal, let's understand it simply and precisely.
What is potassium? Why is it important to us?
Simply put, potassium is a mineral that is essential for the functioning of our body, acting like a small electric current. In medicine, we call this an electrolyte. Think of our body as a complex machine. For this machine to work properly, it needs a 'current'. That's how potassium helps our body.
Here are some of the main functions that potassium performs in our body:
- For muscle function: When you stretch your arm, laugh, or walk, all of these require muscles to contract and stretch. Potassium helps to do just that.
- Nervous system: Nerves carry messages from the brain to other parts of the body, and from parts of the body to the brain. Potassium is essential for this electrical signal transmission to occur properly.
- Nourishment for cells: Potassium helps the trillions of cells in our body absorb nutrients and remove waste products that build up inside the cells.
- Blood Pressure Control: The salt (sodium) we eat can increase blood pressure. Potassium helps balance the effects of that salt and control blood pressure.
So how do these potassium levels increase?
We get potassium from the foods we eat. Bananas, oranges, and some fruits and vegetables are rich in potassium. Normally, our body takes in the amount of potassium it needs, and the excess is filtered out through our kidneys and excreted in the urine. Think of the kidneys as two super 'filters' in our body.
However, if there is a problem with these two filters, for example, if there is something like chronic kidney disease, it will not be able to get rid of this excess potassium. Then that excess potassium starts to accumulate in the blood. That is what we call hyperkalemia.
Most importantly, if the level of potassium in the blood becomes too high, it can directly affect the functioning of our heart. It can cause irregular heartbeats, chest pain, and sometimes even serious conditions like a heart attack.
Normally, the blood potassium level of a healthy adult should be between 3.5 and 5.0 millimoles per liter (mmol/L). If this number is higher than 5.5, we consider it Hyperkalemia. If this level is higher than 6.5, it is a serious condition that requires immediate medical attention.
What are the symptoms of this? How do we recognize it?
One of the biggest challenges here is that most people with mild hyperkalemia don't show any symptoms. Even if they do, they're so common that we don't pay much attention to them. Sometimes these symptoms come and go, or they just gradually increase over weeks or months.
Let's see what these symptoms are in the table below.
| Symptom level | Things that can be felt |
|---|---|
| Mild symptoms |
|
| Severe symptoms (need immediate attention) |
|
What is the main reason for this situation?
As we've discussed before, the main and most common cause is kidney disease. When the kidneys are not functioning properly, waste products in the blood, especially potassium, are not filtered out properly.
In addition, the following can also cause Hyperkalemia:
- Eating foods high in potassium: Some people even take supplements that contain potassium. Taking these without medical advice can be dangerous.
- Certain medications: Some medications, especially those for high blood pressure, can reduce potassium excretion and increase blood levels.
- Diabetes: This risk is higher in people with uncontrolled diabetes.
- Addison's disease: This is a hormone-related condition.
- Extensive burns: When a large area of the body is burned, cells are damaged and their potassium can accumulate in the blood.
- Some genetic diseases: These are very rare.
How does a doctor diagnose this accurately?
Most of the time, this condition is discovered incidentally. That is, when you have a blood test for another condition, you may see that your potassium level is elevated in the report. The specific blood test for this is the serum potassium test.
In addition, your doctor may perform another test, which is an ECG (Electrocardiogram) test.
- ECG test: This is done to record the electrical activity of your heart, which is the rhythm of your heart. When the level of potassium in the blood increases, changes occur in the electrical pattern (rhythm) of the heart. Peaked T waves on an ECG are one of the first signs of hyperkalemia. This can help your doctor understand whether the potassium level is starting to affect the heart.
What are the treatments for this?
Treatment depends on how high your blood potassium levels are and what's causing them. There's nothing to worry about, it's a manageable condition.
Here are some of the main treatment methods:
| Treatment method | Simply put... |
|---|---|
| Diuretics | We usually call these 'water pills'. These medications stimulate the kidneys and make them produce more urine. Excess potassium and sodium are excreted from the body along with the urine. |
| Medication management | Some medications you are already taking (e.g., blood pressure medication) may be causing your potassium levels to increase. If so, your doctor may decide to stop taking that medication or switch you to another medication. Never stop taking your medication without your doctor's advice. |
| Potassium binders | What these medications do is trap the potassium in the food we eat in the intestines and expel it with the stool. That means they don't allow the potassium to be absorbed into the blood. |
| IV Therapy (Intravenous Therapy) | If your potassium levels are very high and dangerously high, this is a treatment that is given intravenously in a hospital, like saline. This includes calcium gluconate to protect the heart, and insulin to move the potassium in the blood into the cells. |
| Dialysis | This treatment is used for people with kidney failure or those who cannot reduce their potassium levels with other treatments. Simply put, it involves using a machine to filter some of the blood, removing unwanted substances and excess potassium. |
How do we prevent and manage this situation?
The best way to prevent this is to take care of your kidney health and control your diet.
A diet low in potassium
If you are at risk for hyperkalemia, it is best to talk to your doctor or a nutritionist about going on a low-potassium diet. You may need to completely eliminate or limit some high-potassium foods.
Foods high in potassium that should be limited or avoided:
- Fruits: bananas, oranges, grapefruit, melon, avocado, raisins, dates, dried apricots.
- Vegetables: Spinach, tomatoes, potatoes, sweet potatoes, beets, mushrooms, gourds.
- Other: tomato sauce, ketchup, beef, fish, some canned fruit juices.
- Salt substitutes: Some 'low-salt' substitutes on the market contain potassium chloride. Avoid using these.
Important: Don't be alarmed by this list of foods. This doesn't mean you have to stop eating everything. Your doctor will advise you exactly what foods to limit and how much, depending on your condition.
When should we see a doctor? When should we go to the ETU?
This is very important. If you know you have Hyperkalemia, it is essential to have your blood tested regularly as your doctor recommends.
If you have these common symptoms, see your doctor:
- Frequent stomach aches
- Diarrhea
- Nausea and vomiting
- Tiredness without reason
However, if you experience any of the following serious symptoms, you should go to the nearest hospital's Emergency Treatment Unit (ETU) without delay:
- Difficulty breathing
- Extreme muscle weakness (unable to even stand)
- Severe chest pain
- Slow or weak pulse rate
These symptoms indicate that potassium levels are seriously affecting the heart and body.
Take-Home Message
- Hyperkalemia is an elevated level of potassium in the blood. It most often occurs in people with kidney disease.
- Often, there are no symptoms in the early stages. Therefore, if you have risk factors such as kidney disease, diabetes, or high blood pressure, get your blood tested regularly as directed by your doctor.
- If you experience serious symptoms such as chest pain, difficulty breathing, or severe muscle weakness, go to a hospital's Emergency Department (ETU) immediately.
- This condition can be well controlled by limiting foods high in potassium (such as bananas, oranges, tomatoes, potatoes) and taking the medication exactly as prescribed by your doctor.
- Never stop or change your medications without medical advice.
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