How to Fix Your High Potassium (Hyperkalemia)

Hyperkalemia, or high potassium, affects a significant portion of individuals with chronic kidney disease, with estimates suggesting over half of those with advanced stages experience elevated potassium at some point. This condition, if left unmanaged, can lead to dangerous and life-threatening heart problems.

Quick Summary

An elevated blood potassium level requires careful management through diet, medication adjustments, and medical intervention. Lifestyle changes, including a low-potassium diet and avoiding certain supplements, can effectively regulate levels. Severe cases may necessitate emergency treatments like IV therapy or dialysis under medical supervision.

Key Points

• Consult a Doctor: High potassium requires medical evaluation, especially for those with kidney or heart issues, to determine the underlying cause and safe treatment plan.

• Modify Your Diet: Restricting high-potassium foods like bananas, potatoes, and tomatoes is crucial. Opt for low-potassium alternatives such as apples, berries, and green beans.

• Prepare Food Carefully: Leaching vegetables by peeling, slicing, soaking, and boiling can help reduce their potassium content significantly.

• Review Your Medications: Speak with your doctor about potential medication adjustments, as some drugs can contribute to high potassium levels.

• Understand Treatment Options: Beyond diet, options include potassium binders, diuretics, and, in severe cases, emergency treatments like IV therapy or dialysis.

Understanding the Causes of High Potassium (Hyperkalemia)

Your body needs potassium for normal nerve and muscle function, especially for your heart. Your kidneys are typically responsible for filtering out excess potassium, but when they are not working correctly, levels can build up in the blood. The causes of high potassium, or hyperkalemia, can be categorized into three main areas:

• Kidney-related issues: Chronic Kidney Disease (CKD) is the most common cause, as impaired kidney function prevents efficient potassium removal. Acute kidney injury and conditions that affect renal tubules can also contribute.
• Medication-induced factors: Certain drugs can raise potassium levels. These include ACE inhibitors and ARBs for blood pressure, potassium-sparing diuretics, NSAIDs, and some chemotherapy agents.
• Diet and supplements: While uncommon to cause hyperkalemia in healthy people, excessive dietary intake or use of potassium supplements can be problematic for those with kidney issues. Salt substitutes often contain potassium chloride and should be avoided.
• Other medical conditions: Conditions like poorly controlled diabetes, Addison's disease, and significant tissue damage (e.g., from severe burns or trauma) can also lead to hyperkalemia.

Dietary Strategies to Fix High Potassium

Managing your diet is a cornerstone of correcting high potassium levels. A low-potassium eating plan typically limits intake to 2,000–3,000 mg per day, though your doctor or a renal dietitian will provide personalized targets.

Limiting high-potassium foods

To lower your potassium intake, it is crucial to reduce or avoid foods that are naturally rich in this mineral. Key foods to limit include:

• Fruits: Bananas, oranges and orange juice, melons (cantaloupe, honeydew), avocados, dried fruits (raisins, prunes, dates).
• Vegetables: Potatoes, sweet potatoes, tomatoes (and tomato products like sauce and paste), pumpkin, winter squash, spinach, and cooked broccoli.
• Protein sources: Large portions of meat, chicken, and fish.
• Dairy: Excess milk and yogurt.
• Other foods: Beans, lentils, nuts, and salt substitutes made with potassium chloride.

Embracing low-potassium alternatives

Focus on incorporating low-potassium foods into your diet to ensure adequate nutrition. Good choices include:

• Fruits: Apples, berries (strawberries, blueberries), grapes, pineapple, and plums.
• Vegetables: Green beans, cabbage, cucumber, eggplant, kale, lettuce, and onions.
• Carbohydrates: White rice, white bread, and plain pasta.
• Proteins: Eggs, canned tuna (drained), and small portions of beef or poultry.
• Beverages: Water, herbal tea, and limited amounts of coffee.

Preparing food to reduce potassium

Cooking methods can also help reduce the potassium content in some foods, particularly vegetables. Since potassium is water-soluble, it can be leached out through boiling. For high-potassium vegetables like potatoes, follow these steps:

1. Peel and rinse the vegetables thoroughly.
2. Slice them into thin, small pieces (about 1/8 inch thick).
3. Soak the slices in warm water for at least two hours, using a large amount of water relative to the vegetables. Change the water every four hours if soaking longer.
4. Rinse the vegetables again under warm water.
5. Cook the vegetables in a fresh pot of water, then drain and discard the cooking water completely.

Medications and Clinical Management

Dietary changes are an important first step, but medication and professional medical care are often necessary, especially in moderate to severe cases.

• Reviewing your medication: Your healthcare provider will review your current prescriptions. Medications known to increase potassium, such as ACE inhibitors and some diuretics, may need to be adjusted or replaced. Never stop or change medication without a doctor's guidance.
• Potassium binders: These medications are used to treat hyperkalemia, especially in chronic cases. They work by binding to excess potassium in the intestines, which is then removed from the body through bowel movements. Examples include sodium zirconium cyclosilicate (Lokelma) and patiromer (Veltassa).
• Diuretics (water pills): Certain types of diuretics, specifically loop diuretics (like furosemide), can help the kidneys excrete more potassium through urine. These are particularly useful if kidney function is mildly impaired.
• Emergency treatments: In cases of severe, acute hyperkalemia, immediate hospital treatment is required. These treatments can include intravenous (IV) calcium to stabilize the heart and IV insulin and glucose to shift potassium into cells temporarily.
• Dialysis: For individuals with advanced kidney failure, dialysis is the most effective way to remove excess potassium from the blood.

Comparison of High vs. Low Potassium Foods

Food Category	High Potassium Foods to Limit	Low Potassium Foods to Choose
Fruits	Bananas, oranges, dried fruits, melon	Apples, berries, grapes, plums, pineapple
Vegetables	Potatoes, tomatoes, pumpkin, spinach	Cabbage, green beans, carrots, onions, lettuce
Protein	Large meat portions, deli meats, beans	Eggs, small portions of fish/chicken, canned tuna
Dairy	Excess milk, yogurt, processed cheese	Rice milk, almond milk, small cheese portions
Snacks	Salt substitutes, nuts, chocolate	Plain crackers, boiled sweets
Drinks	Juices, coffee, milkshakes	Water, herbal tea, soda

Conclusion

Fixing high potassium requires a multi-pronged approach that begins with careful diagnosis and is guided by a healthcare professional. Modifying your diet to include lower-potassium foods and avoiding high-potassium items is a fundamental step. Additionally, medication adjustments, including the potential use of potassium binders or diuretics, can play a critical role. In severe cases, emergency treatments are essential to prevent life-threatening complications. Consistent monitoring of your potassium levels and ongoing collaboration with your healthcare team are key to maintaining a safe balance and managing this condition effectively. For more personalized advice, always consult with a physician or a registered dietitian.

Frequently Asked Questions

What is the fastest way to lower potassium levels?

In an emergency, the fastest way to lower potassium is through hospital treatments like intravenous calcium to protect the heart, or intravenous insulin and glucose to temporarily move potassium into cells. For non-emergency situations, dietary adjustments and prescribed medications work over time.

What foods can I eat to lower potassium?

You can eat low-potassium foods such as apples, berries, carrots, green beans, white rice, and plain pasta to help manage your levels. It is important to avoid or limit high-potassium foods like bananas, potatoes, and tomatoes.

Can drinking more water help fix high potassium?

While staying hydrated is important, simply drinking more water is generally not an effective fix for high potassium, especially for individuals with compromised kidney function. In fact, for those with kidney disease, fluid intake may need to be managed carefully.

What medications are used to treat high potassium?

Medications include diuretics (like loop diuretics) and potassium binders (e.g., Lokelma, Veltassa), which remove excess potassium from the body. Your doctor will determine the right medication based on the cause and severity of your condition.

Are salt substitutes okay to use if I have high potassium?

No, many salt substitutes are made with potassium chloride and should be avoided by people with high potassium or kidney disease. Use herbs, spices, or lemon juice for flavoring instead.

How does cooking affect potassium in vegetables?

Boiling vegetables can reduce their potassium content significantly, as the mineral leaches into the water. This method is particularly useful for high-potassium vegetables like potatoes and squash, but the cooking water must be discarded.

What is the normal range for blood potassium?

A normal potassium level for adults is typically between 3.5 and 5.0 mEq/L. Hyperkalemia is defined as a level above 5.0-5.5 mEq/L, depending on the lab.