Hyperkalemia means that the potassium levels in your blood are too high.

High potassium occurs most often in people with chronic kidney disease (CKD). This is because the kidneys are responsible for getting rid of excess potassium and other electrolytes like salt.

Hyperkalemia usually does not have any symptoms. To find out your potassium levels, a healthcare provider will order a blood test. According to the National Kidney Foundation, a blood potassium level higher than 5 millimoles per liter (mmol/L) indicates hyperkalemia.

Untreated hyperkalemia can be life threatening, resulting in irregular heartbeats and even cardiac arrest. Depending on the severity, hyperkalemia can also weaken your muscles. If left untreated, this can lead to paralysis.

It’s important to follow a healthcare provider’s advice and take steps to lower your potassium levels.

Your treatment will depend on:

  • how severe your hyperkalemia is
  • how quickly it came on
  • what’s causing it

Here are several ways you can lower your blood potassium levels.

Medications

Diuretics and potassium binders are two common types of medication that can treat hyperkalemia.

Diuretics increase the flow of water, sodium, and other electrolytes like potassium out of the body. They’re a common part of treatment for both acute and chronic hyperkalemia. Diuretics can reduce swelling and lower blood pressure, but they can also cause dehydration and other side effects.

Potassium binders work to treat hyperkalemia by increasing the amount of potassium your body gets rid of through bowel movements.

There are several types of potassium binders that your doctor may prescribe, such as:

  • sodium polystyrene sulfonate (SPS)
  • calcium polystyrene sulfonate (CPS)
  • patiromer (Veltassa)
  • sodium zirconium cyclosilicate (Lokelma)

While commonly used, SPS has been associated with bowel necrosis, particularly in older people.

Patiromer and sodium zirconium cyclosilicate are two relatively new treatments for hyperkalemia. Both of these may be especially effective options for people with heart disease or diabetes, as they allow you to continue using certain medications that can lead to hyperkalemia.

Talk to your doctor about which treatment options are best for you.

Dietary changes

Your healthcare provide may recommend a low potassium diet to manage your hyperkalemia.

There are two easy ways to naturally lower the amount of potassium you eat, which are:

  • avoiding or limiting certain high potassium foods
  • boiling certain foods before you eat them

High potassium foods to limit or avoid include:

  • root vegetables, such as beets and beet greens, taro, parsnips, and potatoes, yams, and sweet potatoes (unless they’re boiled)
  • bananas and plantains
  • spinach
  • avocado
  • prunes and prune juice
  • raisins
  • dates
  • sun-dried or pureed tomatoes, or tomato paste
  • beans (like adzuki beans, kidney beans, chickpeas, soybeans, etc.)
  • bran
  • potato chips
  • french fries
  • chocolate
  • nuts
  • yogurt
  • salt substitutes

High potassium drinks to limit or avoid include:

  • coffee
  • fruit or vegetable juice (especially passion fruit and carrot juices)
  • wine
  • beer
  • cider
  • milk

Boiling certain foods can lower the amount of potassium in them.

For example, potatoes, yams, sweet potatoes, and spinach can be boiled or partially boiled and drained. Then, you can prepare them how you normally would by frying, roasting, or baking them.

Boiling food removes some potassium. However, avoid consuming the water you’ve boiled the food in, which is where potassium will remain.

A doctor or nutrition specialist will also likely recommend you avoid salt substitutes, which are made from potassium chloride. These can also increase your blood potassium levels.

Avoiding herbal remedies or supplements

While many people take herbal remedies or supplements to boost overall health, it’s best to avoid them if you have hyperkalemia. They may contain certain ingredients that are thought to increase potassium levels in the body, such as:

  • alfalfa
  • Bufo, Chan’su, or Senso
  • dandelion
  • hawthorn berries
  • horsetail
  • lily of the valley
  • milkweed
  • nettle
  • noni juice
  • Siberian ginseng

Be sure to talk with your doctor before taking any over-the-counter supplements.

Hyperkalemia can affect anyone and is thought to occur in up to 3 percent of the general population. Certain factors may increase your risk of developing hyperkalemia.

Medical conditions

People living with certain health conditions have an increased risk of hyperkalemia.

Those diagnosed with CKD are up to 50 percent more likely to develop hyperkalemia than others. Normally, the kidneys are responsible for removing excess potassium from the body. With CKD, impaired kidney function makes it harder for the kidneys to carry out this role.

Hyperkalemia is also more likely to develop in those who have:

  • heart failure
  • unmanaged diabetes
  • high blood pressure
  • Addison’s disease
  • metabolic acidosis
  • physical trauma including burns or severe injuries

Medications

Certain medications can sometimes cause hyperkalemia. High blood pressure medications known as renin-angiotensin-aldosterone system (RAAS) inhibitors can sometimes lead to high potassium levels.

Other drugs associated with hyperkalemia include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • beta-blockers for high blood pressure
  • heparin, a blood thinner
  • calcineurin inhibitors for immunosuppressive therapy
  • potassium-sparing diuretics, like spironolactone and eplerenone
  • a commonly-prescribed antibiotic, trimethoprim and sulfamethoxazole (Bactrim)

It’s important to talk with your healthcare provider about any and all medications (and supplements) you take to help determine the cause of your hyperkalemia.

If your hyperkalemia is caused by a medication you currently take, your healthcare provider may recommend changing or stopping that medication.

Your treatment plan may vary based on whether you’re dealing with an acute episode of hyperkalemia or managing chronic hyperkalemia.

Acute hyperkalemia treatment

Acute hyperkalemia develops over the course of a few hours or a day. It’s a medical emergency that requires treatment in a hospital.

At the hospital, doctors and nurses will run tests, including an electrocardiogram to monitor your heart.

Treatment will depend on the cause and severity of your hyperkalemia. This may include removing potassium from your blood with potassium binders, diuretics, or in severe cases, dialysis.

If changes on the electrocardiogram indicate hyperkalemia, intravenous calcium may also be used to protect the heart from arrhythmias until potassium levels are lowered. In these cases, this can be lifesaving.

Treatment may also include using a combination of intravenous insulin, plus glucose, albuterol, and sodium bicarbonate. This helps move potassium from your blood into your cells. It can also treat metabolic acidosis, another common condition associated with CKD, which occurs when there’s too much acid in your blood.

Chronic hyperkalemia treatment

Chronic hyperkalemia, which develops over the course of weeks or months, can usually be managed outside of the hospital.

Treating chronic hyperkalemia usually involves changes to your diet, changes to your medication, or starting a medication such as potassium binders.

You and your healthcare provider will also carefully monitor your potassium levels.

Your healthcare provider will work with you to find the right treatment to manage your chronic hyperkalemia or help you avoid an acute episode.

Changing your medication, trying a new medication, or following a low potassium diet can all help. Your doctor may perform more frequent blood tests to monitor your potassium levels and adjust your treatment as needed.

When left untreated, hyperkalemia can lead to serious issues like heart attack or long-term damage to the heart. When managed, most people do not experience long-term complications of hyperkalemia.