How to Lower Potassium Levels

Chronic elevation of potassium levels (also known as hyperkalemia) is usually a sign of reduced kidney function. However, it can also be caused by certain medications, acute injuries, or a severe diabetic crisis (called "diabetic ketoacidosis") among other things. Elevated potassium can be a serious and potentially life-threatening condition (when it is very high); therefore, it is a condition that always warrants the attention of a medical professional.

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Treating High Potassium Levels

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1
Understand that problems with high potassium are generally the result of kidney disease or medication use.^{[1]XResearch source} There are other causes, but these two are the most common by far. Treatment of high potassium will aim to induce potassium loss via excretion through your urine.^{[2]XResearch source}
- Start by getting a blood test from your doctor to confirm whether or not you have high potassium. It is a diagnosis that is hard to tell by symptoms alone, so a blood test is very important prior to start treatment of any sort.^{[3]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Other less common but equally important causes of high potassium are certain "high glucose states" (called "diabetic ketoacidosis") that can occur in the body in severe diabetics, as well as severe injuries to your body, often from an accident of some sort.^{[4]XResearch source}
2
Get an electrocardiogram.^{[5]XResearch source} Because high potassium can be so dangerous to the heart (and because heart symptoms are one of the major ways to diagnose it), your doctor will want to get you an electrocardiogram (a test that evaluates your heart's rate and rhythm pattern) as quickly as possible if your levels are significantly elevated.
- If your potassium is only mildly elevated, however, your doctors may try a more conservative approach and ask you to come back for a repeat test.
- The pattern on the electrocardiogram will give your doctor a lot of valuable information on the current state of your heart.^{[6]XResearch source} This is important not only to help with the diagnosis of high potassium but also to determine the urgency of treatment, as the state of your heart (and the potential of your heart being in danger from too much potassium) will dictate the strategy your doctors use to lower your potassium.
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3
Review your list of current medications with your doctor. You may be taking a prescription drug that is causing hyperkalemia, or high potassium levels. Your doctor may suggest switching to a new medication or lowering your dose. Also, he or she will suggest stopping taking any potassium supplements or multi-vitamins that contain potassium.^{[7]XResearch source}
- If you have very high potassium, your doctor will stop altogether any medications that contribute to elevated potassium that he or she can in the short term, to help speed your recovery.^{[8]XResearch source}
- However, discontinuing medication is not enough on its own to treat severe cases of high potassium, which will need more aggressive methods of treatment.
4
Have an IV inserted.^{[9]XResearch source} Assuming your potassium is high enough to warrant more aggressive medical treatment, your doctor will ask the nurse to insert an IV line as this can help to deliver the appropriate treatments more effectively and efficiently.
- Your doctor will likely suggest intravenous calcium, usually 500-3000 milligrams (10-20 mL) one at a time, 0.2 to 2 mL per minute.
- Your doctor may suggest that you take resin, which will help your body eliminate potassium through the bowels. The typical dose is 50 grams, which can be taken orally or administered in 30 mL of Sorbitol.
- If your doctor believes it is necessary, you may need to take insulin and/or glucose to move potassium into your cells, where it should be. The usual dose of insulin is 10 units by IV; the usual dose of glucose is 50% (D50W) and 50 mL (25 grams). These are typically administered as 1  ampule by IV over 5 minutes, onset in 15 – 30 minutes for 2 to 6 hours.
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Ask about diuretics. Diuretics or water pills are sometimes given to remove excess potassium through urination. Diuretics can be taken orally in a 0.5-2 mg dose, 1-2 times/day, or through an intravenous  insertion, in a 0.5-1 mg dose. Your doctor may repeat in 2-3 hours for up to 2 doses if needed.
- Note that this treatment is not enough for urgent cases, but may be very helpful for more mild cases of elevated potassium.
If you are having kidney failure or if you have a significantly elevated potassium level, hemodialysis – a process by which a machine removes waste, including excess potassium, from your blood, since your kidneys are unable to do so – is your best treatment option.^{[10]XResearch source}
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Continue to be monitored by doctors post-treatment. After you have received treatment for your high potassium, it is extremely important to have continual monitoring of your potassium levels to ensure that they stay in a safe and normal range. Normally, patients stay in hospital for a short time after being treated for high potassium, where they can be hooked up to "cardiac monitors" (which monitor your heart function) and otherwise monitored until the doctors determine it is safe to go home.^{[11]XResearch source}
- High potassium is a potentially life-threatening condition, especially for the effect it can have on your heart.^{[12]XResearch source} Therefore, appropriate monitoring with your doctor post-treatment is key. There are times when this extra monitoring can make the difference between life and death, as your doctors can be there to catch any potential "relapse" of elevated potassium.
A diet with less than 2g per day of potassium is recommended to prevent relapses of elevated potassium. However, it is important to note that eating high potassium foods is rarely the cause of high potassium levels. As previously mentioned, it is usually caused by kidney disease or medications.^{[13]XResearch source}

Part 2

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Recognizing the Symptoms of High Potassium Levels

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Too much potassium can affect the way your heart works, causing symptoms like arrhythmia (an abnormal rhythm), palpitations or skipped heartbeats, and, ultimately, cardiac arrest. If you have any reason to think you might be having cardiac symptoms get to a doctor immediately.^{[14]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
High potassium levels can lead to an upset stomach, nausea, and vomiting.^{[15]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} These symptoms can lead to dehydration.
Potassium helps muscles function, so if you have too much or too little, your muscles can weaken, making you feel weak, tired, and lethargic. This feeling may be exacerbated by other symptoms, especially vomiting.^{[16]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
Feelings of numbness or tingling are also related to muscle activity. You may notice these sensations first in your extremities (the hands and feet) and then around your mouth; this may be followed by muscle twitching. Get medical help if you have these symptoms.^{[17]XResearch source}
Many people have no symptoms and only discover the high potassium levels when their doctors run blood tests.^{[18]XResearch source}