How to lower potassium levels

Even though potassium is an essential nutrient for your body, it’s possible to have too much. Potassium helps you have a healthy heart and muscles. But, when you hit potassium overload, it has a negative effect on your cardiovascular system. Keep reading to learn how much is too much and what to do if your levels are high.

What is hyperkalemia?

Hyperkalemia is the medical term when the potassium level in your blood is too high. “Hyperkalemia can be dangerous if untreated,” says Frank J. Contacessa, MD, an internist at MDVIP in Palm Beach Gardens, Florida. “The balance between sodium and potassium is important for the electrical signals that control the beating of the heart. If the potassium is too high for too long, a dangerously irregular heart rhythm (arrhythmias) can occur.” Our bodies maintain a tight control of serum potassium by the intestines absorbing dietary potassium and the kidneys effectively excreting excesses in the urine.

Causes

The most common causes of high potassium include:

• Renal insufficiency
• Eating too much potassium
• Medications
• Supplements
• Dehydration

People with chronic kidney disease (CKD), heart failure, diabetes mellitus, and those taking renin-angiotensin-aldosterone system inhibitors (RAASi) for high blood pressure have two to three times higher risk for hyperkalemia, according to The National Kidney Foundation.

Symptoms

Typically, there are no signs or symptoms of hyperkalemia. If you do experience symptoms they may include:

• Heart palpitations
• Nausea
• Muscle weakness
• Paresthesia (abnormal sensation of tingling, numbness, or burning that is usually felt in the hands, feet, arms, or legs)

“Many people with hyperkalemia don’t experience symptoms that are easy to notice,” says Po-Chang Hsu, MD, a medical content expert for Sleeping Ocean. “In many cases, they come and go. And the lack of symptom persistence often makes it hard for people to realize there’s something wrong.” 

Diagnosis

The best way to diagnose hyperkalemia is by a routine lab blood test. If your blood potassium >5.0 then you have a potassium imbalance.

Types of hyperkalemia

There are two different types of hyperkalemia: acute and chronic. 

1. Acute hyperkalemia occurs rapidly within hours to a days. Research shows that, “acute hyperkalemia is caused by a sudden abnormal release of potassium from cells, leading to life-threatening symptoms,” Dr. Hsu says. “It requires immediate treatment, cardiac monitoring, and often dialysis.” Since the acute hyperkalemia happens quickly, it is an emergency that requires treatment in a hospital. The treatment is dependent on the potassium level and cause. The objective is to remove the potassium from your blood by using potassium binders, diuretics, or dialysis.
2. Chronic hyperkalemia happens gradually, over weeks or months. “Chronic hyperkalemia occurs when there’s an increased potassium load or an impaired potassium secretion process,” Dr. Hsu says. “This chronic condition requires ongoing management and pharmacological interventions. The treatment goal is to normalize potassium levels by reducing the potassium load and fixing the underlying issues causing potassium imbalance.” 

How to lower potassium levels

Treatment options for chronic hyperkalemia can be done by using medications, removing medications, or changing your diet.

1. Take medication as prescribed

According to Dr. Hsu, the following medications can be used to treat hyperkalemia: diuretics, sodium bicarbonate, albuterol, IV calcium, patiromer, IV glucose and insulin, sodium polystyrene, and Veltassa. If the case of hyperkalemia is severe enough dialysis is needed.

2. Review medication side effects with a professional

Some medications have a side effect of preventing your kidneys from adequately removing potassium. “A number of commonly prescribed blood pressure drugs can cause the kidneys to retain potassium, so the level should be checked periodically,” says Dr. Contacessa.

Medications that can raise potassium by decreasing the excretion of potassium include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers
• Potassium sparing diuretics
• Non-selective beta blockers
• Direct renin inhibitors
• Nonsteroidal anti-inflammatories (NSAIDs)
• Calcineurin inhibitors
• Anti-infectives

If you’re high-risk for hyperkalemia, ask your provider or pharmacist when starting a new medication.

3. Take water supplements (diuretics)

If you’re wondering how to flush excess potassium out of your body, ask your healthcare provider about taking water pills. These pills cause your body to excrete more potassium in the urine. You should aim to drink eight to 10 glasses of water daily.

4. Follow a low-potassium diet

Watching what you eat can help lower your potassium levels. “It’s also crucial to control meal sizes, as larger servings increase potassium intake,” Dr. Hsu says. Here are other tips.

Consume low-potassium foods: When possible, choose from the following foods to lower potassium:

• Apples
• Berries
• Pineapples
• Watermelons
• Grapefruits
• Peaches
• Plums
• Green beans
• Peas
• Kale
• Lettuce
• Cabbage
• Eggplants
• Onions
• Fresh corn
• Asparagus
• Eggs
• Canned tuna
• White rice
• White bread
• White pasta
• Black coffee
• Tea
• Herbal teas
• Rice milk
• Water

For vegetables that are higher in potassium, you can reduce their effects on your body by cutting, peeling, and soaking them in water for two hours. After soaking them, boil the vegetables for a few minutes. “Boiling certain foods like potatoes, yams, and spinach, can help reduce the potassium content in them,” Dr. Hsu says.

Avoid high-potassium foods: The following foods and beverages contain high levels of potassium, which the National Kidney Foundation defines as 200 mg or more of potassium per serving:

• Bananas
• Avocado
• Oranges
• Cantaloupe
• Honeydew
• Dried apricots (and other dried fruits)
• Acorn squash
• Tomatoes
• White and sweet potatoes
• Spinach
• Beans and lentils
• Meat
• Poultry
• Orange juice
• Prune juice
• Apricot juice
• Grapefruit juice
• Coconut water
• Beer
• Wine

5. Avoid certain supplements

“People with hyperkalemia are advised to avoid supplements because many of them contain ingredients that can cause an increase in potassium,” Dr. Hsu says. Before you take any supplements you should first discuss it with your healthcare provider.

Supplements that are thought to increase potassium levels include:

• Horsetail
• Ginseng
• Dandelion
• Milkweed
• Lily of the valley

The bottom line: Diuretics are the quickest way to flush mildly elevated potassium

Diuretics are the quickest and easiest way to flush excess potassium, along with lifestyle changes. It’s crucial to control your potassium intake and adjust your diet toward low-potassium foods. It’s also important to get regular blood work to ensure their potassium levels are within a healthy range. If potassium is markedly elevated, an inpatient stay in the hospital including emergent dialysis may be the fastest treatment.