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Care During Chemotherapy and Beyond

Hyperkalemia (High Potassium)



What Is Hyperkalemia?

Hyperkalemia is an electrolyte imbalance and is indicated by a high level of potassium in the blood.  The normal adult value for potassium is 3.5-5.3 mEq/L.

Potassium is one of many electrolytes in your body. It is found inside of cells. Normal levels of potassium are important for the maintenance of heart, and nervous system function.

What Causes Hyperkalemia?

One way your body regulates blood potassium levels is by shifting potassium into and out of cells.  When there is a breakdown or destruction of cells, the electrolyte potassium moves from inside of the cell to outside of the cell wall.  This shift of potassium outside of the cells causes hyperkalemia.

Potassium is excreted (or "flushed out" of your system) by your kidneys. Any damage to your kidneys, when they are not working properly, may cause an increase in potassium levels leading to hyperkalemia.

As seen with tumor lysis syndrome - when you receive chemotherapy, the drugs will act by breaking down the tumor cells. When there is a rapid amount of cellular destruction, the components of the cells (including potassium), will move outside of the cell, and into the blood stream. People, who receive chemotherapy for leukemia, lymphoma, or multiple myeloma, may be at risk for tumor lysis syndrome, if there is a large amount of disease present.

Other causes of hyperkalemia include:

  • If you are diabetic, an insulin deficiency may cause hyperkalemia.
  • If you are bleeding internally, you may have hyperkalemia.
  • Some medications that contain potassium, or medications that preserve the amount of potassium that is excreted through your kidneys, can cause hyperkalemia. These may include Angiotensin Converting Enzyme (ACE) inhibitors, such as Lisinopril, or potassium-sparing diuretics, such as Spironolactone (e.g., Aldactone).
  • If your kidneys are not able to process and excrete potassium and other electrolytes, due to renal (kidney) failure, you may be at risk for hyperkalemia.
  • Your adrenal glands are important regulators of potassium in your blood.  Endocrine or hormonal problems (such as Adrenal insufficiency) can cause hyperkalemia.
  • Salt substitutes (containing potassium) or excessive intake of potassium can lead to hyperkalemia.

What Are Some Symptoms of Hyperkalemia To Look For?

  • You may not have any symptoms, unless your blood potassium levels are significantly elevated.
  • Muscle weakness.
  • Diarrhea (with very high potassium levels).
  • Chest pain, or heart palpitations.

Things You Can Do If Your Blood Test Results Indicate Hyperkalemia:

  • Follow your healthcare provider's instructions regarding lowering your blood potassium level. If your blood levels are severely elevated, he or she may prescribe medications to lower the levels to a safe range.
  • If you are taking heart medication, and you have a chronic (long-term) elevated blood potassium level, you may be advised to eat a low potassium diet. Foods that are high in potassium include most fresh fruits and vegetables. Some specific examples include:
    • Oranges and orange juice
    • Leafy green vegetables, such as spinach and greens (collard and kale)
    • Potatoes
  • Take all of your medications as directed
  • Follow all of your healthcare provider's recommendations for follow up blood work and laboratory tests.
  • Avoid caffeine and alcohol, as these can cause you to have electrolyte disturbances.

Drugs That May Be Prescribed By Your Doctor for Hyperkalemia:

  • Your doctor or healthcare provider may prescribe medications to lower your blood potassium levels if your blood test results show hyperkalemia. These may include:

    • Loop Diuretics - are also known as "water pills" as they work to decrease blood potassium levels, by making you urinate out extra fluid. When you lose fluid through the kidneys, you will lose potassium as well. 
    • Sodium polystyrene sulfonate (e.g.Kayexalate) - This medication works to lower blood potassium levels by binding with the potassium in your stomach or gut. You may take this medication by mouth, or by enema. If you are given this medication and become constipated, you must take a special laxative (called sorbitol) to relieve your constipation.
    • Insulin/Calcium/Bicarbonate - These medications are given usually intravenously, to drive the potassium electrolyte from your bloodstream, back into the cells. This is usually given with another potassium lowering therapy.
    • Hemodialysis - If your blood test results indicate a severely elevated blood potassium level, and you are currently in kidney failure, your healthcare provider and a kidney specialist may order dialysis treatments.

When To Call Your Doctor or Health Care Provider About Hyperkalemia:

  • Nausea that interferes with your ability to eat, and is unrelieved by prescribed medication.
  • Vomiting (vomiting more than 4-5 times in a 24 hour period).
  • Severe constipation, unrelieved by laxatives, lasting 2 to 3 days.
  • Muscle weakness, poor appetite that does not improve.
  • Feeling your heart beat rapidly (palpitations).

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Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.