How Doctors Choose Your Hyperkalemia Treatment

Reviewed by Brunilda Nazario, MD on December 15, 2020

If you have hyperkalemia -- high levels of potassium -- your treatment will depend on how high your levels have risen, how quickly it happened, and whether you have serious symptoms.

Severe hyperkalemia is a medical emergency. You might need dialysis. But if it’s a mild case, you and your doctor may be able to manage it without you staying in a hospital.

The first thing your doctor will likely do is retest your potassium level to see if the first test was accurate. Blood tests will also check your kidney function. Chronic kidney disease is the most common cause of hyperkalemia.

Next, if your potassium level is high, you’ll probably get an electrocardiogram (ECG or EKG) to check your heart’s electrical activity. To do an ECG, a doctor or other health care professional will attach electrodes to your legs and chest using stickers, a process that takes a few minutes. You won’t feel a thing, and the test will be over in seconds.


Your treatment will depend on what the blood tests and ECG results show.

It’s an emergency if you have symptoms (such as severe muscle weakness, paralysis, or some types of heart rhythm problems) or if you have certain patterns on your ECG results. You’ll need urgent treatments to quickly lower your potassium level. These may include intravenous (IV) calcium, insulin and glucose, and albuterol. These shift potassium out of your blood and into your body's cells. You will also need to remove the extra potassium from your body -- these treatments include diuretics (water pills) and dialysis.

If it’s not a crisis, you may still need medicines to help flush out the excess potassium, just not quite as urgently.

After your potassium levels come back down, your doctor will look for other conditions that might explain why you had hyperkalemia, like diabetes or adrenal disease, and other possible causes.

Check Your Meds

Your doctor will check to see if you are on any medications that could lead to hyperkalemia.


Medications that could lead to high potassium include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen
  • Heparin
  • ACE inhibitors
  • Beta-blockers
  • Trimethoprim
  • Certain types of diuretics (water pills)
  • Chemotherapy

You may need to stop taking the drugs in order to get better. Also, tell your doctor about any supplements you take in case they have potassium in them.

Ask About Your Diet

Your doctor may ask about this to make sure you’re not getting an unusually large amount of potassium from what you eat or drink. Normally, healthy kidneys flush out any extra potassium. But if you have kidney problems or some other conditions (such as type 1 diabetes, heart failure, or liver disease) or take certain medications, your body might not be able to do that as well as it should.

Decide on Next Steps

If it turns out that habits you’re following for heart health, such as a low-sodium diet or taking a medication (such as an ACE inhibitor) to prevent heart disease, is what’s throwing off your potassium level, your doctor will try to figure out a solution.

Importance of TreatmentA nephrologist breaks down hyperkalemia and its effect on your kidneys.111


HAROLD FRANCH: Hyperkalemia is

having a high level of potassium

in the blood.

Potassium is a common mineral

found in a variety of foods.

And it's essential for life.

A slight increase

in the potassium level

is not dangerous at all.

But a greater increase can lead

the heart to stop and muscles

to get paralyzed.

The body actually uses salts

like potassium to create

the electricity that moves

through the body.

And so if you disrupt the amount

of potassium, if you change it,

then that changes the amount

of electricity generated.

Hyperkalemia is usually caused

by either decreased kidney


or by changes in the hormones

that control potassium

in the body.

There are common blood pressure

drugs that effect

these hormones.

And they are the most common

cause of hyperkalemia.

Another common cause are

over-the-counter pain medicines.

The main treatment option

is to stop the medicine that

caused the hyperkalemia.

If that is not enough,

you can use other medicines,

such as diuretics and sodium


the mineral that's in baking


Finally, there are

potassium-binding drugs that

directly remove potassium

from the body.

There are no symptoms

of the condition until it

becomes life-threatening.

So it's very important

that if your potassium is high

that you keep it under control.

Harold Franch, MD/delivery/53/e2/53e2c1ca-9194-4443-ad1a-a9cbb2e61af6/funded-expert-feature-hyperkalemia_,2500k,1000k,4500k,750k,400k,.mp403/01/2019 12:00:00650350illustration of kidneys/webmd/consumer_assets/site_images/article_thumbnails/video/hyperkalemia_expert_video/650x350_hyperkalemia_expert_video.jpg091e9c5e81bcda69

Diuretics (water pills) can help. If your kidneys aren’t removing enough acid from your body, your doctor will also find out why this is happening and treat it. After that, another option is to take a potassium-binding agent, either patiromer (Veltassa), sodium polystyrene sulfonate (Kayexalate), or sodium zirconium cyclosilicate (Lokelma). Sodium polystyrene sulfonate rarely causes side effects, but can sometimes cause intestinal problems, so tell your doctor if you have any stomach issues. If you’re on patiromer, your doctor will take blood tests and recheck your potassium levels. Side effects of this drug can be low magnesium levels, drowsiness, appetite loss, mood or mental changes, nausea, and muscle spasms.

Think Long-Term

If your doctor finds that your hyperkalemia is mild, your condition may be something you can manage as an outpatient, meaning that you don’t have to stay in a hospital. You’ll know you’re on the mend when your potassium levels return to normal and stay that way.

WebMD Medical Reference



Journal of Managed Care and Specialty Pharmacy: “Expert Panel Recommendations for the Identification and Management of Hyperkalemia and Role of Patiromer in Patients with Chronic Kidney Disease and Heart Failure.”

Cleveland Clinic Journal of Medicine: “Diagnosis and treatment of hyperkalemia.”

Cleveland Clinic: “Electrocardiogram (EKG).”

The Royal Children’s Hospital Melbourne: “Hyperkaelemia.”

Reviews in Endocrine and Metabolic Disorders: “Updates in hyperkalemia: Outcomes and therapeutic strategies.”

Kidney International Supplements: “New options for the management of chronic hyperkalemia.”

North American Journal of Medical Sciences: “Markers of renal function tests.”

National Institutes of Health Office of Dietary Supplements: “Potassium Fact Sheet for Health Professionals.”

Mayo Clinic: “Sodium Polystyrene Sulfonate,” “Patiromer (Oral Route).”

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