July 6th 2023
By Ari Parker
Older adults are at a higher risk for hyperkalemia (high potassium). Learn about the causes, symptoms, and risks to avoid emergencies.
Potassium is an essential nutrient that regulates fluid balance, helps the heart beat properly, and assists brain cell function. Many have heard of the dangers of low potassium levels, but high potassium levels can also be dangerous. Older adults are at a higher risk for hyperkalemia (excess potassium). But is this something all older adults should be worried about?
Hyperkalemia (high potassium) can be an acute or chronic condition. Chronic hyperkalemia is typically less severe and less dangerous than acute hyperkalemia. Acute hyperkalemia, caused by sudden rises in blood potassium, can result in severe effects, including cardiac arrhythmia or heart attack. In some cases, acute hyperkalemia may require treatment with dialysis.
Potassium levels are measured with a simple blood test. The normal potassium level range is between 3.6 to 5.2 millimoles per liter (mmol/L). Having a potassium level above six can be an emergency.
Most of us know that aging causes loss of muscle mass. Aging also causes loss of renal (kidney) mass. This loss of kidney mass is accompanied by reduced blood flow and kidney function, making it more difficult for your body to get rid of excess potassium. This is one reason high potassium levels are more common in older adults. Reduced kidney function is also tied to chronic conditions like diabetes and hypertension, putting anyone with these common conditions at higher risk for high potassium.
Many medications can cause elevated potassium levels. Because many older adults take multiple medicines to manage chronic conditions, medicine is the most common cause of high potassium. Certain combinations of drugs are more likely to cause high potassium. Common medications that cause elevated potassium include:
Potassium-sparing diuretics (spironolactone, triamterene)
NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naproxen)
ACE inhibitors - lisinopril, benazepril, captopril
Bactrim (used to treat adult urinary tract infections)
Be sure to share all of the medications you’re taking with your providers so they can ensure you’re avoiding risks. If you have concerns about the medications that you are taking, talk with your healthcare provider to discuss the benefits and risks of your drugs.
Kidneys act as a filter for the human body, removing waste products and controlling the levels of substances we consume, like potassium. If you have kidney disease, your kidneys are unable to remove extra potassium from your blood, so you are at high risk for higher potassium levels.
Dehydration can make any health condition worse, including hyperkalemia. If you're experiencing mild hyperkalemia symptoms, including feeling weak or tired, drinking water may help your body fix an electrolyte imbalance.
While not typical, excessive intake of potassium can cause high potassium. One common cause of excess potassium intake is salt substitutes because many salt substitutes are made with potassium chloride.
Other naturally potassium-rich foods include:
Bananas
Tomatoes
Avocados
Sweet potatoes
Yogurt
Pumpkin
Dark leafy greens
Canned tomato products
Juices (prune, carrot, tomato)
Stone fruits (dried prunes, apricots, and peaches)
If you’ve had higher potassium levels in the past or are taking medications that interfere with potassium levels, discuss any foods you should avoid with your doctor.
In many cases, high potassium will be asymptomatic. Regularly monitoring your blood levels is vital if you are at a higher risk for high potassium. Acute hyperkalemia caused by a rapid increase in your potassium levels will have noticeable symptoms, including:
Muscle Weakness
Nausea or Vomiting
Muscle Pain
Muscle Cramps
Heart palpitations
General weakness
Treatment for high potassium will vary depending on the severity, the presence of cardiac symptoms, and the cause. Any sign of cardiac symptoms, such as chest pain or heart palpitations, is a medical emergency. Emergency treatment for high potassium may include IV calcium therapy, IV insulin, loop diuretics, or dialysis.
Treatment for chronic high potassium generally occurs outside of the hospital. Initial treatment begins with removing the cause. Reviewing your current medications, new supplements, and diet will help your healthcare provider determine what is causing high potassium levels. Changing your medications, stopping certain supplements, or changing your diet may be the only treatments you need. Closely monitoring your potassium levels will help you determine when your potassium has returned to normal.
Preventing high potassium levels can be simple if you know what to do. Maintaining good hydration will help your body regulate all essential nutrients and electrolytes, including potassium. Limiting high-potassium foods and keeping your daily potassium intake at the recommended level of roughly 2,600-3,400mg per day will help keep your levels in check.
If you have diabetes or high blood pressure, managing your condition effectively to prevent high potassium levels is essential. If you have diabetes, keeping your blood sugar well-controlled improves kidney function and potassium excretion. Maintaining a healthy blood pressure also helps preserve kidney function and makes it easier for your body to manage your potassium levels.
Avoiding medications and supplements that interfere with kidney function or otherwise cause an increase in potassium, such as NSAIDs, will also help. Talk with your healthcare provider before changing your medications or diet.
