Be proactive about monitoring your potassium

I will never forget the hot August day when my body started to feel so heavy that I told my mom all I wanted to do was lay flat on the floor. She immediately called my doctor, who told her to get me to the hospital as quickly as possible. I remember being very disoriented during the ride. I knew I was very sick and needed medical attention immediately. When I saw the hospital entrance, I was so desperate to see a doctor that I opened the door and flung myself out of the car while it was still moving, albeit, slowly. My mom realized what had happened and she slammed on the brakes. I was lying on the road in my favorite blue dress with big red flowers that I had received for my 14th birthday. The hot asphalt was scorching my legs and I could not move them at all. I felt so helpless. I was immediately scooped up by a security guard, placed in a wheelchair, and taken to a treatment room next to the dialysis unit. A doctor immediately came in to examine me—and that is when my heart stopped. The culprit?

Potassium!

This would not be the first time, nor the last, that high potassium levels would wreak havoc in my life. In this case I ended up in the hospital, but, thankfully, I recovered. Others have not been as fortunate. Moreover, there are many other serious health consequences related to high potassium.

The symptoms associated with high potassium levels can include an irregular heartbeat, a slow heart rate, weakness, numbness, and tingling (this is only a partial list). These symptoms can be mild or severe, or in some cases patients may not experience any symptoms. In addition, many of these same symptoms can be caused by a variety of health problems. Health care professionals need to talk to their patients about the symptoms that may indicate that a patient’s potassium level may be high, including when to notify their health care team or seek immediate medical attention.

Because of the problems associated with high potassium levels, it is vital that people with kidney disease know what medications and foods can contribute to an increase in potassium. Although you cannot avoid all potassium (low potassium levels are also dangerous), people should know the common foods and medications that can increase potassium.

Medications. Medications can increase potassium levels. But some of the medications that individuals with kidney disease may need to improve their health can also increase potassium levels. The list of these medications is long, and will probably sound familiar to many who work with people who have kidney disease. Examples include renin-angiotensin-aldosterone system (RAAS) inhibitors, nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen and naproxen), beta-blockers, calcineurin inhibitors (e.g., cyclosporine, tacrolimus), heparin, ketoconazole, potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene), trimethoprim, pentamidine, and many more. At one time or another, I have had to take most of these medications in order to maintain my health and well being; therefore, it is also important for health care professions to talk to their patients if they are on one or more of these medications, so that patients understand the effect that these medications might have on potassium levels. This is a key reason why it is important to encourage patients to bring in a list of all medications they are taking to every doctor’s visit.

Food. People with kidney disease (both those on dialysis and many who are not) are also well aware of dietary potassium restrictions. I am no exception. Throughout my teenage years I needed dialysis to live. As a teenager, it seemed that I lived my life surrounded by tempting high potassium foods. When I went to parties or out for a meal with friends, I was constantly reminded of all the “forbidden” or “limited” foods, like potatoes, tomatoes, avocadoes and bananas. I often tried dialyzing potatoes. This is where you cut potatoes into slices and soak them overnight to reduce the potassium.

Trying to lose weight by eating more fresh fruits and vegetables can be challenging due to their potassium content. I have known many patients who would use a 1K potassium bath during dialysis so that they could eat more potassium in between dialysis treatments. This practice has been stopped by many providers, out of fear that patients having too low of a potassium concentration can also be dangerous.

Determining how much potassium patients can safely eat and sticking to that plan is one of the biggest problems for many patients. The renal dietitian has to work with patients and family members to help create a food plan that is doable, and educate patients on the best foods to choose when dining out. Finally, it is important that patients’ potassium levels are regularly checked, and that health care professionals share potassium laboratory results with their patients.

Today, I have a new kidney thanks to a transplant, and I am so thrilled that I do not have to worry about eating too much potassium. This has improved my quality of life tremendously. Potassium restrictions take a lot of pleasure out of eating, as many of the foods that I like contain large amounts of it. My potassium level is normal and I can eat all of the fruits and vegetables that I want, without worrying about a hospital visit or another cardiac arrest.

By being informed about the potential warning signs of dangerously high potassium levels, watching potassium intake, and knowing your current potassium level, patients can help prevent adverse consequences. -by Lori Hartwell

References

Palmer, B.F. (2004). Managing Hyperkalemia Caused by Inhibitors of the Renin–Angiotensin–Aldosterone System. New England Journal of Medicine 351, 585–592.

McMahon, G.M., Mendu, M.L., Gibbons, F.K., and Christopher, K.B. (2012). Association between hyperkalemia at critical care initiation and mortality. Intensive Care Med 38, 1834–1842.