Table of ContentsView AllTable of ContentsBlood TestsUrine TestsCardiac TestsDifferential DiagnosisFrequently Asked QuestionsNext in Hyperkalemia GuideLow-Potassium Diet
Table of ContentsView All
View All
Table of Contents
Blood Tests
Urine Tests
Cardiac Tests
Differential Diagnosis
Frequently Asked Questions
Next in Hyperkalemia Guide
1:50An Overview of Hyperkalemia
1:50
An Overview of Hyperkalemia
Testing can help to determine which of these mechanisms is triggering your high potassium. Only when you know why you havehyperkalemiacan youtreat itproperly and hopefully prevent recurrences.
Verywell / Joshua Seong
Before you go down the path of a formal evaluation, your healthcare provider will want to make sure you have true hyperkalemia.
Oftentimes, potassium levels are falsely elevated, a situation known aspseudohyperkalemia, because ofhow your blood is drawn.
Your healthcare provider’s first task is to recheck your potassium level. If your levels remain high, they may order the following tests.
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Initial Tests
Renal failure, whether it is acute or chronic, is one of the most common causes of hyperkalemia. When the kidneys fail, they are not able to excrete potassium properly. This can lead to the build-up of potassium in the blood.
Screening Tests May IncludeBUNCreatinineMetabolic panelComplete blood count
Screening Tests May Include
BUNCreatinineMetabolic panelComplete blood count
Blood urea nitrogen (BUN) and creatinine measure how well your kidneys are functioning and are included as part of the basic metabolic panel. Other tests in the panel include sodium, chloride, bicarbonate, and glucose. These lab values are used to calculatean anion gapthat, if elevated, indicates metabolic acidosis.
Acidosis can draw potassium out of cells and into the blood. High glucose levels, as can be seen inuncontrolled diabetes, can do the same. Lowsodium levelsin the face of high potassium levels can suggest a hormonal condition known as hypoaldosteronism.
Specific Tests
Depending on your symptoms and medical history, your healthcare provider may also choose to pursue some of the following tests.
Medications That Can Cause HyperkalemiaDigoxin is not the only medication that increases the risk for hyperkalemia. Changing the dose of a medication or discontinuing a medication may be the best way to return potassium levels to normal.Aldosterone antagonists (i.e., spironolactone)Angiotensive-converting enzyme inhibitors(i.e., enalapril, lisinopril, etc.)Angiotensin receptor blockers (i.e., losartan, valsartan, etc.)Antibiotics (i.e., trimethoprim)Immunosuppressants (i.e., cyclosporine, tacrolimus, etc.)Potassium-sparting diuretics (i.e., amiloride, triamterene, etc.)
Medications That Can Cause Hyperkalemia
Digoxin is not the only medication that increases the risk for hyperkalemia. Changing the dose of a medication or discontinuing a medication may be the best way to return potassium levels to normal.Aldosterone antagonists (i.e., spironolactone)Angiotensive-converting enzyme inhibitors(i.e., enalapril, lisinopril, etc.)Angiotensin receptor blockers (i.e., losartan, valsartan, etc.)Antibiotics (i.e., trimethoprim)Immunosuppressants (i.e., cyclosporine, tacrolimus, etc.)Potassium-sparting diuretics (i.e., amiloride, triamterene, etc.)
Digoxin is not the only medication that increases the risk for hyperkalemia. Changing the dose of a medication or discontinuing a medication may be the best way to return potassium levels to normal.
A simpleurinalysislooks for blood, glucose, protein, or infection in the urine. Abnormal findings could indicate glomerulonephritis, inflammation of the kidney, or glomerulonephrosis, a non-inflammatory condition where the kidney leaks protein. It could also show diabetes that is uncontrolled.
Urine Tests May Include:Basic urinalysisUrine potassium and sodiumUrine myoglobin
Urine Tests May Include:
Basic urinalysisUrine potassium and sodiumUrine myoglobin
More specific urine tests may be pursued to check how well the kidneys are performing. If urine secretion of potassium and sodium are within expected limits, the kidneys are not to blame. A non-renal cause ought to be investigated. Testing for urine myoglobin can confirm a diagnosis of rhabdomyolysis (see above).
Hyperkalemia can trigger life-threatening arrhythmias if your potassium levels get too high. Anelectrocardiogram (ECG)is an important diagnostic tool,not only to detect more severe cases of hyperkalemia but to also identify what kind of arrhythmia is present.
An ECG measures the electrical conduction through the heart, from the top chambers of the heart, the atria, to the bottom chambers, the ventricles. Each line on an ECG from PQRST represents activation or recovery of a different chamber of the heart muscle.
As serum potassium increases, ECG changes become more severe. Starting at levels 5.5 meq/L and above, the ventricles may have difficulty recovering. This may be seen as peaked t-waves on ECG. Atrial activation is impacted at 6.5 mEq/L so that p-waves may no longer be seen. At 7.0 mEq/L, QRS waves are widened, corresponding with delayed activation of the ventricles.
Cardiac arrhythmias tend to develop at 8.0 mEq/L. This can include everything from sinus bradycardia toventricular tachycardia. In the worst case scenario, asystole, loss of all electrical impulses, can occur and the heart stops.
While an ECG does not diagnose the cause of hyperkalemia, it reflects the severity of the condition. Cardiac arrhythmias require emergent treatment.
People withcirrhosis,congestive heart failure, and diabetes are at higher risk for developing hyperkalemia. Other chronic conditions that can be a factor include amyloidosis andsickle cell disease.
If you are prescribed medications like ACE inhibitors, angiotensin-receptor blockers,beta-blockers, cyclosporine, digoxin, minoxidil, spironolactone, and tacrolimus, be aware that your potassium levels could increase.
Your doctor may look for other causes of hyperkalemia, like renal failure and hypoaldosteronism, as outlined above.
If you have a sudden increase in your potassium levels, you may haveheart palpitations, shortness of breath, chest pain, nausea, or vomiting.If you have risk factors for hyperkalemia such as kidney disease or diabetes and experience these symptoms, seek emergency medical attention.
In advancedkidney disease, the kidneys are not able to remove potassium from your body as efficiently as healthy kidneys.The potassium in foods cannot be filtered out, which leads to hyperkalemia.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Merck Manual Professional Version.HyperkalemiaNational Kidney Foundation.Facts About High Potassium in Patients with Kidney DiseaseU.S. National Library of Medicine. MedlinePlus.High potassium levelMount Sinai. Health Library.Creatine phosphokinase testNational Kidney Foundation.Know Your Kidney Numbers: Two Simple TestsLehnhardt A, Kemper MJ.Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-84. doi:10.1007/s00467-010-1699-3Viera AJ, Wouk N.Potassium disorders: hypokalemia and hyperkalemia.Am Fam Physician. 2015;92(6):487-495.National Kidney Foundation.Six steps to controlling high potassium.National Kidney Foundation.Facts about high potassium in patients with kidney disease.Additional ReadingLewis JL. Hyperkalemia.Merck Manual: Professional Version.https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.Mount DB. Causes and Evaluation of Hyperkalemia in Adults. In: Forman JP (ed),UpToDate [Internet], Waltham, MA.Simon LV, Farrell MW.Hyperkalemia. In:StatPearls [Internet].Treasure Island (FL): StatPearls Publishing.Kehnhardt A, Kemper MJ.Pathogenesis, Diagnosis and Management of Hyperkalemia.Pediatr Nephrol.2011 Mar; 26(3): 377–384. doi: 10.1007/s00467-010-1699-3.Levis JT.ECG Diagnosis: Hyperkalemia.Perm J.2013 Winter; 17(1): 69.doi: 10.7812/TPP/12-088
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Merck Manual Professional Version.HyperkalemiaNational Kidney Foundation.Facts About High Potassium in Patients with Kidney DiseaseU.S. National Library of Medicine. MedlinePlus.High potassium levelMount Sinai. Health Library.Creatine phosphokinase testNational Kidney Foundation.Know Your Kidney Numbers: Two Simple TestsLehnhardt A, Kemper MJ.Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-84. doi:10.1007/s00467-010-1699-3Viera AJ, Wouk N.Potassium disorders: hypokalemia and hyperkalemia.Am Fam Physician. 2015;92(6):487-495.National Kidney Foundation.Six steps to controlling high potassium.National Kidney Foundation.Facts about high potassium in patients with kidney disease.Additional ReadingLewis JL. Hyperkalemia.Merck Manual: Professional Version.https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.Mount DB. Causes and Evaluation of Hyperkalemia in Adults. In: Forman JP (ed),UpToDate [Internet], Waltham, MA.Simon LV, Farrell MW.Hyperkalemia. In:StatPearls [Internet].Treasure Island (FL): StatPearls Publishing.Kehnhardt A, Kemper MJ.Pathogenesis, Diagnosis and Management of Hyperkalemia.Pediatr Nephrol.2011 Mar; 26(3): 377–384. doi: 10.1007/s00467-010-1699-3.Levis JT.ECG Diagnosis: Hyperkalemia.Perm J.2013 Winter; 17(1): 69.doi: 10.7812/TPP/12-088
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Merck Manual Professional Version.HyperkalemiaNational Kidney Foundation.Facts About High Potassium in Patients with Kidney DiseaseU.S. National Library of Medicine. MedlinePlus.High potassium levelMount Sinai. Health Library.Creatine phosphokinase testNational Kidney Foundation.Know Your Kidney Numbers: Two Simple TestsLehnhardt A, Kemper MJ.Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-84. doi:10.1007/s00467-010-1699-3Viera AJ, Wouk N.Potassium disorders: hypokalemia and hyperkalemia.Am Fam Physician. 2015;92(6):487-495.National Kidney Foundation.Six steps to controlling high potassium.National Kidney Foundation.Facts about high potassium in patients with kidney disease.
Merck Manual Professional Version.Hyperkalemia
National Kidney Foundation.Facts About High Potassium in Patients with Kidney Disease
U.S. National Library of Medicine. MedlinePlus.High potassium level
Mount Sinai. Health Library.Creatine phosphokinase test
National Kidney Foundation.Know Your Kidney Numbers: Two Simple Tests
Lehnhardt A, Kemper MJ.Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-84. doi:10.1007/s00467-010-1699-3
Viera AJ, Wouk N.Potassium disorders: hypokalemia and hyperkalemia.Am Fam Physician. 2015;92(6):487-495.
National Kidney Foundation.Six steps to controlling high potassium.
National Kidney Foundation.Facts about high potassium in patients with kidney disease.
Lewis JL. Hyperkalemia.Merck Manual: Professional Version.https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.Mount DB. Causes and Evaluation of Hyperkalemia in Adults. In: Forman JP (ed),UpToDate [Internet], Waltham, MA.Simon LV, Farrell MW.Hyperkalemia. In:StatPearls [Internet].Treasure Island (FL): StatPearls Publishing.Kehnhardt A, Kemper MJ.Pathogenesis, Diagnosis and Management of Hyperkalemia.Pediatr Nephrol.2011 Mar; 26(3): 377–384. doi: 10.1007/s00467-010-1699-3.Levis JT.ECG Diagnosis: Hyperkalemia.Perm J.2013 Winter; 17(1): 69.doi: 10.7812/TPP/12-088
Lewis JL. Hyperkalemia.Merck Manual: Professional Version.https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hyperkalemia.
Mount DB. Causes and Evaluation of Hyperkalemia in Adults. In: Forman JP (ed),UpToDate [Internet], Waltham, MA.
Simon LV, Farrell MW.Hyperkalemia. In:StatPearls [Internet].Treasure Island (FL): StatPearls Publishing.
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