Patients with certain underlying conditions, such as renal insufficiency or adrenal hypofunction (Addison’s disease), and patients taking diuretic medications in combination with antihypertensive agents should think about hyperkalemia and seek medical attention if they suddenly notice a furry sensation on the tongue or tingling on the skin. Cardiac arrhythmias may be the result of this disorder.
What is hyperkalemia?
In hyperkalemia, the patient’s electrolyte balance is disturbed and the level of potassium in the blood is elevated compared to normal. In adults, this level should not exceed 5.0 mmol/l, and children should not exceed 5.4 mmol/l. Hyperkalemia usually occurs in chronic kidney failure; more rarely, antihypertensive drugs such as ACE inhibitors or diuretic drugs are the triggers of the disorder. In the patient, it is noticeable by a tingling sensation on the skin as well as a furry feeling on the tongue. In addition, paralysis and muscle weakness may occur. If left untreated, hyperkalemia is an extremely threatening condition, as it can lead to cardiac arrhythmias. It can also result in ventricular fibrillation with subsequent cardiac arrest.
Causes
Hyperkalemia refers to an increase in the level of potassium in the blood. In chronic renal failure, the kidney can no longer adequately excrete the available potassium. However, since the concentration of potassium is crucial for the transmission of impulses of the heart muscle, cardiac arrhythmias can occur, which are life-threatening for the patient. Hyperkalemia can occur intermittently during infusion therapy or as a result of the breakdown of red blood cells, as occurs after extensive burns. An increase in the level of potassium in the blood can also occur during chemotherapy. Hyperkalemia can also occur if the patient is severely acidotic, a condition known as acidosis. Medications such as beta-blockers and ACE inhibitors to lower blood pressure, as well as diuretics, may also lead to hyperkalemia.
Typical symptoms and signs
- Tingling
- Muscle twitching (fasciculation)
- Cardiac arrhythmia
- Circulatory arrest (cardiovascular failure)
Diagnosis and course
In the anamnesis interview, the information provided by the patient already suggests hyperkalemia when the patient reports typical symptoms such as a furry feeling on the tongue and a tingling sensation on the skin. Muscle weakness and paralysis symptoms, as well as ringing in the ears, may also occur even before the cardiac arrhythmias. The disorder is diagnosed by the physician based on a laboratory test of the blood. For this purpose, the electrolyte values potassium and sodium as well as calcium and chloride and other enzyme values are determined. Conclusions about kidney function can be drawn from the creatinine value. The pH value of the blood and the acid-base status are also used to diagnose hyperkalemia. Since cardiac arrhythmias can be the result of hyperkalemia and can be fatal if left untreated, an ECG (electrocardiogram) is also obtained to check cardiac function and immediately detect any disorders present.
Complications
Hyperkalemia can be fatal in some cases but does not always result in death. For this reason, competent assessment and treatment by a physician is required in individual cases. Cardiac complications, which include cardiac arrhythmias, ventricular fibrillation, and cardiovascular arrest, are particularly problematic. Such abnormalities in the heart rhythm can be visualized with the aid of an electrocardiogram (ECG). Hyperkalemia often results from another condition. Without treatment of the underlying condition (if possible) as well as the hyperkalemia, the condition may worsen. Symptoms of hyperkalemia include paresthesias and muscle weakness. Both can increase the risk of accidents in critical situations (for example, driving machinery and vehicles or working on scaffolding). Injuries and falls that may occur may also need to be treated. Furthermore, mental symptoms such as confusion and hallucinations are possible with hyperkalemia. They can result in sufferers being unaware of their own condition or unable to communicate clearly.These circumstances can make diagnosis and treatment more difficult. The person’s confusion may also contribute to other people misjudging the situation and being “put off” by it.
When should you see a doctor?
Patients suffering from kidney disease should see a doctor if they experience ringing in the ears, muscle weakness, or other unusual symptoms. If symptoms such as cardiac arrhythmias or persistent muscle twitching develop, a medical professional should be consulted immediately. In the event of severe complications, emergency medical assistance is required. For example, in the event of circulatory arrest or signs of a heart attack, the emergency medical services should be alerted immediately. Accompanying first aid measures should be administered. The patient must then spend several days in hospital. Depending on the course and the underlying disease, further medical check-ups are indicated. Hyperkalemia occurs in association with various diseases of the kidneys. These include renal insufficiency, adrenal insufficiency and kidney cancer. There is also an increased risk of high blood potassium levels during chemotherapy or after extensive burns. Anyone belonging to these risk groups should have the above-mentioned signs clarified by a doctor. Suitable contacts are the family doctor or a nephrologist. In the event of a medical emergency, the emergency physician must be called in any case.
Treatment and therapy
Treatment of hyperkalemia depends on its cause. If medications are causative for the disorder, they are discontinued or replaced with other agents. Medications that reduce intestinal potassium absorption may also be prescribed. However, if the potassium level is severely elevated, the patient must receive intensive medical care, as he or she is in a life-threatening condition. Under constant ECG monitoring, he is given a combination of drugs that stimulate urine formation by the kidney on the one hand and drive the absorption of potassium into the cells of the body on the other. Simultaneous administration of insulin and glucose also promotes potassium absorption. The aim of these measures is to lower the potassium level in the blood and thus protect the heart muscle. To prevent cardiac arrhythmias, infusions of calcium can also be helpful. If these therapeutic measures do not show sufficient effect, blood washing can also be used to lower the potassium level and thus eliminate the hyperkalemia.
Outlook and prognosis
The excess of potassium in the organism results from an underlying disease present. Therefore, relief of the symptoms of hyperkalemia is based on the prognosis for cure of the disease that has already been diagnosed and treated. Patients with tumor disease have a good chance of recovery if the tumor was detected early and successfully removed. If no metastases have developed in the body, it usually takes several years to achieve a complete recovery. Since hyperkalemia usually develops as a side effect of the initiated cancer therapy, relief from the symptoms is only possible after the necessary chemotherapy has been completed. If the cancer is considered cured, hyperkalemia is also cured. Otherwise, the patient’s treatment is changed to relief of severe symptoms and no cure of hyperkalemia is sought. In the case of kidney dysfunction, reduction of the excess potassium produced cannot occur until treatment of the kidney shows success or organ donation has occurred. A cure is possible through kidney transplantation if the donor organ has been successfully accepted by the body. In principle, therefore, the overall prognosis is based on the existing kidney disease and its treatment options. If the hyperkalemia arose because of medication, the symptoms can be completely reduced within a short period of time in most patients by using replacement medication.
Prevention
Hyperkalemia occurs very rarely. In certain underlying diseases, such as renal insufficiency and Addison’s disease, and in patients who must take diuretic and antihypertensive medications, blood potassium levels should be checked regularly so that countermeasures can be initiated immediately at the first sign of hyperkalemia.
Aftercare
In hyperkalemia, the measures or options for follow-up care are usually severely limited, so the focus in this disease is early detection with subsequent treatment. A physician should be contacted at the first signs and symptoms of this disease to prevent further complications or to prevent further deterioration of the disease. Early diagnosis always has a positive effect on the further course of hyperkalemia. In most cases, the disease is treated by taking medication, although some medications must be discontinued first. Attention should be paid to correct dosage and also to regular intake. In case of interactions or side effects, a doctor should always be consulted first. In severe cases, dialysis may become necessary. In this case, patients usually need the support and help of friends and their own family. Loving care and support always have a positive effect on the further course of the disease. Contact with other hyperkalemia patients can also be useful. In many cases, this disease reduces the life expectancy of the affected person.
This is what you can do yourself
Hyperkalemia is a disease that patients cannot diagnose themselves. Often, its only symptom is cardiovascular arrest. In most cases, however, it is detected via routine blood count monitoring. The treatment of hyperkalemia is based on a treatment plan worked out by a physician, which the patient should follow conscientiously. Essentially, the goal is to eliminate the excess potassium from the body and then ensure that no further excess builds up. The kidneys are mainly responsible for excreting the potassium. Patients can support the process by adjusting their lifestyle habits to strengthen and support kidney function as much as possible. This includes following certain dietary rules that relieve the kidneys. It is also very important in this context to flush the kidneys well and thus make their work easier. Patients affected by hyperkalemia should therefore drink a lot during the therapy measure and later as a preventive measure. Two to three liters a day are ideal. Still mineral water is recommended, but unsweetened fruit teas or diluted juices also have a positive effect on kidney function. Since hyperkalemia often also interacts with other medications, it is necessary for the patient to provide his doctor with accurate information about the medications he is taking and not to take additional therapeutic measures himself.
