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Treatment of Severe Hyperkalemia: Potassium

Normal lab value range and cause of imbalance

Normal blood potassium levels are 3.5 to 5.0 millimoles per liter (Potassium blood test, 2019).
Potassium is an electrolyte, and its optimal concentration is necessary for the body to perform physiological functions. With an average level of potassium in the blood, there is an effective exchange of signals between nerves and muscles, nutrients are successfully transferred to cells, and harmful ones are removed from cells. Also, normal potassium levels are essential for heart function and maintenance of normal body fluids, blood pressure.
The most common cause of high potassium levels is kidney disease. The kidneys control the level of potassium in body fluids and the amount of potassium excreted. When kidney function is impaired, potassium is not excreted efficiently in the urine, and therefore its level in the blood rises.
Other common causes of high potassium levels are dehydration, trauma causing heavy bleeding, and uncontrolled diabetes (Potassium blood test, 2019).
Causes of hyperkalemia: Kidney disease, Addison’s disease (when the adrenal glands are damaged and cannot produce enough cortisol), type 1 diabetes, rhabdomyolysis (muscle disease associated with drug and alcohol use or muscle injury).
Causes of hypokalemia: kidney disease, diabetic ketoacidosis, folate deficiency (folate is a B vitamin that helps create new cells). Other reasons: diarrhea, dehydration, overuse of certain medications (Lewis, 2020).

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Hyper- conditions

A blood potassium level of 5.0 to 6.0 mmol/l is called mild hyperkalemia; from 6.0 to 7.0 mmol/l with moderate hyperkalemia, and above 7.0 mmol/l – severe hyperkalemia. If the potassium level rises above 6.0 mmol/l, the patient needs urgent medical intervention (Potassium blood test, 2019).
Symptoms: nausea, arrhythmia, weakness, fatigue, slow heart rate, numbness and tingling, chest pain. In rare cases, paralysis of the arms, hands, and legs, heart failure.
Severe hyperkalemia requires immediate medical attention. Symptoms: possible lethal arrhythmias, possibly cardiac arrest, and death.

Hypo- conditions

A blood potassium level below 3.5 mmol/l is called hypokalemia. Mild hypokalemia is diagnosed under 3.5 mmol/l to 3.0 mmol/l, moderate hypokalemia – 3.0 mmol/l to 2.5 mmol/l, and severe hypokalemia below 2.5 mmol/l (Potassium blood test, 2019).
Symptoms: weakness, muscle cramps, muscle stiffness and pain, digestive problems, tingling and numbness, difficulty breathing, mood changes, heart palpitations.
Symptoms of severe hypokalemia include acute respiratory failure, cardiac arrhythmias, and cardiovascular collapse.


In hypokalemia, potassium can be replaced by oral potassium supplements. Because potassium can irritate the digestive tract, supplements are taken in small doses with meals several times a day. Specialty types of potassium supplements, such as waxed or microencapsulated potassium chloride, are less likely to irritate the digestive tract (Lewis, 2020).
Potassium is given intravenously if potassium levels are dangerously low, if low levels cause an irregular heartbeat, or if supplements taken by mouth are ineffective if the person continues to lose more potassium, than can be replenished with oral supplements.
Potassium levels are monitored periodically in people taking diuretics so that supplements can be prescribed if needed. An alternative may be a diuretic that helps the kidneys retain potassium (potassium-sparing diuretics), such as amiloride, eplerenone, spironolactone, triamterene. These drugs are used if the kidneys are functioning normally (Lewis, 2020).
Treatment of severe hyperkalemia involves monitoring the patient’s condition and administering immediate drugs that act quickly and synergistically. Treatment of severe hypokalemia is direct potassium supplementation.


Lewis, L. J. (2020). hypokalemia (low level of potassium in the blood). Web.

Potassium blood test – low, high, and normal range. (2019). Web.

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