December 03, 2019
Hyperkalemia can be caused by a host of conditions including chronic kidney disease (CKD), metabolic disorders and medications. Traditionally, as the potassium serum level rises it can begin to have various physiological effects, however, cardiac conduction abnormalities is the primary concern. As the serum potassium level increases above 6 mEq/L, and higher, it results in proarrhythmic effects that ultimately can result in a fatal cardiac arrhythmia.
One of the most common patient populations pharmacists and other health care professionals work with on a daily basis, that are at greatest risk of hyperkalemia, are patients with CKD. These patients have a more difficult time with potassium elimination and must be evaluated much more closely due to this electrolyte disorder. Pharmacists do an excellent job in reviewing the patient medications that may increase serum potassium, however, diet is sometimes overlooked which may have a significant increase in serum potassium.
Many foods from fruits, vegetables, meats and other products have a significant amount of potassium. It is recommended the average adult should include approximately 5,000mg potassium in their daily diet. 1 However, patients with CKD should consume 1500-2700mg/day. 2 Common foods with significant potassium content include: 1 medium banana (425mg), 1 medium baked potatoes (925mg), ½ cup of broccoli (230mg), 1 small orange (240mg). In addition, salt substitutes that are routinely used for patient with chronic heart failure to limit sodium ingestion contain significant amount of potassium. One product Nu-Salt contains 530mg of potassium per 1/6 teaspoon. 3
Pharmacists counseling CKD patients on medication use should routinely incorporate a brief list of foods with potassium content as a guide for patients to understand. In addition, pharmacists may refer the patient to a dietician for a more comprehensive diet assessment. In helping the patient with better food choices, we can prevent many emergency department admissions due to hyperkalemia.
Michael J. Cawley, PharmD, RRT, CPFT, FCCM, is a professor of clinical pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has more than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.
- Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride and sulfate. Washington, DC: The national Academies Press, 2005.
- Healthline. Kidney disease and potassium: How to create a kidney-friendly diet. https://www.healthline.com/health/kidney-health/kidney-disease-and-potassium. Accessed Nov 17, 2019.
- Nu-Salt FAQ. http://www.nusalt.com/faq/index.html. Accessed November 16, 2019.