High Potassium Levels

Factual Questions
1

Let me preface this by saying I am under a doctor’s care and I am not asking for medical advice but rather medical information.

After more years than I want to admit, and thanks to the health insurance we now have (yay!), I was able to get a thorough physical check up recently. Everything is healthy and functioning properly (yay!)… and then the doctor called…

Seems my blood test results were very good, except I had high potassium levels in my blood. Not sky-high, no, in fact, he said, just slightly over the normal range, but he wanted to know if I was taking any form of potassium supplement, and if so, please stop immediately. No, not taking anything of the sort. I think he was a little disappointed, since, after all, if I had been this might have been an easy fix.

We did talk briefly. He said my kidney function was normal and there was no sign of diabetes and the EKG said my heart rhythms were normal and… well, basically, everything was either normal or very good except this one marker. Just that one. So he said we’ll keep an eye on it (we officially have insurance for next year, so follow up testing and visits are no issue) and if I start feeling unwell please do come in for a look.

Of course, I did a little research when I got home. My potassium is “5.2”, which seems to be either the top end of normal or yes, just slightly over, depending on where you look. There were all sorts of dire things about kidney problems and heart problems and diabetes so on which puts his statements about those things into context. No one has ever mentioned high potassium before, so this is something new. I suppose it could be one of those idiosyncratic things and I gather that as long as it stays where it is, it is merely unusual, not dangerous.

I’m not taking a supplement. I’m not even taking a multi-vitamin at this point. I am eating a crapload of fresh vegetables from the garden, and I know fresh vegees have potassium but it shouldn’t be that much potassium, should it? I’m not on any medications aside from my usual fall allergy stuff (loratidine, pseudoephedrine, diphenhydramine, and the occasional shot of albuterol) which isn’t even a daily thing since it’s all “as needed”.

My husband says I need to drink more water. Well, as a person with a history of kidney stones and who currently has diabetes he drinks a lot of fluids. He sort of thinks I’m weird because outside of meals, or manual labor in the hot sun, I don’t get thirsty. I will make an effort to drink more water because it won’t hurt and I probably should.

I’m also going to check the condiment labels to make sure I’m not inadvertently eating a lot of something with potassium in it. Should probably stick to regular salt (sodium chloride) rather than No-Salt (potassium chloride), for example. Not that I normally use No-Salt, but some of my friends and family do and this may be a case where what’s good for them is bad for me and vice versa.

**So… my question is, what would cause unusually high potassium levels in an otherwise healthy woman in her mid-40’s? **

2

Ranges are good – but not perfect – estimates of where each of our numbers should fall. Testing once = nice info, but I’d ask to be checked a number of times again.

Lot’s of veggies = raised levels.

It’s possible that you are good at absorbing potassium, or it is possible that something you take increases absorption.

I’d go about business as usual and get checked at least two more times. Yes, you said you will wait for insurance…

Do you exercise or break a sweat from time to time?

3

As I said, that’s already in the works. The doctor made it clear that his concern is that this level doesn’t keep going up.

Yes. I currently work in construction. Sweating all day on the jobsite is nothing new, I’m routinely hauling around equipment 1/2 to 2/3 my own bodyweight. Work is not as steady as I like, but I break a sweat several times a week on average.

4

I see levels in that area all the time, and frankly it’s often due to mild hemolysis of some of the RBCs in the blood sample. I don’t even repeat the lab, unless I’m suspecting other disease.

I also suspect that level is normal for some folks.

If the patient isn’t on any meds which cause potassium changes, and has normal kidney function, and otherwise has a normal history, I don’t pursue it.

5

I should clarify: It’s due to mild hemolysis of the RBCs in the process of obtaining the sample> Hemolysis releases potassium from the red blood cells. So it does not reflect the situation inside the patient, only inside the blood sample tube.

6

As an ED physician, I’ve done thousands of serum potassiums–pretty much every patient who has a medical condition is likely to get a set of electrolytes, which includes potassium.

Agreed with **QtM **100%. (Not that my disagreement would render any of his excellent replies less likely to be exactly right).

Every lab establishes its own normal ranges, based on standard deviations from what they see. Typical normal values are given in the 3.5-5.5 range. Measurement of potassium levels is particularly sensitive to phlebotomy technique. Since most potassium in the body is intracellular, any disruption of cells (platelets, red and white cells) spills potassium into the serum and can factitiously elevate the measured result.

In any case, although it’s actually a bit unusual to be at the high end of the range (assuming it was measured correctly) most physicians would simply make sure the patient is not taking too much exogenous potassium nor any medication which impairs renal potassium-handling, and let it go at that if renal function is otherwise normal.

7

I don’t have any information but I want to say hooooooray for Broomstick now having insurance. I actually was worrying about Broomstick’s lack of medical insurance last night. Seriously, I was.

8

Can’t top the excellent info posted by our MDs.

However, i urge you to drink more fluids. Thirst is definitely not a good indicator of how much water you need, and many people are running “a quart low.”

It is difficult to keep track of your fluid intake. Every morning I fill a big pitcher with water, and make sure I drink all that, in addition to what I take at meals. Of course, living in Arizona and doing vigorous exercise daily, I also slug down a lot of water while climbing mountains and taking long hikes in +100 F. weather.

I doubt not drinking enough would affect the potassium level, but don’t think that is anything to worry about. Just try to slurp up more fluids (but definitely not soft drinks with loads of sugar).

9

Thanks for the answers folks. I think I’m filing this under “Yay, I don’t have a deficiency. Continue to eats lots of fresh fruits and vegetables. Don’t take potassium supplements.”

I don’t know if more fluids would have any effect or not, but my husband is always encouraging me to drink more (non-alcoholic) stuff and whatever thirst reflex I have is pretty weak. When doing manual labor I load up my lunchbox with a liter of beverages (two or more if it’s summer and hot) and tell myself half has to be consumed by lunch, the remainder by quitting time. I’m also lucky to have a boss who reminds everybody on the jobsite to drink adequate amounts while at work (aside from not likely possible ill effect of dehydration in his workers, he’s also a pretty nice guy who likes to take care of people)/ On days I’m not working I try to take a swig of water whenever I go by the fridge, in addition to what is consumed at mealtimes, but it’s hard to remember when you’re just never thirsty barring extreme circumstances.

And I pretty much gave up on softdrinks decades ago. I drink them if I can’t get water or tea, but that’s about it. (And yes, I know tea is a mild diuretic, but it’s only about half my daily fluid intake and about my only vice, so too bad)

Oh, and SigmaGirl, thanks for the concern - I’ve had about four appointments for various tests and what not over the last month, with one more to go, just to check the ol’ body and see how it’s working, all covered by insurance. This is the only thing that stood out, which is pretty minor apparently, and in fact the doc said something about the really unusual thing is just how healthy and normal I am for my age and poverty level. Nice to know all the effort I put into maintenance and keeping healthy has paid off.

10

Mentioning in passing, owing to having family and friends with the opposite problem – low potassium absorption – that Gatorade™ and its imitators, along with many fruit juices, are really good sources of potassium – and that many people engaged in high-perspiration activities regularly drink Gatorade or something similar. While I think the M.D.'s have targeted the 'problem ', I submit that if you’re among their number, this might contribute to the marginally elevated reading.

11

I’ve a liking for fruit juice, but limit myself to 1 glass a day (usually cranberry diluted 50% with water, but I do enjoy others) as I am aware that it is a calorically dense beverage and, anyhow, I like real fruit, too. Can’t stand gatorade. When doing sweaty stuff I just drink plain old water, which I do like. I figure I eat healthy enough that I’m getting sufficient electrolytes in my diet (well, maybe more than enough in some cases!) and don’t need to add more on top of it. Water, water, water - it’s good stuff.

12

Do you take birth control pills? There are some that can raise potassium levels.

That said, the most likely reason for a randomly high K++ level is blood drawing technique. Was the tourniquet left on too long? Was the suction too strong? Was the vial agitated too much?
Even though in vitro hemolysis is detectable in the lab, it isn’t always noticed/reported.

13

No, I have never taken birth control pills.

Tourniquet on too long? No, I don’t think so - seemed like a very quick, efficient, business like blood draw. Suction? Haven’t a clue. Agitation? I don’t think I was present for it, or would have noticed less than ideal technique.

>shrug<

We’ll see if it happens again, won’t we?

14

Even sitting too long can cause hemolysis. Has the doctor suggested you have it re-drawn?

15

What, me sitting too long or the sample sitting too long? :wink:

No, the doctor has not suggested a re-draw because the insurance doesn’t pay for do-overs. He is aware that there’s no way in hell I can afford to pay out of pocket for another blood test. As this is not life-threatening, or even causing symptoms, we’ll just have to wait until enough time goes by the insurance will pay again and re-test. That is how modern medicine in the US works - you only get what you can afford, or your insurance is willing to pay for.

16

I meant the specimen, not you, silly. :slight_smile:

Sorry, I didn’t mean to sound insensitive or frivolous. I understand how the no do-overs rule is, my lipid panel went from normal to off the scale then normal again in a three month period only to be told I must have odd eating habits. :eek: Since the lab test is expensive, I surely was to blame.

17

So the “normal” ranges are for the “local” population only, whatever composition it happens to have?

I remember how, years ago, a man got sick in a small Spanish town, the lab took one look at his results, said “this can’t be right,” took one look at the name, said “wait a minute…,” confirmed he was from Japan and called the local government “hey, can you guys hook us up with the Japanese Ministry of Health or a hospital there? We need Japanese normal ranges.” But they wouldn’t have expected a Swede’s normal values to be different from those of a Spaniard.

18

Each lab has its own specific devices and measuring techniques. In the US, at least, these are carefully regulated and standardized, but they are not exactly the same from lab to lab. The range is not great between labs. It’s unlikely the “local population” per se affects the normal ranges much unless the overall heterogeneity of ethnic groups being tested varies from one place to the next.

Even then, most of the time this is not clinically significant. There are some exceptions. You might, for instance, be measuring creatinine kinase and your “local population” happens to be heavily skewed toward asians. If a creatinine kinase comes back high and the patient is black, the reference range for asians would not be appropos because there is a significant difference in normal ranges between those two populations. In those types of situations a lab might need to comment on reference ranges specific for a particular sub-population group.

Distribution of Creatine Kinase: Implications for Statin Therapy e.g.

19

Just this AM I got a guy with a reported potassium of 6.1, which is a bit high.

But he’s healthy, normal kidney function, young, on no meds.

Phlebotomist remembers him as a ‘tough stick’.

I’m re-checking another sample, with the expectation it’ll be normal. IF his next stick goes better, anyway.

20

His repeat level came back at 4.6, only 24 hours after his initial 6.1 level.

Definitely a case of sample error due to hemolysis.