High potassium associated with certain drugs, diet

DEAR DR. GOTT: Can you please address high potassium levels? My husband’s level went from 4.6 in 2008 to 5.6 in 2009. Other than food that is high in potassium, what could cause the level to jump? Should he be on a restricted diet? Can exercise bring it down?

His physical this year did show his total cholesterol level rose, mainly his LDL to 143, HDL to 77 and triglycerides to 115. His blood pressure is normal.

We would welcome any advice, as this is all new to us. I did search the Internet but was unable to find an answer.

DEAR READER: Potassium is important for the function of nerve and muscle cells. Common causes of elevated levels (known as hyperkalemia) are acute or chronic kidney failure. A normal blood-potassium level is between 3.6 and 4.8 milliequivalents per liter, known as mEq/L. Levels above 6.0 can be the result of type 1 diabetes; Addison’s disease; angiotensin-converting enzyme (ACE) inhibitors; alcoholism; heavy drug use; severe injury, such as burns, that cause destruction of red blood cells; and potassium supplements.

As you have discovered, elevated potassium levels are commonly found when a physician orders lab testing. Let’s pause briefly here. Does your husband have a specific problem his physician was attempting to confirm or rule out? Or is he on a medication (such as an ACE inhibitor) that might require monitoring? If so, the elevation might be medication-related and can be corrected with a substitute drug. My guess is that his physician would have checked him for diabetes, so we can likely rule that out. Addison’s disease results from either partial or complete failure of the adrenal glands, which sit on top of each kidney and produce hormones that control many functions. Causes of Addison’s include tumor, bleeding into the gland, infection and autoimmune diseases. Another possibility is a false positive, and a repeat test may reveal a normal level.

Elevated potassium levels can result in heart arrhythmias, weakness, fatigue, nausea and more. Treatment is commonly tied to the underlying cause, so your husband may need additional testing. At the very least, he should return to his physician for a thorough discussion of the situation and what can be done to correct it.

I would be surprised if your husband’s diet were the cause of his hyperkalemia. Foods high in potassium include lima beans, bananas, cantaloupe, cooked spinach, winter squash, raisins, tomato products and more. If your husband consumes substantial amounts of the foods mentioned, he might wish to make modifications. It will not harm him to follow a low-potassium diet.

In terms of his cholesterol levels, did he eat prior to the testing or did he fast? Cholesterol is fickle, and reports can be conflicting if food or drink has been ingested. You don’t indicate what his total cholesterol level was, nor if he has any medical condition(s) that might not have been mentioned.

He should speak with his physician before starting an exercise program. If he is relatively sedentary and there are no restrictions, he might begin by walking or using a treadmill at home. He might speak also with a physical therapist at a local hospital or fitness center and join an abbreviated exercise program. Water aerobics are low-impact and often beneficial. The possibilities are limitless.

To provide related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Vitamins and Minerals.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my Web site at www.AskDrGottMD.com.