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What happens if high potassium is not treated?

High potassium or hyperkalemia is a medical condition that occurs when the potassium levels in the blood are higher than normal. This condition can be caused by several factors including kidney dysfunction, certain medications, or an excessive intake of potassium-rich foods. High potassium levels can be life-threatening and can lead to various complications if left untreated.

If high potassium is not treated, the excess potassium in the bloodstream can cause several adverse effects on the body. Some of the potential complications of untreated hyperkalemia include:

1. Cardiac Arrhythmias: High potassium levels can cause the heart to beat irregularly or slow down, leading to cardiac arrhythmias. If left untreated, arrhythmias can lead to cardiac arrest, a life-threatening emergency.

2. Muscle Weakness: High potassium levels can also lead to muscle weakness, which can affect many muscles of the body including the heart muscle. If the heart muscle is affected, it can lead to cardiac arrest.

3. Numbness and Tingling: In some cases, high potassium levels can cause numbness and tingling in the feet and hands. These symptoms can also indicate muscle weakness or paralysis.

4. Breathing Difficulties: High potassium levels can cause breathing difficulties, which can be life-threatening if not treated immediately.

5. Kidney Failure: If hyperkalemia is left untreated for a long time, it can lead to kidney failure. This happens when the excess potassium in the bloodstream damages the kidneys, reducing their ability to function properly.

If high potassium is not treated, it can lead to severe complications, which can be potentially life-threatening. Therefore, it is essential to seek medical attention immediately if you experience symptoms of hyperkalemia such as weakness, palpitations, or breathing difficulties. With proper treatment and management, hyperkalemia can be effectively managed, and the potential complications can be prevented.

Does high potassium go away on its own?

High potassium is a medical condition known as hyperkalemia, which occurs when there is excessive potassium in the bloodstream. Potassium is an essential mineral responsible for numerous bodily functions, including regulating heartbeat, muscle contractions, and nerve impulses. However, having too much potassium in the blood can be dangerous and may cause various symptoms ranging from mild to severe.

The answer to whether high potassium goes away on its own depends on the cause and severity of hyperkalemia. In mild cases, where the levels are just slightly elevated, it is possible for the body to regulate and balance the potassium levels on its own. However, this may take some time and can also depend on your current state of health, the foods you eat, and any medications or supplements you take.

In more severe cases, where the potassium levels are dangerously high, medical attention and treatment are necessary. The doctor may perform a blood test to determine the cause of high potassium and recommend various treatments depending on the severity, including:

1. Medications: Depending on the underlying cause of hyperkalemia, medications such as potassium-binding resins or diuretics may help to remove excess potassium from the bloodstream.

2. Dialysis: In severe cases, where hyperkalemia is life-threatening, dialysis may be necessary to remove excess potassium from the body quickly.

3. Lifestyle changes: Making changes to your diet and avoiding foods high in potassium, such as bananas, tomatoes, and spinach, can help to regulate potassium levels. Also, avoiding potassium supplements or medications that may cause hyperkalemia is also beneficial.

The answer to whether high potassium (hyperkalemia) goes away on its own depends on the severity and cause of the condition. Mild cases may resolve on their own over time, but more severe cases require medical attention and treatment to prevent potentially life-threatening complications. Therefore, if you suspect that you have high potassium levels, it is always advisable to consult your doctor, who will assess your condition and provide the necessary treatment or advice.

How do you flush excess potassium?

Excess potassium can be harmful to the body and may lead to hyperkalemia, which can cause serious health complications such as heart and kidney problems. Therefore, it is necessary to flush excess potassium from the body to maintain a healthy balance of electrolytes.

There are several ways to flush excess potassium from the body. The first step is to stop consuming foods that are high in potassium. Some of the foods that are high in potassium include bananas, potatoes, yogurt, spinach, avocados, and beans. Especially if the person is suffering from an illness in which the kidneys are affected, it is important to avoid foods with high potassium content as they may exacerbate the condition.

Increasing water intake is an easy and effective way to flush potassium out of the body. Drinking plenty of water can help increase urine output, which can help remove potassium from the body. Moreover, drinking water may also help in promoting the excretion of potassium through the kidneys.

In addition to water, consuming fluids that contain glucose and insulin can also help to clear excess potassium from the body. Glucose and insulin help to move potassium into the cells, which leads to lower levels of potassium in the blood. This process is called “transcellular shift” and is helpful in lowering potassium levels in the blood.

Another way to flush excess potassium is to take medications that bind potassium in the gastrointestinal tract. These medications can prevent the absorption of potassium from the diet, leading to its excretion from the body through the feces.

Lastly, if the above methods are not sufficient to lower potassium levels in the blood, a medical procedure called dialysis can be used. Dialysis involves removing excess potassium from the blood by filtering it through a machine outside the body.

Flushing excess potassium from the body can be achieved through a combination of lifestyle modifications, such as avoiding potassium-rich foods, increased water intake, and medication if necessary. In more severe cases, dialysis can be used to remove excess potassium from the body. It is important to seek medical advice before attempting to flush excess potassium from the body, especially if it is caused by an underlying condition.

How long does it take to normalize potassium?

The time it takes to normalize potassium levels in the body can vary depending on the severity of the imbalance and the underlying cause. In mild cases, where the potassium levels are only slightly low or high, normalization can occur within a few hours to a couple of days. However, in more severe cases, where the potassium levels are significantly low or high, the normalization process can take a few days to several weeks.

For instance, if the cause of the potassium imbalance is due to a dietary deficiency or an increase in potassium intake, normalization can occur within a few hours to a day once the individual consumes a balanced and healthy diet or reduces their potassium intake. However, if the potassium imbalance is due to an underlying medical condition or medication side effect, the time it takes to normalize potassium levels can be longer.

If the cause of the potassium imbalance is due to a medical condition such as kidney disease or adrenal insufficiency, the individual may need to undergo additional testing and treatments to manage the condition and restore normal potassium levels. This process can take several weeks or even months, depending on the severity of the medical condition.

Similarly, if the individual is taking medication that affects potassium levels, the healthcare provider may need to adjust the dose or switch to another medication that does not cause potassium imbalance. This process can take a few days to a couple of weeks depending on the medication and the individual’s response to the treatment.

The time it takes to normalize potassium levels depends on several factors such as the severity of the imbalance, the underlying cause, and the response to treatment. Therefore, it is important for individuals to seek prompt medical attention and follow the treatment plan recommended by their healthcare provider to restore normal potassium levels and prevent any complications associated with potassium imbalance.

How do you feel when your potassium is too high?

Hyperkalemia, a condition in which the potassium levels in the bloodstream are abnormally high, can cause a range of symptoms, from mild to severe, and can even be life-threatening in some cases. One of the common symptoms of elevated potassium levels is muscle weakness, particularly affecting the legs and arms.

Individuals with hyperkalemia may feel fatigued, experience numbness or tingling sensations, and may have difficulty controlling their limbs.

In addition to muscle weakness, hyperkalemia can cause an irregular heartbeat, which can lead to chest pain, heart palpitations, and shortness of breath. Digestive symptoms, including nausea, vomiting, and abdominal cramping, are also common. High levels of potassium can also affect the kidneys, leading to frequent urination or decreased urine output.

If left untreated, severe cases of hyperkalemia can lead to more serious complications, including kidney failure, heart attacks, and arrhythmias. If you suspect that you have an elevated level of potassium, it is critical to seek medical attention immediately to prevent potentially life-threatening consequences.

Your healthcare provider can provide treatment options, such as medication or dialysis, to bring your levels back to a safe range.

What are the warning signs of high potassium?

High potassium, medically known as hyperkalemia, is a condition where the blood has an abnormally high concentration of potassium ions. Potassium is an essential nutrient that plays several vital roles in the body, including muscle function, heart contraction, and nerve transmission. However, too much potassium in the bloodstream can disrupt these processes and cause severe health problems.

There are several warning signs of high potassium, and it is essential to recognize and address them promptly to prevent complications. Some of the most common symptoms of hyperkalemia include:

1. Weakness or Fatigue: High levels of potassium in the blood can cause muscle weakness, fatigue, and general malaise.

2. Numbness and Tingling: Hyperkalemia can cause a tingling or numb sensation in the arms, legs, or other parts of the body.

3. Abnormal Heart Rhythm: One of the most severe complications of high potassium is cardiac arrest, which can cause chest pain, shortness of breath, and an irregular heartbeat. Therefore, if you experience any of these symptoms, seek medical attention immediately to prevent a fatal outcome.

4. Nausea and Vomiting: Hyperkalemia can cause gastrointestinal symptoms such as nausea, vomiting, and diarrhea.

5. Muscle Cramps: Fatigue, muscle weakness, and muscle cramps are common signs of hyperkalemia.

6. Breathing Problems: High potassium levels can interfere with proper lung function, causing difficulty breathing or shortness of breath.

7. Confusion and Mental Changes: Hyperkalemia can affect brain function, leading to confusion, dizziness, and even a loss of consciousness.

It is essential to note that the warning signs of high potassium may vary depending on the individual’s overall health status and underlying medical conditions. In people with kidney disease, high potassium can occur gradually with few symptoms. In contrast, athletes may experience symptoms more quickly due to the effects of exercise on potassium levels in the body.

If you are experiencing any of these symptoms, it is essential to seek medical attention immediately. If left untreated, high potassium levels can lead to life-threatening complications such as cardiac arrest, muscle paralysis, and kidney failure. Your healthcare provider may perform a blood test or other diagnostic tests to determine your potassium levels and the cause of hyperkalemia.

Treatment options may include potassium-lowering medications, intravenous fluids or other medical interventions, and lifestyle modifications such as dietary changes to reduce potassium intake.

High potassium levels in the bloodstream can cause severe health problems, and it is essential to be aware of the warning signs of hyperkalemia. If you experience any of the symptoms mentioned above, seek medical attention immediately to receive prompt treatment and avoid complications. Early diagnosis and treatment are essential for managing high potassium levels and preserving your overall health and wellbeing.

How can I lower my potassium level quickly at home?

Before I answer your question on how to lower potassium levels at home, it is important to understand why you need to lower your potassium levels. High potassium levels in the blood, a condition known as hyperkalemia, can cause serious health complications, such as irregular heartbeats and cardiac arrest.

Therefore, it is important to follow your doctor’s recommendations on how best to manage high potassium levels.

That being said, there are some steps that individuals can take to help lower their potassium levels at home. Here are some tips:

1. Increase your water intake: Drinking plenty of water can help flush excess potassium out of the body. However, it is important to remember that overhydration can also be harmful, so speak to your doctor about how much water you should be drinking.

2. Choose low-potassium foods: Limit your intake of high-potassium foods such as bananas, potatoes, avocados, spinach, and tomatoes. Instead, opt for low-potassium foods such as apples, berries, pineapple, cauliflower, and kale.

3. Use a salt substitute: Many salt substitutes contain potassium chloride, which can increase your potassium levels. Instead, look for a substitute that is sodium-based.

4. Take medication as prescribed: If you have been prescribed medication to lower your potassium levels, make sure to take them as directed by your doctor.

5. Avoid supplements: Some supplements, including potassium supplements and herbal remedies such as licorice, can increase your potassium levels. Therefore, be cautious when taking supplements and speak to a healthcare professional.

6. Monitor your levels: Test your potassium levels regularly to ensure that they are within the normal range. Speak to your doctor about the frequency of testing that is appropriate for your situation.

Managing high potassium levels is an important part of ensuring good health. While these tips can help manage your potassium levels at home, it is important to work with your doctor to develop a treatment plan that is best for you.

What is immediate treatment for high potassium?

When high potassium levels are detected in the body, immediate treatment is necessary to prevent serious health complications such as muscle weakness, heart arrhythmias, respiratory failure or even cardiac arrest. The normal range for serum potassium is 3.5-5.0 mmol/L, and when the blood test shows potassium levels exceeding the range, the condition is referred to as hyperkalemia.

The initial step in the treatment of hyperkalemia is to identify the cause of elevated potassium levels. The main causes of hyperkalemia include kidney disease, medications, acid-base imbalance, dehydration, adrenal insufficiency, and cellular destruction. Once the underlying cause is identified, the next step would be to reduce the potassium levels and regularize cardiac functioning using immediate treatment options such as:

1. Calcium gluconate infusion: Calcium gluconate is a medication that helps stabilize the heartbeat and decrease the risk of arrhythmias caused by high potassium levels. This medication counteracts the effects of potassium on the heart and is administered intravenously.

2. Insulin and glucose injection: Insulin is an effective way of driving potassium levels back into the cells, thereby reducing the amount of potassium in the bloodstream. Glucose is also given, along with insulin to prevent hypoglycemia.

3. Salbutamol inhalation: Salbutamol inhalation is a nebulizer therapy that can be used in cases of mild to moderate hyperkalemia. The medicine helps to move potassium into the cells and out of the bloodstream.

4. Loop diuretics medication: Loop diuretics accelerate the elimination of excess potassium through the kidneys, before it enters the bloodstream.

5. Hemodialysis: In severe cases of hyperkalemia, hemodialysis may be required. During this procedure, the patient’s blood is filtrated outside the body using a dialysis machine, which helps to remove excess potassium and other waste products from the blood.

It is important to note that treatment for hyperkalemia should be customized for each individual patient, based on the underlying cause, severity of the condition, and other medical conditions present. Monitoring of potassium levels and cardiac function is also necessary following intensive treatment.

Does drinking water help lower potassium?

Drinking water is an essential task for maintaining a healthy body. It is crucial for various bodily functions, including digestion, absorption, and transportation of nutrients. However, the question that arises is whether drinking water helps lower potassium in the human body. To answer this question, we need to understand the role of potassium in the body.

Potassium is a mineral that is vital for the proper functioning of various bodily processes such as nerve signaling, muscle contractions, and fluid balance. It helps in maintaining a regular heartbeat, regulating fluid balance, and promoting overall health. However, high levels of potassium in the blood can result in a condition known as hyperkalemia, which can lead to severe health issues such as muscle weakness, heart attack, and paralysis.

To lower potassium levels in the body, it is crucial to understand the underlying causes that trigger hyperkalemia. Several factors can contribute to high potassium levels, such as kidney disease, certain medications, and poor dietary habits. Therefore, to lower potassium levels, it is essential to identify the root cause and address it accordingly.

Drinking water alone may not significantly lower potassium levels in the body. However, increasing water intake can help improve kidney function, which is the essential organ responsible for regulating potassium levels in the body. Staying hydrated can enhance the kidney’s ability to filter and excrete excess potassium from the body through urine.

Therefore, drinking adequate amounts of water can help maintain proper kidney function and prevent the buildup of excess potassium in the body.

Additionally, making dietary changes such as avoiding potassium-rich foods and increasing water-soluble fiber intake, can help lower potassium levels in the body. Some foods that are high in potassium include bananas, sweet potatoes, avocados, and spinach. Cutting down on these foods or consuming them in smaller portions can significantly lower potassium levels in the body.

Drinking water can play a significant role in managing and preventing high potassium levels in the body by promoting proper kidney function. However, it is essential to identify the underlying cause of hyperkalemia and make appropriate dietary changes for effective management of this condition. Therefore, while drinking water alone may not help to lower potassium levels in the body, it is an essential part of an overall healthy lifestyle that can promote optimal kidney function and prevent hyperkalemia.

What drink lowers potassium?

Potassium is an essential nutrient that is important in maintaining several physiological functions in the body. It is involved in maintaining fluid balance, regulating nerve and muscle function, and supporting the proper functioning of the heart. However, in some cases, excessively high levels of potassium in the blood can lead to hyperkalemia, a condition that can cause serious health problems such as heart arrhythmias, muscle weakness, and even paralysis.

It is, therefore, essential to maintain adequate potassium levels in the body.

When it comes to the question of what drink lowers Potassium, it is important to understand that there is no single drink that can lower potassium levels in the body. In cases where blood potassium levels are high, a combination of dietary changes and medications may be required to keep potassium levels in check.

There are certain foods and drinks that are known to be high in potassium, and consuming them in large quantities can lead to hyperkalemia. For example, banana, avocado, sweet potato, white potato, spinach, and prune juice are all high in potassium. On the other hand, drinks that are lower in potassium include water, soda, coffee, beer, and wine.

However, these drinks should be consumed in moderation, and should not be used as the sole method of reducing potassium levels in the body.

If an individual has been diagnosed with hyperkalemia, a doctor may recommend a low-potassium diet, which may involve limiting certain high-potassium foods and beverages. In addition to this, certain medications such as diuretics or potassium-binding agents may also be prescribed to help lower potassium levels in the body.

There is no one drink that can lower potassium levels in the body. Maintaining adequate potassium levels is important for overall health and wellbeing, and in cases where blood potassium levels are high, dietary changes and medications may be recommended to keep potassium levels in check. It is always best to consult a doctor or a registered dietitian before making any significant changes to one’s diet, as they can guide you on the best course of action based on your individual health needs.

When should you be hospitalized for high potassium?

High potassium, also known as hyperkalemia, is a medical condition that happens when there is an excessive amount of potassium in the blood. While most people are able to handle small amounts of high potassium, a severe case can be life-threatening and requires immediate medical attention. In general, when the potassium levels in the blood exceed 5.5 millimoles per liter (mmol/L), hospitalization may be necessary.

There are several factors that can contribute to high potassium levels, including dehydration, kidney disease, medication use, and certain medical conditions. Symptoms of high potassium include muscle weakness, nausea, vomiting, and abnormal heart rate. If you experience any of these symptoms, it is important to seek immediate medical attention to determine the underlying cause and receive appropriate treatment.

If you have a history of kidney disease or other medical conditions associated with high potassium levels, it is important to monitor your potassium levels regularly. This can be done through blood tests at your doctor’s office or through home monitoring devices. If your potassium levels reach a dangerous level, your doctor may recommend hospitalization to receive medications to lower your levels.

Other factors that may warrant hospitalization for high potassium include severe symptoms or potassium levels greater than 6.5 mmol/L. In these cases, emergency medical care may be necessary to manage symptoms, lower potassium levels, and prevent complications.

High potassium levels can be a serious medical condition that requires prompt medical attention. If you experience symptoms of high potassium or have a history of kidney disease or other medical conditions associated with high potassium levels, it is essential to seek medical attention promptly. Hospitalization may be necessary depending on the severity of your symptoms and potassium levels.

By getting the appropriate treatment and monitoring, you can manage high potassium and prevent further health complications.

How urgent is high potassium?

High potassium, also called hyperkalemia, is a medical condition that can be life-threatening if left unmanaged. Potassium is an essential mineral that plays a vital role in the proper functioning of muscles, nerves, and the heart. A normal potassium level in the blood is between 3.5 and 5.0 millimoles per liter (mmol/L).

When potassium levels exceed 5.0 mmol/L, it is considered hyperkalemia.

The severity of hyperkalemia is determined by the level of potassium in the blood and the rate at which the level increases. Mild hyperkalemia may not cause any symptoms, but moderate to severe hyperkalemia can cause a range of symptoms such as muscle weakness, nausea, numbness, and tingling. Severe hyperkalemia can also lead to cardiac arrest, which can be fatal.

The urgency with which hyperkalemia must be treated depends on the severity of the condition. If a patient has a potassium level of 5.5 to 6.0 mmol/L and is asymptomatic, the condition may not require immediate treatment. In such cases, the doctor may schedule a follow-up appointment to monitor the patient’s potassium levels over time.

However, if a patient has a potassium level greater than 6.0 mmol/L or is experiencing severe symptoms, immediate medical attention is necessary. A medical professional may administer medications such as calcium gluconate, insulin, and glucose, or may recommend dialysis to remove excess potassium from the body.

High potassium can be a dangerous condition that requires prompt attention. The urgency of treatment depends on the level of potassium in the blood and the severity of the symptoms. If you experience symptoms related to high potassium, it is important to seek medical attention immediately.

What is a fatal potassium level?

Potassium is a vital electrolyte that helps regulate various bodily functions. It plays a critical role in the proper functioning of the muscles, heart, and nervous system. The normal range of potassium levels in the blood is between 3.5 to 5.0 millimoles per liter (mmol/L). If the level of potassium in the blood falls below this range, it may lead to hypokalemia, which can cause several symptoms such as weakness, cramps, and irregular heartbeat.

On the other hand, if the level of potassium in the blood goes excessively high, it can lead to hyperkalemia. Hyperkalemia is a potentially life-threatening condition that can cause severe heart problems and other complications. A fatal potassium level refers to the level of potassium in the blood that is high enough to cause death.

However, the exact level at which potassium becomes fatal can vary depending on several factors, such as the person’s overall health, the underlying medical conditions, and the speed at which the potassium level rises.

Medical guidelines suggest that a potassium level above 6.0 mmol/L is considered severe hyperkalemia and requires immediate attention. If left untreated, severe hyperkalemia can cause life-threatening complications such as cardiac arrest, paralysis, kidney failure, and even death. However, the symptoms of hyperkalemia may vary depending on the severity of the condition.

The early symptoms may include muscle weakness, fatigue, nausea, and vomiting. As the potassium level in the blood continues to rise, the person may experience irregular heartbeat, chest pain, shortness of breath, and loss of consciousness.

A fatal potassium level is a condition where the level of potassium in the blood is so high that it can cause death. Hyperkalemia is a severe medical emergency that requires immediate treatment, and if left untreated, it can cause life-threatening complications. Therefore, it is essential to keep a close eye on your potassium levels and seek medical attention if you notice any symptoms of hyperkalemia.

A healthy lifestyle, a balanced diet, and regular medical checkups can help prevent hyperkalemia and other related conditions.

What medication is given when potassium is too high?

When potassium levels in the blood are too high, a condition called hyperkalemia can occur. Hyperkalemia can cause various symptoms such as muscle weakness, irregular heartbeat, and even cardiac arrest if left untreated. The primary aim of treating hyperkalemia is to reduce potassium levels in the blood to normal levels by either removing potassium from the body or shifting potassium from the bloodstream to the cells.

One of the most common medications given for hyperkalemia is potassium binders such as sodium polystyrene sulfonate (SPS) or calcium polystyrene sulfonate (CPS). These medications work by binding potassium in the gut, preventing it from being absorbed into the bloodstream. SPS and CPS are typically given as oral medications, and they are often mixed with sorbitol to hasten their efficacy.

Another medication used to treat hyperkalemia is diuretics such as furosemide or bumetanide. Diuretics help lower potassium levels by increasing the excretion of urine and promoting the elimination of potassium from the body. A combination of diuretics and potassium binders is often used to manage hyperkalemia in severe cases.

Furthermore, intravenous insulin and glucose may be used to shift excess potassium from the bloodstream to the cells. Insulin helps to convert glucose into energy, which subsequently leads to the uptake of potassium into the cells. This results in a temporary drop in potassium concentration in the bloodstream.

The treatment of hyperkalemia mainly involves the administration of medications that help to reduce potassium levels in the blood. Potassium binders, diuretics, and insulin are among the drugs that may be used individually or in combination, depending on the severity of hyperkalemia. It is important to note that treatment should be initiated promptly to prevent serious complications.

Should I worry about high potassium levels?

High potassium level, also known as hyperkalemia, is a medical condition characterized by excess potassium in the bloodstream. It is a serious condition that requires medical attention as it can lead to life-threatening complications.

Potassium is an essential mineral that plays a vital role in maintaining the normal function of nerves, muscles, and the heart. The normal range for serum potassium levels is between 3.5 and 5.0 mmol/L. When the levels go above 5.0 mmol/L, it is considered high and requires immediate medical attention.

High potassium levels can be caused by a variety of factors such as kidney disease, diabetes, alcoholism, adrenal insufficiency, and the use of certain medications such as ACE inhibitors, beta-blockers, and potassium-sparing diuretics. Some common symptoms of hyperkalemia include muscle weakness, numbness or tingling, nausea, vomiting, irregular heartbeat, and difficulty breathing.

If you suspect that you have high potassium levels, it is important to seek medical attention immediately for proper diagnosis and treatment. Your doctor may request blood tests to confirm the diagnosis and determine the severity of the condition. Treatment includes medications to remove excess potassium from the body, such as diuretics or glucose and insulin therapy.

In severe cases, dialysis may be necessary.

While hyperkalemia is a serious condition, with timely diagnosis and proper treatment, it can be managed effectively. It is important to monitor your potassium levels regularly, especially if you have risk factors for hyperkalemia, such as kidney disease or diabetes. Eating a diet low in potassium can also be helpful in managing high potassium levels.

It is essential to monitor your potassium levels regularly, seek medical attention if you suspect high potassium levels, and work with your healthcare provider to manage the condition effectively. With proper care and management, high potassium levels can be controlled, and serious complications can be avoided.

Resources

  1. Hyperkalemia (high potassium) – National Kidney Foundation
  2. Six Steps to Controlling High Potassium
  3. High potassium (hyperkalemia): Causes, prevention and …
  4. Hyperkalemia (High Potassium): Symptoms, Causes, Treatment
  5. High potassium (hyperkalemia) When to see a doctor