Using Water Pills to Lower Potassium

High potassium or hyperkalemia can be dangerous. A life-threatening complication of high potassium is a problem with the rhythm of the heart. Please compare the following two pictures: one is a normal heart rhythm, and the other is abnormal in the setting of very high potassium.

This is a picture of a patient with a normal potassium with a normal heart rhythm:

Normal sinus rhythm

This is a picture of a patient with an elevated potassium with an abnormal rhythm:

High potassium with abnormal EKG changes prior to kidney dialysis

One function of the kidneys is to remove potassium from the body. As the kidneys worsen over time, especially in the later stages of chronic kidney disease, the kidneys have more difficulty performing the function of potassium removal.

To treat hyperkalemia, your kidney provider may suggest a low potassium diet. Some low potassium foods you should consider when your potassium is high are broccoli, eggplant, and apples. Some high-potassium foods you might avoid when you have hyperkalemia are bananas, avocados, spinach, and watermelon.

There are several approaches that we can try to help lower your blood potassium level. For example, we can order potassium binders.

Another strategy is to use a water pill or diuretic that helps the kidneys rid the body of potassium. One strong potassium spilling water pill nephrologists use is called chlorthalidone. It is a thiazide diuretic.

Many patients are familiar with the thiazide hydrochlorothiazide. Consider hydrochlorothiazide a weaker version of the more potent diuretic chlorthalidone. The higher potency thiazides can have a stronger effect on lowering the serum potassium. If you are on hydrochlorothiazide, your nephrologist might switch you to chlorthalidone to help with lowering blood potassium, and improving the hyperkalemia.

If the above approaches are ineffective to lower the serum potassium, kidney providers consider ordering dialysis. We try to avoid that if we can.

In summary, if you have hyperkalemia, we will consider using a thiazide diuretic, such as chlorthalidone, to lower your potassium to a safe range. This therapy may help cure hyperkalemia.