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Spotting Hyperkalemia Symptoms: A Guide for Nursing Students

Nurse Mike (Mike Linares)
By SimpleNursing | Published December 27th, 2023
Published December 27th, 2023
Young woman nurse in scrubs attends to a patient in bed.

Hyperkalemia may sound like the name of a far-off galaxy, but it’s a medical condition that hits close to home.

You’ll likely encounter hyperkalemia in your nursing career, and knowing how to spot it could make all the difference for clients.

What is hyperkalemia?

Hyperkalemia happens when the potassium level in the bloodstream is higher than the normal range of 3.5-5.0 mEq/L.

Potassium is a key electrolyte that helps nerves and muscles, including the heart, function properly. But when there’s too much of it in the blood, it can lead to serious or life-threatening health complications.

These complications include:

  • Cardiac arrest
  • Kidney failure
  • Paralysis

Hyperkalemia is more common among clients with kidney disease or another condition affecting the body’s ability to process potassium properly.

What causes hyperkalemia?

Before we dive into the signs of hyperkalemia, it’s important to understand the common causes that can lead to this electrolyte imbalance.

Here is a list of factors that can contribute to the development of hyperkalemia.

Addison’s disease

This disorder occurs when the adrenal glands don’t produce enough hormones to regulate electrolytes.

Cell damage

Conditions that cause cellular damage or breakdown, such as rhabdomyolysis or tumor lysis syndrome, can release too much potassium into the bloodstream.

Severe injuries or burns can also cause damage to the cells and release too much potassium into the blood.

High potassium foods

Excessive consumption of potassium-rich foods, especially in clients with compromised kidney function, can lead to severe hyperkalemia.

Foods high in potassium include:

  • Bananas
  • Beans
  • Oranges
  • Nuts
  • Potatoes
  • Tomatoes

Encourage clients to eat a low-potassium diet if they’re at risk for hyperkalemia. Consider limiting their portions of potassium-rich foods or substituting other low-potassium options such as broccoli or cauliflower.

Clients should also avoid potassium-enriched salt substitutes because they can add to the risk of hyperkalemia. If changing eating habits doesn’t lower potassium levels, clients may need to take medications to help reduce the amount of potassium in their bodies.

For example, a health care provider (HCP) may prescribe potassium binders to help the kidneys excrete excess potassium.

Kidney dysfunction

The kidneys help maintain potassium balance in the body.

Any impairment in function, such as acute kidney injury or chronic kidney disease, can result in hyperkalemia as the kidneys struggle to remove excess potassium in the blood.


Certain medications can increase potassium levels if not monitored closely.

These medications include:

  • Angiotensin II receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Beta blockers
  • Potassium-sparing diuretics (e.g., spironolactone)
  • Some antibiotics

Poorly-controlled diabetes

High blood glucose levels can lead to increased potassium in the bloodstream.

Recognizing hyperkalemia signs and symptoms

The signs of hyperkalemia vary from mild to severe, with the most serious cases requiring emergency medical attention.

To help you identify the most common symptoms, remember the acronym MURDER.

  • Muscle weakness
  • Urine production — minimal or none (renal failure)
  • Respiratory failure because of seizures or impaired breathing muscle function
  • Decreased cardiac contractility (hypotension, weak pulse)
  • Early indications of cramps or muscle twitches (flaccid, late profound frailty)
  • Rhythm changes (Flat P waves; prolonged PR interval; tall, peaked T waves; widened QRS)

If you’re a nursing student, it’s essential to watch for these manifestations, especially in clients with kidney disease or those taking medications that increase blood potassium levels.

The importance of early detection

Early detection and treatment of hyperkalemia are crucial to prevent serious complications.

It’s vital to conduct regular monitoring of potassium in high-risk clients. Educating clients about dietary restrictions and the importance of adhering to prescribed medications is also important.

This guide provides an overview of symptoms, but nothing replaces professional medical advice. Always consult with an HCP when dealing with potential cases of hyperkalemia.

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Nurse Mike (Mike Linares)
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