Dialysis patients are known to tolerate high potassium due to the chronic hyperkalemia that is inherent in their disease. Despite this, most reports of extremely high potassium (>9 mmol/L) are in the setting of cardiac arrest. We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments.