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Potassium is important for a healthy nervous system and a
regular heart rhythm. It helps prevent stroke and works with
sodium to control the body's water balance.
Potassium, sodium, chloride, and bicarbonate are called electrolytes.
They are responsible for the acid-base balance and osmotic pressure
in the body; excessively high or low levels are life-threatening.
Other physiologic functions in which potassium plays a role
include energy metabolism, membrane transport, normal water balance,
acidbase balance, and osmotic equilibrium. The relationship
of potassium and sodium is essential to good health, with a ratio
of dietary potassium to sodium recommended at 5:1.
Vomiting, diarrhea, or perspiration can, if severe enough,
can cause a dangerous low level of potassium. Trauma also causes
a precipitous drop (between 50 and 68 percent of trauma patients
have low level).
Hypokalemia - the name given to low blood potassium is rarely
caused by poor nutrition. The widespread use of diuretics, is
the main reason hypokalemia has become so prevelant. An estimated
20 percent of all people who take "water pills," as
these drugs are known, are hypokalemic.
Recent studies have provided strong evidence that potassium
may have an antihypertensive function. A meta-analysis of 33
randomized controlled clinical trials with approximately 2,600
participants demonstrated that potassium supplementation was
associated with a significant reduction in mean systolic and
diastolic blood pressure.
Potassium readings can be used with a great degree of accuracy
to predict an individual's risk for heart rhythm abnormalities.
Leg cramps, particularly the ones that awaken you at night,
may also stem from low levels of the mineral (as well as of magnesium
and calcium).
Low-calorie dieting and extreme exercising make an individual
prone to potassium-related energy loss.
Insufficient potassium and magnesium may contribute to the
onset of chronic fatigue syndrome.
Deficiency: Fatigue or weakness may be the most
common indicators of a need for more potassium. Edema and hypoglycemia
are signs of potassium deficiency disease.
Depleting Agents: Medications that may diminish
potassium levels include corticosteroids, amphotericin B, antacids,
loop diuretics, thiazide diuretics, and insulin. Alcohol, coffee
and sugar can cause depletion of potassium as well.
Sources:.Food sources of potassium include dairy
foods, fish, fruit, legumes, meat, poultry, vegetables, and whole
grains. High amounts are found in apricots, avocados, bananas,
lima beans, blackstrap molasses, brewer's yeast, brown rice,
dates, dulse, figs, dried fruit, garlic, nuts potatoes, raisins,
spinach, winter squash, torula yeast, wheat bran, yams, and yogurt.
Herb Sources: Herbs that contain potassium include
catnip, hops, horsetail, nettle, plantain, red clover, sage and
skullcap.
Precautions: Use with caution in patients with
renal insufficiency. Should not be used in patients with severe
renal impairment. Because renal function declines with age, the
elderly are at high risk of renal insufficiency. Care should
be taken when prescribing potassium supplements to the elderly.
Dosage Ranges and Duration of Administration: Potassium
supplements are usually available in the form of potassium salts
or potassium bound to mineral chelates. These include the following:
- Potassium acetate
- Potassium bicarbonate
- Potassium chloride
- Potassium citrate (effervescent)
- Potassium gluconate
- Potassium is also sometimes included in multivitamin preparations.
The average potassium intake estimated by the National Research
Council is as follows:
- In infants: 780 mg/day
- In children: 1,600 mg /day
- In adults: 3,500 mg/day
There is no recommended increased intake of potassium during
pregnancy and lactation.
INTERACTIONS
Angiotensin-Converting Enzyme (ACE) Inhibitors
ACE inhibitors may produce hyperkalemia, particularly when
used in combination with nonsteroidal anti-inflammatory drugs
(NSAIDs), potassium-sparing diuretics, potassium supplements,
potassium-containing salt substitutes, and in patients with autonomic
neuropathy, adrenal insufficiency, renal impairment, and diabetes
mellitus. For this reason, potassium supplements may not be warranted
in patients taking these medications; serum potassium levels
should be monitored closely.
Beta-Adrenergic Blockers
Beta-adrenergic blockers may elevate potassium levels by
promoting a redistribution of this electrolyte. Potassium levels
should be monitored in patients taking these medications, particularly
in patients with compromised renal function.
Cyclosporine
Cyclosporine may induce hyperkalemia by decreasing renal excretion
of potassium and interfering with aldosterone production or secretion.
Potassium levels in patients on cyclosporine therapy, particularly
those with renal insufficiency, should be monitored carefully.
Digoxin
Hypokalemia increases the risk of cardiac glycoside toxicity.
Normal levels of potassium should be maintained during digoxin
treatment.
Heparin
Heparin may contribute to hyperkalemia by impairing renal excretion
of potassium as a result of interference with aldosterone production
or secretion. Serum potassium levels should be monitored in patients
on heparin therapy, especially if potassium supplements are added
to the medication regimen.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs can affect renal function and decrease potassium excretion.
Hyperkalemia can occur in patients with mild renal insufficiency
or normal renal function. Ibuprofen may increase the risk for
renal insufficiency and cause hyperkalemia in patients that are
over 76 years old, on certain diuretic therapy, or who have cirrhosis
and renal vascular disease. Individuals taking NSAIDs should
avoid potassium supplements.
Trimethoprim; Co-Trimoxazole
Standard doses of trimethoprim monotherapy as well as trimethoprim
combined with sulfamethoxazole have been shown to cause hyperkalemia
in a significant number of patients treated for various infections.
Patients treated with these medications should be closely monitored
for hyperkalemia, especially those with renal insufficiency.
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