Consensus guidelines for the use of potassium replacement in clinical practice
Low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. According to the ‘National Council on Potassium in Clinical Practice’, in order to maintain normal levels of potassium several factors must be take into account such as:
- Baseline potassium values
- The presence of underlying medical conditions (such as CHF)
- The use of medications that alter potassium levels (eg, non–potassium-sparing diuretics) or that lead to arrhythmias in the presence of hypokalemia (eg, cardiac glycosides)
- Patient variables such as diet and salt intake, and
- The ability to adhere to a therapeutic regimen
Because of the multiple factors involved, guidelines should be directed toward patients with specific disease states, such as those with cardiovascular conditions, and toward the general patient population. The following list encompasses the guidelines developed at the 1998 meeting of the National Council on Potassium in Clinical Practice. This council has also called for the continued research on potassium to determine specific recommendations.
- Dietary consumption of potassium-rich foods should be supplemented with potassium replacement therapy.
- Potassium replacement is recommended for individuals who are sensitive to sodium or who are unable or unwilling to reduce salt intake; it is especially effective in reducing blood pressure in such individuals. A high-sodium diet often results in excessive urinary potassium loss.
- Potassium replacement is recommended for individuals who experience nausea, vomiting, diarrhea, bulimia, or diuretic/laxative abuse. Potassium chloride has been shown to be the most effective means of replacing acute potassium loss.
Patients with hypertension
- Patients with drug-related hypokalemia (therapy with a non–potassium-sparing diuretic) should receive potassium supplementation.
- In patients with asymptomatic hypertension, an effort should be made to achieve and maintain serum potassium levels of at least 4.0 mmol/L. This can be achieved with a diet high in potassium-rich foods as well as potassium supplementation.
Patients with CHF
Potassium replacement should be routinely considered in patients with CHF, even if the initial potassium levels appear to be normal (eg, 4.0 mmol/L).The majority of patients with CHF have an increased risk of hypokalemia. In patients with CHF or myocardial ischemia, mild-to-moderate hypokalemia can increase the risk of cardiac arrhythmia. In addition, diuretic-induced hypokalemia can increase the risk of life-threatening arrhythmias.
The risk of hyperkalemia secondary to drug therapy with ACE inhibitors or angiotensin II receptor blockers, makes the regular monitoring of serum potassium level a life saving strategy for these patients. Stress is something also to be considered in these patients as it can trigger the secretion of aldosterone, and therefore a loss of potassium levels.
Patients with cardiac arrhythmias
Maintenance of optimal potassium levels (at least 4.0 mmol/L) is critical in these patients and routine potassium monitoring should be mandatory. Patients with heart disease are often susceptible to life-threatening ventricular arrhythmias. In particular, such arrhythmias are associated with heart failure, left ventricular hypertrophy, myocardial ischemia, and myocardial infarction. Magnesium supplementation should be considered too in order to facilitate the cellular uptake of potassium.
Patients prone to stroke
In patients at high risk for stroke, including those with a history of atherosclerotic or hemorrhagic cerebral vascular accidents, achieving optimal levels of potassium should be a priority. Although the effectiveness of potassium supplementation in reducing the incidence of stroke in humans has not been demonstrated in randomized controlled trials, prospective studies suggest that the incidence of fatal and nonfatal stroke
correlates inversely with dietary potassium intake. In addition, the association of stroke with hypertension is well known.
Patients with diabetes
Patients with diabetes show a marked decline in the levels of potassium, accompanied by a high incidence of cardiovascular and renal complications. Potassium levels should be closely monitored in patients with diabetes and potassium replacement therapy should be administered when appropriate.
Patients with renal impairment
Data suggest a link between potassium levels and lesions of the kidneys in patients with renal disease or diabetes. Animal studies have demonstrated that potassium may offer a protective effect on the renal arterioles. The clinical implications of these findings are not yet clear.
Electrolytes are electrically charged minerals that are significant for providing the infinitesimally small units of life called cells with the electrical energy they need to do their work. Electrolytes exist within cells as well as in the fluid that surround our cells, and can create an electrical flow when they are in the right balance. One of these electrolytes is potassium, which has been shown to have a great positive effect in heart health. A diet rich in potassium, paired with the many benefits of supplemental potassium, like the ‘Heart and Body Extract’ will ensure your heart is well taken care of. Get your bottle today!
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(3) Wilson, Lawrence D. “Nutritional Balancing and Hair Mineral Analysis.” Nutritional Balancing and Hair Mineral Analysis, Center for Development, Inc., 2010, pp. 316–317.