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Hypokalemia, Low plasma potassium

Discussion in 'General ME/CFS Discussion' started by pattismith, Nov 25, 2017.

  1. pattismith

    pattismith Senior Member

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    Normal potassium range should be 3.6-5.2 mmol/l

    but many of us may feel more comfortable around 4.2-4.6 mmol/l

    It's important to remember that both hypo and hyper kalemia can be deadly, so regular monitoring is advised.

    symptoms for hypokalemia:

    Drug induced hypokalemia:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357351/table/t2-ptj4003185/

    I found another possible trigger: supplementation with B12 can compete with Potassium chloride for intestinal absorption. Sublingual B12 or injections may prevent this issue.

    Other triggers (follow the link if you wish a more complete list):


    "Increased potassium entry into cells

    This can occur by a number of mechanisms.

    • Elevation in extracellular pH: metabolic or respiratory alkalosis can facilitate potassium entry into cells (hydrogen ions leave the cells and potassium enters into cells to maintain electroneutrality). Administration of sodium bicarbonate to treat metabolic acidosis can also cause this phenomenon.

    • Increased beta-adrenergic activity: catecholamines promote potassium entry into the cells by increasing Na-K-ATPase activity. [4] .... Transient hypokalemia may also occur during stress-induced release of epinephrine and cortisol (e.g., during acute illness or coronary ischemia). [6]

    • Increased availability of insulin: insulin promotes the entry of potassium into skeletal muscle and hepatic cells by increasing the activity of the Na-K-ATPase pump. [4] ... The plasma concentration of potassium may also be reduced by a large carbohydrate load.

    • Increased blood cell production during anabolic states: increased potassium entry into cells may be caused by sharp increases in hematopoietic cell production that occurs with the use of granulocyte-macrophage colony-stimulating factor (GM-CSF) in neutropenia. [11] This may also occur after the administration of vitamin B12 or folic acid in megaloblastic anemia. [11]

    • Chloroquine intoxication: hypokalemia is a common finding in acute chloroquine intoxication. [12] This is caused by potassium movement into cells and can be exacerbated by the use of epinephrine to help treat the intoxication.

    • Hypothermia: there have been reports that hypothermia may result in a drive of potassium into cells associated with a plasma potassium concentration decrease to below 3.0 to 3.5 mEq/L. [13] This is reversible on rewarming. Supplementation of potassium during hypothermia can also cause a significant increase in serum potassium concentration on rewarming.


      Losses from the GI tract
      Loss of gastric or intestinal secretions from any cause (vomiting, diarrhea, laxatives, or tube drainage) can cause hypokalemia. [11]
    Increased loss of potassium in urine
    A wide variety of causes are associated with increased potassium loss in urine.

    • Mineralocorticoid excess: urinary potassium wasting is also characteristic of any condition associated with primary hypersecretion of mineralocorticoids (primary aldosteronism) or hypersecretion of catecholamines via enhanced release of renin. Apparent mineralocorticoid excess, characterized by edema, hypertension, and hypokalemia, has been well documented as occurring in disorders with congenital deficiency, or lack of renal 11-beta-hydroxysteroid dehydrogenase type 2 or its inhibition by chronic licorice ingestion, acute alcoholism, chronic liver or renal disease, preeclampsia (hypocalcemia), .....

    • Presence of nonreabsorbable anions: a marked increase in potassium excretion by reabsorbing sodium in exchange for potassium can occur during vomiting or type 2 renal tubular acidosis, or beta-hydroxybutyrate in diabetic ketoacidosis, or it may be drug-induced. [23] [24] In these conditions a decrease in distal chloride delivery and the enhanced secretion of aldosterone also promote potassium secretion. [25]

    • Hypomagnesemia: this is present in up to 40% of patients with hypokalemia. [27] Hypomagnesemia can lead to increased urinary potassium loss via an uncertain mechanism, possibly involving an increase in the number of open potassium channels. The presence of hypocalcemia is often a clue to underlying hypomagnesemia. It is important to determine whether there is hypomagnesemia because hypokalemia often cannot be corrected until the magnesium deficit is corrected first.

    • Polyuria: this is most likely to occur in primary (often psychogenic) polydipsia in which the urine output may be elevated over a prolonged period of time. [28] Polyuria can also occur in central diabetes insipidus, although patients typically seek medical care soon after the polyuria begins.
    Increased loss via sweating and skin
    • Exercising in a hot climate can produce more than 10 L of sweat daily, leading to potassium depletion if losses are not replaced. [29]

    • Urinary potassium excretion also may contribute, since aldosterone release is enhanced both by exercise (via catecholamine-induced renin secretion) and volume loss.

    • Burns and other dermatologic conditions (i.e., eczema or psoriasis involving a large surface area of the skin, especially with the use of topical steroids) can cause increased loss of potassium through the skin.
    Miscellaneous
    • Chronic alcoholism is a common cause of hypokalemia. Hypokalemia occurs for various reasons, such as poor oral intake, associated vomiting, and secondary hyperaldosteronism.

    • Hypokalemia can be induced in some patients by maintenance dialysis. Potassium losses can reach up to 30 mEq/day in patients on chronic peritoneal dialysis. This may become clinically important if potassium intake is reduced or if there are concurrent GI losses. [31]

    • Plasmapheresis removes potassium in the same concentration as it is present in plasma. Albumin use as a replacement fluid can cause transient dilutional hypokalemia. [32]"
     
    Last edited: Nov 26, 2017
    pamojja and notmyself like this.
  2. aquariusgirl

    aquariusgirl Senior Member

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    This was helpful & timely fir me. I tanked my potassium by taking High dose B1
     
  3. alicec

    alicec Senior Member

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    Me too (maybe other high dose B vitamins also).
     
  4. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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    These problems are one of the reasons I've taken to eating liver - it gives me the B vitamins along with the minerals including potassium.

    Top 120 Foods High in Potassium - FoodTips.org
    https://www.foodtips.org/potassium-foods/
    beef liver braised, 352. beef liver fried, 351. pork shoulder lean roasted, 346. veal meat lean cooked, 338. lamb leg braised in oil, 336...

    It contains a large amount of high-quality protein, an easily absorbed form of iron, all of the B vitamins (including B12 and folic acid in significant amounts), balanced quantities of vitamin A, many trace elements and minerals including copper, zinc, chromium, phosphorous and selenium, essential fatty acids EPA, DHA ...
    Benefits of Eating Liver: 10 Questions Answered - Radiant Life Blog
    https://blog.radiantlifecatalog.com/bid/.../Benefits-of-Eating-Liver-10-Questions-Answer...
     
  5. pamojja

    pamojja Senior Member

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    Usually a bid different with each lab, for example mine gives 3.5-5.1. Heard optimal would be something between 4 and 5. Potassium is perplexing to me, since the more I supplement (now 2.2 g/d already for 2 years, beside 4.2 g from diet) it didn't really change much in my labs:

    Serum: 4.5 (average values since 9 years)
    Arterial blood: 3.9 mmol/l (3.6-4.8 normal range)
    Whole blood: 1781 mg/l (1750-1850 normal range)
    Hair tissue; 56 ug/g (20-240 normal range; 100 allegedly ideal)

    I start to suspect that it is really difficult to overdose on potassium, as expressed in this a bit contrarian article:

    http://www.bibliotecapleyades.net/salud/salud_potassium.htm

    And indeed, even the least contrarian wikipedia confirms:

    But of course, always be careful, measure blood and kidney function, and do dissolve the potassium well in water before consumption.
     
    Last edited: Nov 26, 2017
  6. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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    For some it's actually quite easy to overdose on potassium.

    If you have low adrenal function, in particular - low aldosterone, you are at high risk for overdosing on potassium because your kidneys no longer excrete excess potassium, so it just builds up in a very dangerous manner.

    Normally, your kidneys keep a healthy balance of potassium by flushing excess potassium out of your body. But for many reasons, the level of potassium in your blood can get too high. This is called hyperkalemia, or high potassium. May 22, 2017
    High Potassium: Causes, Symptoms, and Diagnosis - Healthline
    https://www.healthline.com/health/high-potassium-hyperkalemia

    Unfortunately many of us here are abynormal. Then there are the meds that cause high potassium:

    Examples of medications that can increase blood potassium levels include:
    • ACE inhibitors,
    • nonsteroidal anti-inflammatory drugs (NSAIDs),
    • Angiotensin II Receptor Blockers (ARBs), and.
    • potassium-sparing diuretics (see below).
    What Is Hyperkalemia? Symptoms, Treatment, Causes, & Signs
    https://www.medicinenet.com/hyperkalemia/article.htm
     
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  7. pattismith

    pattismith Senior Member

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    Did you monitor your blood potassium after your intake, or had you just your blood potassium tested in the morning (fasting)? I guess you just had a morning fasting test, which won't tell you what happened in your blood the day before when you took oral potassium.

    Did you take oral normal potassium or Extended Release Potassium?
    The normal potassium is quickly absorbed and will raise your blood level only a short time, so you won't catch it if you test the day after...

    If you want to know what happen when you take potassium you need to monitor your levels.

    I did it with 600 mg Extended Release Potassium, my level increased from 3.9 to 4.5 mmol/l then decreased to 3.9 the next morning.
     
    Last edited: Nov 27, 2017
  8. pamojja

    pamojja Senior Member

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    It's just if one is long enough on health forums one hears of hypokalemia almost every day, therefore these allegedly easy oral potassium-overdoses must be all deathly, so one never hears of one? ;)

    This is not just 1, but the average of 30 potassium serum tests taken during 9 years. Most are fasted, some are not. Lowest 3.4, highest >8.5 (probably a lab error), some month afterwards 5.3. Not associated with intake but a severe chronic bronchitis. Without any hyperkalemia symptoms.

    Wouldn't want such concentrated boluses of potassium as in extented release (for reasons outlined in the linked article). Usually get a mix of potassium chloride, citrate and bicarbonate well dissolved in water.

    Not only in serum, but blood and tissue just as well.

    So still not optimal. I want optimal levels also in the morning, therefore consider it more accurate to test it fasted.
     
    Last edited: Nov 27, 2017

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