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- Title
Diuretics and potassium metabolism: A reassessment of the need, effectiveness and safety of potassium therapy.
- Authors
Kassirer, Jerome P.; Harrington, John T.
- Abstract
The lack of clear evidence of clinically important potassium depletion in the nonedematous patient treated with diuretics, coupled with a small risk of life-threatening hyperkalemia, leads us to conclude that neither potassium-sparing diuretics nor potassium supplementation should be given routinely to such patients. It seems rational to recommend instead that serum potassium concentration should be monitored prior to therapy and at one to two-month intervals thereafter until a pattern emerges. If the serum potassium concentration remains above 3.0 mEq/liter, there is little justification to attempt to change the potassium concentration, unless symptoms clearly attributable to potassium deficiency develop. In the rare instance in which serum potassium concentration falls below 3.0 mEq/liter, administration of 10% potassium chloride solution, 50 to 60 mEq/day by mouth, is an inexpensive and effective means of restoring normal potassium balance in most patients. Wax-matrix formulations of potassium chloride appear to be safe, well-tolerated, and can be given to patients who are intolerant of oral potassium chloride solutions. If distal-blocking agents are used, careful monitoring of serum potassium concentration is certainly in order. Distal-blocking agents should be given to patients with renal functional impairment only with great caution because of the substantial risk of hyperkalemia. The data are conflicting in edematous patients. Nevertheless, the value of restoring potassium balance appears to outweigh the risk of treatment with potassium salts or potassium-sparing diuretics. Therapy is probably warranted in patients receiving digitalis and in those susceptible to developing hepatic coma. In such patients, an oral potassium chloride supplement usually suffices to correct the deficit. Mild deficits are usually corrected by giving 40 to 80 mEq/day, and more severe deficits may require as much as 100 to 120 mEq/day with careful monitoring of the serum concentration. If serum potassium concentration does not increase with an oral potassium supplement, a distal-blocking agent can be used instead of the supplement. Spironolactone is quite effective but it is fairly expensive, and if prolonged therapy is required it may cause gynecomastia. Triamterene is less expensive but it also may be less effective, and its use may be complicated by intolerable gastrointestinal side effects or a rash. Amiloride has some possible value, but it is not yet available in some countries. As noted before, potassium chloride administration is more dangerous in the elderly, in patients with impaired renal function, and in those receiving distal-blocking agents. Potassium chloride and distal-blocking agents should be used together only in patients with severe refractory potassium deficiency, and when this combination is utilized, frequent monitoring of the serum potassium concentration is mandatory.
- Subjects
POTASSIUM metabolism; POTASSIUM in the body; DIURETICS; THERAPEUTICS; POTASSIUM deficiency diseases; POTASSIUM chloride; SPIRONOLACTONE
- Publication
Kidney International, 1977, Vol 11, Issue 6, p505
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1038/ki.1977.67