Life-threatening hyperkalemia associated with postassium-sparing therapy - abstract

The clinical course of four patients with hyperkalemia and symptomatic bradycardia presenting to the Queen Elizabeth Hospital over a six-month period was studied and risk factors assessed. Four patients were seen over a six-month period who presented with symptomatic bradyarrhthymia due to severe hyperkalemia. Patients' ages were 64 (D), 66 (C), 77 (A), and 83 (B) years and had plasma creatinine concentrations of 238, 805, 195 and 129 æmol/respectively. One pateint (C) was a male. All patients were hypertensive and two (C and D) were diabetic. All four were receiving a fixed dose combined diuretic containing amiloride and hydrochlorothiazide (5 mg A/50 mg H). Three patients (A< B and C) were on this combination for several months before presentation, while case D had been treated for just 5 days. In addition, one patient (B) was receiving supplemental postassium "Slow K" 1 tablet daily (8 mmol) for one week before presentation. Two patients (A and B), both of whom survived, were also receiving nadolol 80 mg daily and one (C) was receiving digoxin 0.125 mg daily. Two patients (C and D) arrested and died shortly after admission (serum K+ 9.3 and 10.0 mmol/1 respectively) while patients B and A (serum K= 8.0 and 8.8 mmol/l respectively) were treated in the intensive care unit. Emergency therapy was given to three patients (A, B and D) based on the characteristic ECG changes. Once the diagnosis was made patients received calcium gluconate, dextrose and insulin infusions and calcium resonium resin. No patient required dialysis or pacemaker insertion. The two patients treated in the intensive care unit were discharged uneventfully. We remind clinicians that caution should be exercised in the use of potassium sparing diuretics especially in those with renal insufficiency. It would be worthwhile that all patients receiving K+ sparing diuretics should have renal function and electrolytes measured before and during therapy (AU)

Efficacy and safety of medium term indapamide treatment in hypertensive diabetic patients

To assess the efficacy and safety of Indapamide, 33 maturity onset diabetics with essential hypertension were treated with Indapamide for 90 days at the single daily dose of 2.5 mg. These patients responded well to treatment: as early as the tenth day, the diastolic blood pressure decreased by 10 mm Hg (p<0.01). At the second month, blood pressure on average was normalized. At the third month, the blood pressure decrease was 16 mm Hg for diastolic and 25.5 mm Hg for systolic. The two-hour post-breakfast blood sugar level was not significantly modified, nor were the other biological parameters monitored: serum creatinine, serum uric acid and serum potassium levels. Indapamide at 2.5 mg per day is effective and safe in hypertensive diabetic patients (AU)

The bioavailability of potassium in bananas

Bananas are known to have a high K+ content. The bioavailability of the K+ in bananas was compared with that in Slow-K tablets in 5 normal subjects. 24-hr urinary K+ excretion was assumed to be an index of K+ absorbed from the gatro-intestinal tract. The results indicate that the K+ in bananasis available, since 24-hr K+ excretion rose significantly during the period of banana consumption. The rise in K+ excretion while taking Slow-K was however, greater, the difference between the two being highly significant (p<0.01). The possible reasons for this difference are discussed. It is suggested that bananas may be a useful and safer alternative to Slow-K for K+ supplementation in patients in whom the extra calories are not contraindicated (AU)

Effect of triamterene on leucocyte sodium and potassium levels in heart disease

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant (AU)