Does a cc check electrolytes free#
Potassium-sparing diuretics may not free the clinician from checking a potassium level, however. One of these transiently hypokalemic patients was also taking triamterene, a potassium-sparing diuretic. Three of these patients normalized without therapy. Peters and coworkers6 documented potassium levels below 3.5 mEq/L in 6 of 19 patients taking hydrochlorothiazide 25 or 50 mg for 20 weeks. Only 3 patients in this group had potassium levels below 3.5 mmol/L, and all decreases were only transient. Lemieux and colleagues8 followed 50 patients receiving a variety of diuretic regimens (hydrochlorothiazide 50 to 100 mg daily or every other day with or without reserpine 0.25 mg daily). The latter risk factor may be related to a higher dose-to-weight relationship. Widmer and coworkers5 found that the risk of hypokalemia was greatest with concomitant glucocorticoid use, polypharmacy (greater than 12 medications administered), and female sex. Factors including the type of diuretic used, dosage, duration of use, dietary potassium, and so forth, make predicting an individual patient’s progression nearly impossible. The incidence of hypokalemia reported for patients on diuretic therapy is broad (7.2% to 56%), 3- 6 and the time period required to develop hypokalemia varies (1 week6 to >1 year 7). Hypokalemia is defined as a serum potassium level less than 3.5 mmol/L (3.5 mEq/L) hypokalemia at levels between 3.1 and 3.4 mmol/L is considered mild. Serum K+ concentration should be measured before initiation of a diuretic and 1 week after initiation of increase in dose of the diuretic.”
The University of Iowa Family Practice Handbook2 states: “Maximal decrease in serum K+ concentration is usually seen after 7 days of treatment. For patients with asymptomatic hypertension they recommend trying to maintain a serum potassium level of at least 4.0 mmol/L. The National Council on Potassium in Clinical Practice issued a set of guidelines for potassium replacement in September 2000.1 The authors recommend using thiazide diuretics at a low dose only (eg, 12.5-25 mg of hydrochlorothiazide daily) and adding a potassium-sparing diuretic drug when higher diuretic doses are needed. Hypokalemia and diuretics: an analysis of publications. Left ventricular mass, serum electrolyte levels and cardiac arrhythmias in patients with mild hypertension treated with cilazapril or hydrochlorothiazide. Plasma potassium levels in hypertensive patients receiving fixed-combination diuretic therapy. Hypokalemia during the treatment of arterial hypertension with diuretics. Lemieux G, Beauchemin M, Vinay P, Gougoux A. Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension. Diuretic-related hypokalaemia: the role of diuretics, potassium supplements, glucocorticoids and -adrenoceptor agonists. Potassium restoration in hypertensive patients made hypokalemic by hydrochlorothiazide. Schnaper HW, Freis ED, Friedman RG, et al. Hypokalemia associated with diuretic use and cardiovascular events in the systolic hypertension in the elderly program. Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB. Chapter 5 Hematologic, electrolyte, and metabolic disorders: potassium.ģ. University of Iowa family practice handbook. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Cohn JN, Kowey PR, Whelton PK, Prisant M.
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