Potassium impairment

Patients receiving spironolactone or amiloride anuria severe hepatic disease hyperkalemia hypersensitivity to triamterene severe or progressive kidney disease or dysfunction, with the possible exception of nephrosis preexisting elevated serum potassium (impaired renal function, azotemia) or patients who develop hyperkalemia while on triamterene. 

Agents acting in the proximal tubule are seldom used to treat hypertension. Treatment is usually initiated with a thiazide-type diuretic. Chlorthalidone and indapamide are structurally different from thiazides but are functionally related. If renal function is severely impaired (i.e., serum creatinine above 2.5 mg/dl), a loop diuretic is needed. A potassium-sparing agent may be given with the diuretic to reduce the likelihood of hypokalemia. 

Til tee successive tubule portions contribute to the ASDN the late portion of the distal convoluted tubule, the connecting tubule, and the collecting duct. The recent observation that collecting duct-specific inactivation of aENaC in the mouse kidney does not impair sodium and potassium balance, suggests that the more proximal nephron segments (late distal convoluted tubule, connecting tubule) are mainly important for-achieving sodium and potassium balance. 

Renal diseases Mutations in KCNJ1 disiupt the function of Kirl.l in apical renal outer medulla of the kidney. The loss of tubular K+ channel function and impaired K+ flux could prevent apical membrane potassium recycling and lead to antenatal Bartter s syndrome. 

Potassium is contraindicated in patients who are at risk for experiencing hyperkalemia, such as those with renal failure, oliguria, or azotemia (file presence of nitrogen-containing compounds in the blood), anuria, severe hemolytic reactions, untreated Addison s disease (see Chap. 50), acute dehydration, heat cramps, and any form of hyperkalemia Potassium is used cautiously in patients with renal impairment or adrenal insufficiency, heart disease, metabolic acidosis, or prolonged or severe diarrhea. Concurrent use of potassium with... 

Potassium-sparing diuretics may cause hyperkalemia, especially in patients with chronic kidney disease or diabetes, and in patients receiving concurrent treatment with an ACE inhibitor, ARB, NSAID, or potassium supplement. Eplerenone has an increased risk for hyperkalemia and is contraindicated in patients with impaired renal function or type 2 diabetes with proteinuria. Spironolactone may cause gynecomastia in up to 10% of patients, but this effect occurs rarely with eplerenone. 

The inhibition of amino-acid transport has been regarded as the main toxic effect of mercury compounds [82], The biochemical mechanism underlying the inhibition is unclear. In unfertilized sea-urchin eggs an interaction with the amino-acid carrier was found, whereas in fertilized eggs inhibition of amino-acid transport was indirect and might result from an elevation of the Na + content of the egg caused by the inhibition of the Na+ pump [83]. The action on the diffusional process could be mediated by an effect on membrane phospholipids or on membrane proteins, or by interaction with Ca2+ which stabilizes membrane structure. Mercuric chloride in skate liver cells inhibited amino acid transport, decreased Na + /K + -ATPase (adenosinetriphosphatase) activity, impaired volume regulatory mechanisms and increased the permeability of the plasma membrane to potassium [84]. It has been suggested that... 

These results suggest acute renal failure (ARF) due to tubular necrosis caused by phenol. Plasma sodium is low due mainly to impaired reabsorption in the nephron, although the slightly low albumin suggests haemodilution possibly as a result of excessive i.v. fluids. Potassium is raised due to poor exchange with sodium in the distal tubule and the acidosis (low pH and low bicarbonate concentration) arises from defective acidification of the glomerular filtrate acidosis is often associated with hyperkalaemia (raised plasma... 

Foster et al. have developed a method for determining technetium in dissolved nuclear fuel solutions. Tetrapropylammonium pertechnetate is doubly extracted from a basic medium into chloroform and the colored technetium (V) thiocyanate complex is formed in the chloroform phase by the addition of sulfuric acid, potassium thiocyanate and tetrapropylammonium hydroxide. The colored complex absorbs at 513 nm, has a molar extinction coefficient of 46,000 and is stable for several hours. Of more than 50 metals studied, none impairs measurements at ratios less than 100 to 1 mol with respect to technetium. Most anions do not disturb the determination of technetiiun. The standard deviation for a single determination is 0.09 fig over the range of 1 to 20 fig of technetium. 

Plasma volume and the extracellular fluid space have been observed to constrict 30% during reducing diets (300-600 calories per day) (B22). These changes can be accompanied by functional impairment of glomerular filtration and hepatic perfusion with transient increases up to 2 mg/100 ml in serum creatinine and BSP retention up to 40% (B22). In rare instances a significant fall in serum calcium, magnesium, or potassium was observed. Hyperuricemia was also observed, with concentrations as high as 9 mg/100 ml (B22). 

Oral Severe renal impairment with oliguria or azotemia untreated Addison disease hyperkalemia from any cause adynamia episodica hereditaria acute dehydration heat cramps patients receiving potassium-sparing diuretics or aldosterone-inhibiting agents. 

Renal impairment or adrenal insufficiency - Renal impairment or adrenal insufficiency may cause potassium intoxication. Potassium salts can produce hyperkalemia and cardiac arrest. Potentially fatal hyperkalemia can develop rapidly and be asymptomatic. Use with great caution, if at all. 

Renal function impairment Renal function impairment requires careful monitoring of the serum potassium concentration and appropriate dosage adjustment. 

Renal function impairment No correlation was observed between plasma clearance of epierenone and creatinine clearance. Epierenone is not removed by hemodialysis. Hepatic function impairment In 16 subjects with mild to moderate hepatic impairment who received 400 mg of epierenone, no elevations of serum potassium above 5.5 mEq/L were observed. The mean increase in serum potassium was 0.12 mEq/L in patients with hepatic impairment and 0.13 mEq/L in normal controls. The use of epierenone in patients with severe hepatic impairment has not been evaluated. 

Hypersensitivity to amiloride serum potassium greater than 5.5 mEq/L antikaliuretic therapy or potassium supplementation renal function impairment patients receiving spironolactone or triamaterene. 

Renal function /mpa/rmenf Anuria, acute or chronic renal insufficiency and evidence of diabetic nephropathy are contraindications because potassium retention is accentuated and may result in the rapid development of hyperkalemia. Do not give to patients with evidence of renal impairment (BUN greater than 30 mg/dL or serum creatinine greater than 1.5 mg/dL) or diabetes mellitus without continuous monitoring of serum electrolytes, creatinine, and BUN levels. 

Hyperkalemia Carefully evaluate patients for possible fluid and electrolyte balance disturbances. Hyperkalemia may occur with impaired renal function or excessive potassium intake and can cause cardiac irregularities that may be fatal. Ordinarily, do not give potassium supplements with spironolactone. 

Renai function impairment Perform periodic BUN and serum potassium determinations to check kidney function, especially in patients with suspected or confirmed renal insufficiency and in elderly or diabetic patients diabetic patients with nephropathy are especially prone to develop hyperkalemia. 

Renal function impairment Up to 20% of the magnesium in magnesium salts may be absorbed. Do not use products containing phosphate, sodium, magnesium, or potassium salts in the presence of renal dysfunction. 

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