Potassium supplementation

The hypotensive effects of most antihypertensive dru are increased when administered with diuretics and other antihypertensives. Many dnigp can interact with the antihypertensive drugs and decrease their effectiveness (eg, antidepressants, monoamine oxidase inhibitors, antihistamines, and sympathomimetic bronchodilators). When the ACE inhibitors are administered with the NSAIDs, their antihypertensive effect may be decreased. Absorption of the ACE inhibitors may be decreased when administered with the antacids. Administration of potassium-sparing diuretics or potassium supplements concurrently with the ACE inhibitors may cause hyperkalemia. When the angiotensin II receptor agonists are administered with... 

The nurse must closely observe patients receiving a potassium-sparing diuretic for signs of hyperkalemia (see Display 46-1), a serious and potentially fatal electrolyte imbalance The patient is closely monitored for hypokalemia during loop or thiazide diuretic therapy. A supplemental potassium supplement may be prescribed to prevent hypokalemia. The primary health care provider may also encourage the patient to include... 

Fbtassium-sparing diuretics Avoid eating foods high in potassium and avoid the use of salt substitutes containing potassium. Read food labels carefully. Do not use a salt substitute unless a particular brand has been approved by the primary health care provider. Avoid the use of potassium supplements. Male patients taking spironolactone may experience gynecomastia. This is usually reversible when therapy is discontinued. 

Each year in the United States, about 30 million prescriptions for potassium supplements are written for people with hypertension (high blood pressure). These supplements are often prescribed with diuretics. Diuretics cause increased urination and reduce the volume of retained fluids in the body, thus reducing blood pressure. Explain why potassium supplements are prescribed. 

In patients without contraindications, spironolactone is initiated at a dose of 12.5 to 25 mg daily, or occasionally on alternate days for patients with baseline renal insufficiency. Eplerenone is used at a dose of 25 mg daily, with the option to titrate up to 50 mg daily. Doses should be halved or switched to alternate-day dosing if creatinine clearance falls below 50 mL/minute. Potassium supplementation is often decreased or stopped after aldosterone antagonists are initiated, and patients should be counseled to avoid high-potassium foods. At anytime after initiation of therapy, if potassium concentrations exceed... 

Moderate hypokalemia is defined as a serum potassium of 2.5 to 3.5 mEq/L (2.5 to 3.5 mmol/L) without ECG changes. In this setting, potassium replacement can usually be given orally at a dose of 40 to 120 mEq/day (40 to 120 mmol/day). Anecdotally, oral potassium supplementation (see Table 24-7) is often more effective in repleting moderate hypokalemia. For patients with an ongoing source of potassium loss, chronic replacement therapy should be considered. The potassium... 

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. 

ACE inhibitors decrease aldosterone and can increase serum potassium concentrations. Hyperkalemia occurs primarily in patients with chronic kidney disease or diabetes and in those also taking ARBs, NSAIDs, potassium supplements, or potassium-sparing diuretics. 

Whenever possible, potassium supplementation should be administered by mouth. Of the available salts, potassium chloride is most commonly used because it is the most effective for common causes of potassium depletion. 

Q95 Patients taking bendroflumethiazide are often given a potassium supplement. The patient may not need one because she is also taking ... 

Hypokalaemia occurs when the plasma-potassium level falls below 3.0 mmol/L Hypokalaemia may occur following loop or thiazide diuretic therapy. Patients at risk of developing hypokalaemia are often prescribed potassium supplements to counteract the potassium loss caused by the diuretic therapy. Symptoms of hypokalaemia include muscle weakness and cramps. Severe cases may lead to muscle paralysis and respiratory failure. 

Diuretics - Generally initiate therapy with a thiazide or other oral diuretic. Thiazide-type diuretics are drugs of choice hydrochlorothiazide or chlorthalidone are generally preferred. Reserve loop diuretics for selected patients. This therapy alone may control many cases of mild hypertension. Consider treating diuretic-induced hypokalemia (less than 3.5 mEq/L) with potassium supplementation or by adding a potassium-sparing diuretic to therapy. 

Potassium supplements Tell patients receiving losartan not to use potassium supplements or salt substitutes containing potassium without consulting the prescribing physician. 

Potassium Concomitant use of potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium and AIIRAs may lead to increases in serum potassium. 

Also contraindicated for the treatment of hypertension in patients with the following conditions Type 2 diabetes with microalbuminuria serum creatinine greater than 2 mg/dL in males or greater than 1.8 mg/dL in females Ccr less than 50 mL/min concomitant use of potassium supplements or potassium-sparing diuretics (amiloride, spironolactone, or triamterene). 

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

Children-A dose of 1 to 2 mg/kg twice/day has been recommended. Hypokalemia 25 to 100 mg/day. Useful in treating diuretic-induced hypokalemia when oral potassium supplements or other potassium-sparing regimens are considered inappropriate. 

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. 

When triamterene is added to other diuretic therapy, or when patients are switched to triamterene from other diuretics, discontinue potassium supplementation. Hypersensitivity reactions Monitor patients regularly for blood dyscrasias, liver damage, or other idiosyncratic reactions. 

Magnesium Sulfate (various) Multivitamins (Table VI-6) Phytonadione [Vitamin K] (Aqua-MEPHYTON) Potassium Supplements (Kaon, Kaochlor,... 

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