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Meg Mangin R.N.
Research Team
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Posted: Tue Sep 19th, 2006 01:00 |
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My potassium is elevated. What should I do?
Elevated serum potassium is called hyperkalemia. Hyperkalemia is common; it is diagnosed in up to 8% of hospitalized patients in the U.S. Most patients have mild hyperkalemia which is usually well tolerated.
The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L).
Potassium levels between 5.1 mEq/L to 6.0 mEq/L are mild hyperkalemia.
Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia.
Potassium levels above 7 mEq/L are severe hyperkalemia.
Because failure to promptly separate serum from cells in a clot tube is a notorious source of falsely elevated potassium, you may want to have your test repeated to rule out lab error. There are other factors that can result in faulty test results (pseudohyperkalemia), such as fist clenching during the blood draw. See Factors That Influence Test Accuracy.
The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is an electrical reading of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating.
As with other electrolyte disturbances, the speed of onset of hyperkalaemia is very important. A relatively small increase, if it occurs over a short time, can precipitate a fatal arrhythmia where a much higher level may be tolerated (for instance, in the insidious onset of renal failure) if it has developed over a longer period.
Consider the risk/benefit ratio
If continued elevated potassium concerns your doctor, point out to him/her that treatment is a matter of risk/benefit and you are determined to resolve your Th1 disease and kidney inflammation with the Marshall Protocol while regularly monitoring serum potassium and evaluating the risk.
Refer your doctor to this article (click here), Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and/or serum potassium concentration rises, which explains that long-term benefits have to be the focus when using ARBs.
Decreased Kidney Function Causes Hyperkalemia
Potassium is a mineral naturally found in many fruits and vegetables, like oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in your blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium, resulting in hyperkalemia.
Disorders that decrease kidney function, such as Th1 inflammatory diseases, can result in elevated potassium. This can happen when chronic inflammation has damaged tiny blood vessels (glomeruli) in the kidney. See My kidney function tests are worse since I started the MP. What should I do?
Some sources of information about hyperkalemia list ARBS (Benicar is an ARB) as causing elevated potassium without any references to confirming scientific studies.
However, in the Center for Drug Evaluation and Research Approval Package for Olemesartan (Benicar) (Application #21-286) and the Clinical Pharmacology, including the Pharmacodynamics of the drug, there is no mention of hyperkalemia. In fact, on page 4, under the pharmacodynamics in the distributed eleven page document summarizing Olmesartan (Benicar), it clearly states the following:
"Repeated administration of up to 80mg olmesartan medoxomil (Benicar) had minimal influence on aldosterone levels and no effect on serum potassium". It is also highly bound to plasma proteins (99%) and does not penetrate red blood cells where K+ is found.
Continue Benicar
It is important to continue the Benicar blockade while treating kidney inflammation (even in the presence of mild to moderate hyperkalemia) because it will protect all your organs, including the kidneys and heart from the damage caused by inflammation and it will reduce inflammatory symptoms.
Renoprotective effects of an ultrahigh dose of olmesartan
Benicar decreases myocardial inflammation
Benicar protects liver function
Managing your immunopathology should reduce elevated potassium. An increase in potassium (and variations in other electrolytes) while on the Marshall Protocol can occur due to the expected immune system reaction. See My immune system reaction is too strong. What should I do?
Diuretics
Do not use thiazide diuretics because they are too hard on the kidneys. See Thiazide diuretics are contraindicated in kidney disease
Do not use potassium-sparing diuretics.
The following diuretics are contraindiated because they are potassium-sparing and might result in hyperkalemia:
-spironolactone (Aldactone, Novospironton, Spiractin)
-triamterene (Dyrenium)
-amiloride (Midamor)
Consider a potassium-depleting diuretic
Any condition causing mild hyperkalemia should be monitored to prevent progression into more severe hyperkalemia. If your doctor remains concerned about your elevated potassium, ask if taking a diuretic that is known to deplete potassium is an option for you.
Lasix (furosemide) is potassium-depleting and is compatible with the MP. Anyone on Lasix with cardiorespiratory sx exacerbation should be evaluated periodically by their Dr for CHF to see if their cardiac medications need to be adjusted.
Avoid sources of ingested potassium
Taking in too much potassium (either through foods, supplements, or salt substitutes containing potassium) can cause hyperkalemia if there is kidney dysfunction.
If you have a tendency to have elevated potassium while on the MP, you should avoid foods high in potassium, potassium supplements, salt substitutes containing potassium and other medications that tend to increase potassium. including some sports drinks. We do not recommend the use of Gatorade or similar products. Even the ones that are low in sugar contain extra potassium which you may not need.
Avoid other medications
Other medications that are reported to decrease urine potassium excretion and increase serum potassium should be avoided. These include NSAIDs, amiloride, aminocaproic acid, antineoplastic agents, β-blockers, epinephrine, heparin, histamine, indomethacin, isoniazid, lithium, mannitol, methicillin, potassium salts of penicillin, phenformin, propranolol, salt substitutes, spironolactone (Aldactone), succinylcholine, triamterene (Dyrenium), and tromethamine.
(Scroll down for more information)
Last edited on Mon Aug 11th, 2008 03:19 by Meg Mangin R.N.
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Meg Mangin R.N.
Research Team
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Posted: Wed Nov 29th, 2006 18:38 |
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(filelink)
Benicar protects kidneys
These days, in all my presentations to physicians, I make a point of helping them to understand that it is the immune system which is doing the germ-killing in the MP, not the drugs. They tend to make the mistake of focusing on the drugs.
The problem is that even after you stop taking the Benicar and abx, the immune system will keep killing the bacteria. Since you no longer are taking the Benicar to protect your kidneys, and your other organs, from damage, you are now fully exposed to the liklihood that real damage will be done by the immunopathology.
Even though hyperkalemia may not harm your body when your body is protected by the Benicar, it is quite another matter altogether when you stop taking the Benicar.
It is also logically incorrect reasoning to assume that because a particular level of hyperkalemia, say 6.4, might be harmful in folks who are not taking Benicar, that this same level will also be harmful in the presence of the drug. This is a non-sequitur. As your physician noted, your own cardiac response didn't seem to be adversely affected by the measured hyperkalemia.
Please look after yourself, and understand that although your physicians are the only people licensed by the State to make decisions about your health, their training is clearly inadequate to help them manage situations like you are currently experiencing.
..Trevor..
See My kidney function tests are worse since I started the MP. What should I do?
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Meg Mangin R.N.
Research Team
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Posted: Thu Nov 30th, 2006 02:18 |
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(filelink)
Members' experiences
-Last year I tested over the maximum for potassium. The doctor (an Infectious Disease specialist) who discovered it was new to me but it was very clear that he was as closed-minded as they come. He insisted that I was one of a small percentage of people that just couldn't take THAT drug (Benicar) and when his over-the-top bullying didn't work he tried scare tactics.
I was told to immediately discontinue benicar and come back first thing in the morning to retest. I came back for the retest - only so he wouldn't think he had correctly predicted my sudden death - and had a good little snicker to myself when he came in with the lower results and "I told you so"s. I didn't tell him that I never stopped the Benicar or that I had called my MP doc who had ordered a late night retest elsewhere the evening before.
My MP doc said it was high, but I need not fear dropping dead and that we would keep a close watch on it. I cut way down on high potassium foods for a while (which, incidentally, I had been eating a lot of) and haven't given it another thought. BTW, I just had some bloodwork done and my potassium levels are ideal. ~Renee
-MP day 142 (17/05/06) I have had problems with retaining potassium and it got dangerously high at the three month mark. I took a diuretic for a few days and my potassium levels normalized. I am avoiding potassium rich foods and my GP is monitoring it now and I will have a blood test to check on it again at the end of May.
Update - MP day 179 (23/06/06) At the end of May I had some blood tests and my GP was happy with all the results. My potassium has returned to normal (after a further 2 months since I had the high result) and it appears that my body has adjusted to the Benicar. I have also been avoiding foods with high potassium (tomato, potatoes, banana etc) and so now I am experimenting with occasional exposure to these foods. I will have my potassium levels tested again at the end of July to check that my potassium levels remain normal.
Update – 2 years on MP (27/12/07) My GP has continued to check my potassium levels after I had a ‘too high’ reading at the end of Phase 1. I adjusted my diet to avoid potassium rich foods and also added a bit of salt to my food and had no more worrying figures. Now I am not so careful about avoiding all of those foods and just add some salt to them. ~Vicki SA
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Meg Mangin R.N.
Research Team
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Posted: Thu Apr 19th, 2007 00:48 |
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(filelink)
Factors that influence test accuracy
As you all may know, a good lab will note the lysis of cells in its report and request a re-draw if the K is high. Given the nature of this churn-it-out industry, we can only assume some lab workers will not bother to do so all of the time.
An article detailing things that can go wrong in the blood draw and lab, leading to pseudohyperkalemia: Investigating Elevated Potassium Values. The article reports that common lab factors that can result in falsely elevated serum potassium values include:
- fist clenching or excessive tourniquet during the blood draw
- hemolysis from a small needle or traumatic venipuncture
- migration of potassium across a compromised gel barrier
- recentrifugation or
- blood sample clotted
The Merck Manual gives further information by advising that fasting can cause elevated serum potassium by suppression of insulin secretion.
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