Potassium and stroke risk

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Despite the fact that potassium is available in many foods, especially fruits and vegetables, only 2 percent of US adults get the recommended daily amount of 4,700 milligrams (mg).2

Importantly, consuming enough potassium-rich food is also important because this nutrient helps offset the hypertensive effects of sodium. Imbalance in your sodium-potassium ratio can not only lead to hypertension (high blood pressure) but may also contribute to a number of other diseases, including heart disease and stroke.

Potassium-Rich Diet Lowers Stroke Risk in Women

Stroke is the number one cause of long-term disability and the fourth leading cause of death in the US.3 The most common type of stroke is called "ischemic stroke," which results from an obstruction in a blood vessel supplying blood to your brain. Once you suffer a stroke, the damage, should you survive it, can be absolutely devastating.

Thankfully, up to 80 percent of strokes are preventable, and positive lifestyle factors can make a major difference. One factor is your diet, and a potassium-rich diet, in particular.

New research found that women without hypertension who consumed the most potassium (nearly 3,200 mg/day) had a 21 percent reduced risk of stroke. Further, women who consumed the most potassium were 12 percent less likely to suffer from a stroke, and 12 percent less likely to die during the study period, than those who consumed the least.4 According to the study’s lead researcher:5

“Potassium may play a role in improving blood vessel function in our brains. This could allow better oxygenation of our brain tissue, and prevent tissue death that occurs from lack of oxygen to the brain… The effect of potassium consumption on reduced stroke risk could also be due to a better diet overall, though we did not investigate this in our study.”

As mentioned, your body needs potassium to maintain proper pH levels in your body fluids, and it also plays an integral role in regulating your blood pressure, which is a major risk factor for stroke if it becomes elevated and that potassium needs to come from food not from supplements or potassium salt.

Too Much Sodium and Too Little Potassium Is Risky for Your Heart

Excess sodium is often blamed for causing high blood pressure (which in turn elevates your stroke risk). However, potassium deficiency may be more responsible for hypertension than excess sodium.

One four-year long observational study (the Prospective Urban Rural Epidemiology (PURE) study), which included more than 100,000 people in 17 countries, found that while higher sodium levels correlate with an increased risk for high blood pressure, potassium helps offset sodium’s adverse effects.6, 7

In the study, those with the lowest risk for heart problems or death from any cause were consuming three to six grams of sodium a day—far more than US daily recommended limits. So while there is a relationship between sodium and blood pressure, it’s not a linear relationship, and potassium plays a role.

The authors proposed that instead of recommending aggressive sodium reduction across the board, it might be wiser to recommend high-quality diets rich in potassium instead. This, they surmised, might achieve greater public health benefits, including blood-pressure reduction. As noted by one of the researchers, Dr. Martin O'Donnell of McMaster University:8

“Potatoes, bananas, avocados, leafy greens, nuts, apricots, salmon, and mushrooms are high in potassium, and it's easier for people to add things to their diet than to take away something like salt.”

According to a 1985 article in The New England Journal of Medicine, titled "Paleolithic Nutrition,” our ancient ancestors got about 11,000 mg of potassium a day and about 700 mg of sodium.9 This equates to nearly 16 times more potassium than sodium.

Compare that to the Standard American Diet where daily potassium consumption averages about 2,500 mg (the RDA is 4,700 mg/day), along with 3,600 mg of sodium. This may also explain why high-sodium diets appear to affect some people but not others.

According to a 2011 federal study into sodium and potassium intake, those at greatest risk of cardiovascular disease were those who got a combination of too much sodium along with too little potassium. The research, published in the Archives of Internal Medicine, was one of the first and largest US studies to evaluate the relationship of salt, potassium, and heart disease deaths.

Tellingly, those who ate a lot of salt and very little potassium were more than twice as likely to die from a heart attack as those who ate about equal amounts of both nutrients.10

Increasing Potassium in Your Diet Is Like Decreasing Your Salt Intake (Without Really Cutting Back!)

A proper balance of potassium both inside and outside your cells is crucial for your body to function properly. As an electrolyte, potassium is a positive charged ion that must maintain a certain concentration (about 30 times higher inside than outside your cells11) in order to carry out its functions, which includes interacting with sodium to help control nerve impulse transmission, muscle contraction, and heart function.

Researchers have also determined that increasing average potassium intake to the recommended 4,700 mg a day would reduce systolic blood pressure by between 1.7 and 3.2 mm Hg on a population-wide scale. This decrease, they suggest, is similar to the reduction that would occur if Americans lowered their salt intake by 4 grams a day.12

I don’t advise consuming all the salt you want, of course, particularly if it’s processed salt. Salt is an essential nutrient required for blood pressure regulation, transportation of nutrients into and out of your cells, ion exchange, and brain-muscle communication. But all salts are not equal, in terms of their impact on your health.

Processed (table) salt is health harming, while natural unprocessed salt is not only healing, but in fact essential for many biological functions. It’s clear that many are consuming far too much processed table salt and not enough natural salt, largely by consuming too many processed foods. And, the easiest way to achieve an imbalance in your sodium-to-potassium ratio is by consuming a diet of processed foods, which are notoriously low in potassium while high in sodium.

The Best Way to Optimize Your Sodium-to-Potassium Ratio

If you eat a lot of processed foods and not many vegetables, there’s a good chance your sodium-to-potassium ratio is unbalanced. If you’re not sure, try a free app like MyFitnessPal, which allows you to enter the foods you eat and will calculate the ratio automatically. It's generally recommended that you consume five times more potassium than sodium, but most Americans get two times more sodium than potassium. If your ratio is out of balance…

• First, ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients
• Eat a diet of whole, unprocessed foods, ideally organically and locally grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium
• When using added salt, use a natural salt. I believe Himalayan salt may be the most ideal, as it contains lower sodium and higher potassium levels compared to other salts

I do not recommend taking potassium supplements to correct a sodium-potassium imbalance. Instead, it is best to simply alter your diet and incorporate more potassium-rich whole foods. Green vegetable juicing is an excellent way to ensure you’re getting enough nutrients for optimal health, including about 300-400 mg of potassium per cup. Some additional rich sources of potassium are:

• Lima beans (955 mg/cup)
• Winter squash (896 mg/cup)
• Cooked spinach (839 mg/cup)
• Avocado (710 mg/cup)  

Other potassium-rich fruits and vegetables include:

• Fruits: papayas, prunes, cantaloupe, and bananas. (But be careful of bananas as they are high in sugar and have half the potassium of an equivalent amount of green vegetables. It is a myth that you are getting loads of potassium from bananas; the potassium is twice as high in green vegetables)
• Vegetables: broccoli, Brussels sprouts, avocados, asparagus, and pumpkin

Tips for Lowering Your Stroke Risk

Your lifestyle has a direct impact on your stroke risk, and even small changes can make a difference. To lower your risk:

• Exercise will go a long way toward improving your insulin and leptin receptor signaling, thereby normalizing your blood pressure and reducing your stroke risk. I recommend a comprehensive program that includes Peak Fitness high-intensity interval exercises along with super slow strength training, Active Isolated Stretching, and core work. If you've had a stroke, exercise is also very important, as research shows it can significantly improve both your mental and physical recovery.13
• Processed meats: Certain preservatives, such as sodium nitrate and nitrite found in smoked and processed meats have been shown to damage your blood vessels, which could increase your risk of stroke. I recommend avoiding all forms of processed meats, opting instead for organic, grass-fed or pastured meats.
• Diet soda. Research presented at the American Stroke Association's International Stroke Conference in 2011 showed that drinking just one diet soda a day may increase your risk of stroke by 48 percent. Ideally, strive to eliminate all soda from your diet, as just one can of regular soda contains nearly twice my recommended daily allowance for fructose in order to maintain good health and prevent disease.
• Stress. The more stressed you are, the greater your risk of suffering a stroke. Research has found that for every notch lower a person scored on their well-being scale, their risk of stroke increased by 11 percent.14 Not surprisingly, the relationship between psychological distress and stroke was most pronounced when the stroke was fatal. My favorite overall tool to manage stress is EFT (Emotional Freedom Technique). Other common stress-reduction tools with a high success rate include prayer, meditation, laughter and yoga, for example. For more tips, see my article "10 Simple Steps to Help De-Stress."
• Vitamin D: According to research presented at the American Heart Association's (AHA) Annual Scientific Sessions in 2010, low levels of vitamin D—the essential nutrient obtained from sun exposure—doubles the risk of stroke in Caucasians.15 While many opt for vitamin D3 supplements to raise their vitamin D level, I strongly recommend optimizing your levels through appropriate sun exposure or by using a safe tanning bed (i.e. one with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields). Ideally, you'll want to maintain your vitamin D level within the range of 50-70 ng/ml year-round.
• Hormone replacement therapy (HRT) and birth control pills. If you're on one of the hormonal birth control methods (whether it's the pill, patch, vaginal ring, or implant), it is important to understand that you are taking synthetic progesterone and synthetic estrogen -- something that is clearly not advantageous if you want to maintain optimal health. These contraceptives contain the same synthetic hormones as those used in hormone replacement therapy (HRT), which has well-documented risks, including an increased risk of blood clots, stroke, heart attack, and breast cancer.
• Statins. Statin drugs are frequently prescribed to reduce your risk of heart disease and stroke. However, researchshows that these cholesterol-lowering drugs actually increase your risk of a second stroke if you've already had one. There are two reasons why this might happen: the drugs may either lower cholesterol too much, to the point that it increases your risk of brain bleeding, or they may affect clotting factors in your blood, increasing the bleeding risk.
• Grounding. Walking barefoot, aka "grounding," has a potent antioxidant effect that helps alleviate inflammation throughout your body. The human body appears to be finely tuned to "work" with the earth in the sense that there's a constant flow of energy between our bodies and the earth. When you put your feet on the ground, you absorb large amounts of negative electrons through the soles of your feet. Grounding helps thin your blood by improving its zeta potential. This gives each blood cell more negative charge which helps them repel each other to keep your blood thin and less likely to clot. This can significantly reduce your risk of stroke.

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Top 14 Surprising Health Benefits of Potassium

Potassium is essential for preventing strokes, building muscles, breaking down carbs, maintaining body growth and most importantly maintaining fluid balance in the body. Continue to read more about the various other health benefits of this macromineral!

CONTENTS [HIDE]

• Introduction
• Buying Potassium Supplements
• Health Benefits of Potassium
  • 1) Potassium Reduces Blood Pressure
  • 2) High Potassium Intake May Protect Against Stroke
  • 3) Potassium Might Reduce the Risk of Cardiovascular Disease
  • 4) Potassium May Decrease the Risk of Diabetes
  • 5) Potassium Intake May Benefit the Kidney
  • 6) Potassium Reduces the Risk of Kidney Stones
  • 7) Potassium Decreases the Risk of Osteoporosis
  • 8) Potassium-Rich Diet Defends Against the Loss of Muscle Mass
  • 9) Potassium Has an Antioxidant Activity
  • 10) Potassium May Reduce Adverse Effects of Lithium
  • 11) Potassium Intake May Prevent Alzheimer’s Disease Onset
  • 12) Potassium Might Decrease Severity of Gum Disease
  • 13) Potassium Helps with Rheumatoid Arthritis Pain
  • 14) Potassium Reduces Risk of Death from Severe Protein Deficiency
• Sources of Potassium
• Bioavailability
• Dosage
• Deficiency
• Side effects
• Contraindications
• Serum Potassium
• Potassium Supplements

Introduction

Potassium is an essential mineral vital for the proper functioning of all living cells.

It is one of the most abundant positively charged ions (cation) in the human body (R).

Approximately 98% of the body’s total potassium is found within a cell. It is present in high concentrations in muscles, bone, liver and red blood cells(R).

The remaining 2% of potassium is present outside of a cell, and it is important for maintaining a voltage difference between the inside and outside of a cell.

Concentration difference between potassium inside and outside of a cell is maintained by Na-K-ATPase enzyme that actively pumps potassium into the cell while moving sodium out of the cell (R, R2).

The major functions of potassium are the maintenance of the cell’s membrane potential and regulation of the fluid within the cell (R).

Potassium is important for (R, R2):

• muscle contraction
• nerve impulse transmission
• normal heart functioning
• prevention of excessive fluid retention
• maintenance of proper pH within the body
• normal growth and muscle building

Potassium is required for the production of carbohydrates, proteins, and energy in the form of adenosine triphosphate (ATP) (R).

A large number of enzymes that participate in several major metabolic processes require the presence of potassium to function properly (R).

Western diets with more processed foods and fewer fruits and vegetables are lower in potassium and higher in sodium. Healthier diets consumed by our ancestors are richer in potassium (R).

Therefore, diets higher in potassium is associated with many positive health outcomes. However, this association may be because diets higher in potassium are generally healthier rather than the higher potassium content itself.

Buying Potassium Supplements

• Gluconate (Tastes least bad),
• Citrate (for kidney stones)
• Chloride (good for mixing with salt)

Health Benefits of Potassium

1) Potassium Reduces Blood Pressure

Potassium supplementation lowers arterial blood pressure in humans with essential hypertension (hypertension with unknown causes, which affects 95% of hypertensive patients) (R, R2, R3).

Previous studies have found that potassium may lower blood pressure substantially in hypertensive patients who consume a lot of sodium (R1, R2).

A high potassium intake does not or only minimally decreases blood pressure in humans with normal blood pressure (R).

An increase in potassium intake of at least 20 mmol (0.78 g) per day was associated with a significant reduction in systolic blood pressure by 4.9 mm Hg and diastolic pressure by 2.7 mm Hg (R).

The DASH (Dietary Approaches to Stop Hypertension) diet, which is also rich in potassium, resulted in reductions in blood pressure by 5 mm Hg systolic and 3 mm Hg diastolic.

This diet also decreased the risk for coronary heart disease by 20% and stroke by 34% (R, R2).

African Americans have a relatively low intake of potassium and a high prevalence of elevated blood pressure and salt sensitivity. Therefore, they would especially benefit from an increased intake of potassium (R, R2).

Blood pressure-lowering effect of potassium may be related to its diuretic activity, and effects on nervous system, blood vessels, the renin-angiotensin-aldosterone system, and natriuretic hormone (R).

Increasing the dietary potassium intake from natural foods reduces the need for antihypertensive medication in patients with essential hypertension.

38% of hypertensive patients on the high-potassium diet had well-controlled blood pressure without any need for drug therapy (R).

2) High Potassium Intake May Protect Against Stroke

Human and animal studies have suggested that increased potassium intake may protect against stroke (R, R2).

The study indicated that an average increase of 1.64 g of potassium per day is associated with a 21% reduced risk of stroke (R).

A 10-mmol increase in daily potassium intake was associated with a 40% reduction in stroke-associated mortality among 859 individuals over the span of 12 years (R, R2).

A greater fruit and vegetable intake protects against the occurrence of stroke. More than 5 servings of fruit and vegetables per day are associated with a 26% lower rate of stroke compared with 3 or fewer servings (R).

A lower blood potassium level in both diuretic users and those not taking diuretics was associated with increased stroke incidence among older individuals (R, R2).

3) Potassium Might Reduce the Risk of Cardiovascular Disease

A number of animal studies confirmed that increased potassium intake protects against cardiovascular disease (R).

The balance between potassium and sodium is more strongly associated with an increased risk of cardiovascular disease than either sodium or potassium intake alone (R).

Patients with congestive heart failure should routinely be given potassium supplementation, a potassium-sparing diuretic, or an angiotensin converting enzyme inhibitor, even if their initial potassium measurement is normal (4.0 mmol/l) (R).

The National Health and Nutrition Examination Survey (NHANES) III, a study of 12,267 US adults, showed that higher potassium intake was associated with a lower cardiovascular and all-cause risk of dying (R).

High dietary potassium intake in Japanese men and women is associated with lower risk of dying from coronary heart disease and total cardiovascular disease (R).

On the other hand, some studies show no association between potassium intake and the risks of coronary heart disease and cardiovascular death (R, R2).

4) Potassium May Decrease the Risk of Diabetes

Potassium is important for insulin secretion from the pancreatic cells (R, R2).

Low potassium intake or blood potassium level is associated with an increased risk for insulin resistance and diabetes, especially in African Americans and those on thiazide diuretic treatment (R, R2, R3, R4, R5, R6).

Potassium depletion studies show that low serum potassium decreases glucose tolerance associated with reduced insulin secretion (R), and lead to marked alterations in glucose metabolism (R).

Studies show that high potassium intake is associated with a 39% reduced risk of metabolic syndrome in both men and women (R).

5) Potassium Intake May Benefit the Kidney

Studies in hypertensive rats showed that a high potassium intake prevented vascular, glomerular, and tubular damage of kidneys (R, R2, R3).

Study of 13,917 participants from NHANES, suggested that higher dietary intake of potassium is associated with lower incidence of chronic kidney disease (R).

The beneficial effects of dietary potassium on vascular lesions are not only through decreases in blood pressure but also through non-blood pressure pathways.

Potassium supplementation can reduce kidney inflammation leading to a regression of chronic kidney disease (R, R2).

Chronic potassium depletion causes kidney functional and structural changes, interstitial nephritis (inflammation of the kidney), or cyst formation in animals and humans (R, R2, R3, R4).

Concurrent supplementation with potassium and magnesium protects kidneys from cyclosporine-induced kidney damage (R).

6) Potassium Reduces the Risk of Kidney Stones

Studies have shown that both men and women taking higher doses of potassium had a 50% lower risk of developing symptomatic kidney stones(R, R2).

Increasing dietary or supplemental potassium intake has been found to decrease calcium excretion in urine. Low levels of calcium in the urine decrease the risk of developing kidney stones (R, R2).

Potassium citrate is effective in reducing the stone size and symptoms of kidney stones not only in adults but also in children on a ketogenic diet (R, R2, R3).

7) Potassium Decreases the Risk of Osteoporosis

Increased intake of food rich in potassium, mainly fruits, and vegetables, is associated with a higher bone mineral density and prevents osteoporosis (R, R2, R3).

Supplementation with potassium is associated with an increased rate of bone formation and decreased bone degradation (R, R2).

In postmenopausal women, treatment with potassium bicarbonate for 18 days (R) and combined treatment with potassium citrate and calcium citrate for 3 months reduces bone loss, especially in women on a high salt diet (R, R2).

8) Potassium-Rich Diet Defends Against the Loss of Muscle Mass

Higher intake of foods rich in potassium may favor the preservation of muscle mass in older men and women (R).

In elderly with dietary deficiency of potassium, increased intake had anti-aging effects (R).

Potassium-rich foods relieve an acidic environment in the body caused by eating the typical Western diet that is rich in meat, dairy, and processed food, and protect from loss of bone density and muscle wasting (R).

9) Potassium Has an Antioxidant Activity

Increase in potassium concentration blocks dangerous oxygen species formation by blood vessel cells or white blood cells (R).

Dietary potassium may protect against cardiovascular damage through its antioxidant effects (R).

Potassium supplementation prevents the development of an autoimmune and inflammatory disease. It has a blocking effect on interleukin IL-17A production in T lymphocytes (R).

10) Potassium May Reduce Adverse Effects of Lithium

Lithium is widely used for the treatment of manic-depressive psychosis. The most common toxic side effects are kidney-related, such as (R):

• nephrogenic diabetes insipidus – excessive urination and thirst due to a kidney problem
• distal tubular acidosis – increased acidity in the body to a malfunction in part of the kidney
• impairment of the kidney’s ability to concentrate urine

Studies suggest that potassium supplementation protects against nephrogenic diabetes insipidus by decreasing the reabsorption of lithiumfrom the kidneys (R).

Potassium also increases elimination of lithium from the tissues, protecting against the potentially toxic accumulation of lithium (R).

11) Potassium Intake May Prevent Alzheimer’s Disease Onset

An increase in potassium intake may be important in the prevention of Alzheimer’s disease onset as a non-pharmacological therapy (R).

Increased potassium intake leads to a change in the aggregation of the amyloid-beta peptide in brain tissues, improvement in the cognitive performance, and a decrease in markers related to inflammation and oxidative stress (R).

12) Potassium Might Decrease Severity of Gum Disease

High consumption of potassium might decrease periodontitis (gum disease) severity.

The beneficial effect of the intake of potassium-rich fruit and vegetables on periodontitis might be related to their roles in inflammation or oxidative stress (R).

Alcohol-free mouth rinse containing 1.4% potassium oxalate significantly reduced tooth sensitivity (R).

13) Potassium Helps with Rheumatoid Arthritis Pain

High-level potassium supplementation helps reduce pain from rheumatoid arthritis (R).

Nearly half of those who took 6000 mg of potassium daily for 28 days reported a 33% reduction in their arthritis pain intensity. Another one-third of the participants reported a moderate decrease in pain (R).

Higher potassium intake leads to elevated blood cortisol production and secretion, which alleviates rheumatoid arthritis symptoms (R).

14) Potassium Reduces Risk of Death from Severe Protein Deficiency

The high potassium supplementation reduced the risk of death in kwashiorkor (a form of severe protein malnutrition).

This may be due to an improved heart and immune function from earlier depletion of potassium (R).

Sources of Potassium

Major food sources containing potassium are fruit (bananas, dried apricots, prunes, dates, avocados, cantaloupe, citruses), vegetables (dark leafy greens, potatoes, tomatoes, squash), legumes (especially beans), mushrooms, dairy, nuts, and fish (R, R2).

Potassium containing supplements are available in the form of salts: gluconate, citrate, chloride, bicarbonate, and acetate.

They are commonly used to treat low levels of potassium in patients who do not have enough potassium in their regular diet or have lost potassium due to illness or treatment with certain medication (R).

Supplemental potassium should be provided under medical supervision due to potential toxicity (R, R2).

Bioavailability

Approximately 90% of dietary potassium is absorbed in the small intestineby passive diffusion (R).

The potassium is primarily balanced by kidney excretion in urine. Approximately 80-90% is excreted in urine, while the remainder is excreted mainly in feces, with much smaller amounts being lost in sweat (R).

Because it is easily excreted by the kidneys rather than stored in the body, humans need constantly consume potassium.

Dosage

Recommended adequate intake of potassium for adults is set at 4.7 g/day(R).

In individuals whose kidney function is impaired, a potassium intake below 4.7 g/day is appropriate because of irregular heart rhythm from the resulting elevated blood potassium concentration (R).

Deficiency

Even though Western diet has led to a diet low in potassium, potassium deficiency rarely occurs through the inadequate intake of dietary potassium (R).

Presently, less than 3% of the population have total potassium intakes that exceeded the adequate intake of potassium. The average intake by adults is approximately 2.2-3.3 g/day (R).

Potassium deficiency can develop as a consequence of increasing losses through the gut (prolonged vomiting or diarrhea) or kidneys (Fanconi syndrome, Cushing’s syndrome, Conn’s syndrome, treatment with diuretics, amphotericin B, cisplatin, theophylline) (R).

Symptoms of potassium deficiency include muscle weakness and cramps, fatigue, irritability, abdominal pain, and constipation. Mental disturbances, e.g. depression and confusion, can also develop.

Severely decreased potassium levels may lead to muscle injury, paralysis, abnormal heart rhythms and impaired respiration that can be fatal (R).

Side effects

There are no reports of adverse effects associated with potassium naturally occurring in food in healthy individuals (R).

Abdominal discomfort has been reported with slow-release and wax matrix formulations as well as oral solutions of potassium salts, but not with potassium from the diet (R).

Potassium chloride irritates upper digestive tract especially in association with delayed stomach emptying. Lesions and ulcerations of the gut lining have been seen (R, R2).

In patients with impaired kidney function or those who take potassium-sparing diuretics, angiotensin receptor blockers, or angiotensin-converting enzyme inhibitors, high potassium intakes from diet and potassium-containing salt substitutes may lead to high potassium in the blood and life-threatening abnormal heart rhythms (R).

Contraindications

In patients with chronic kidney failure, potassium supplementation must be considered carefully because kidneys are the major regulator of potassium balance (R, R2).

Patients with previous history of ulcers and bleeding must be considered carefully for oral potassium supplementation because some potassium salts can be irritating to the gut lining (R, R2).

Serum Potassium

Serum potassium is the amount of potassium in the fluid portion of the blood (serum).

The normal range for serum potassium is narrow (3.5 to 5.5 mmol/L), and minor departure from this range (by less than 1.0 mmol/L) is associated with significant risk of disease and dying (R).

The distribution of potassium between the intracellular and extracellular fluids can markedly affect the serum potassium level without a change in total body potassium (R).

Hypokalemia is defined as a serum potassium concentration of less than 3.5 mmol/L.

It may be caused by the entry of potassium into cells (regulated by insulin, acid-base status, aldosterone, and catecholamines), and a total body depletion of potassium due to kidney, gut, or sweat losses.

Although poor intake is an uncommon cause, patients with extremely poor dietary intake (alcoholics) and patients on severe weight-reduction programs are in danger of developing severe potassium deficiency (R, R2, R3, R4).

Hyperkalemia is defined as a serum potassium concentration above 5.5 mmol/L. Serum potassium above 6.5 mEq/L is associated with significant risk of dying and should be handled as an emergency.

It occurs in kidney failure, adrenal gland insufficiency and massive tissue damage such as in trauma, marked destruction of red blood cells, and in the tumor lysis syndrome (R, R2, R3, R4).

Pseudohyperkalemia is a rise in serum potassium concentration with actual normal plasma potassium concentration.

In pseudohyperkalemia, no toxic manifestation of hyperkalemia is present and no emergency therapy is required because the elevation of serum potassium concentration does not reflect the actual level of plasma potassium in the body.

It is caused by the destruction of red blood cells in the blood sample, prolonged application of a tourniquet or excessive fist clenching when drawing venous blood. Thrombocytosis (elevated platelets) and extreme leukocytosis (elevated white blood cells) can cause pseudohyperkalemia in serum (R, R2).

Both hypokalemia and hyperkalemia may cause asymptomatic changes on electrocardiogram, abnormal heart rhythms, muscle weakness, and death (R).

Potassium Supplements

• Gluconate (Tastes least bad),
• Citrate (for kidney stones)
• Chloride (good for mixing with salt)

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