Potassium

The role of potassium in the kidneys

Potassium is a mineral that's essential for life. Most of the potassium in your body is within your cells. As a result, the amount of potassium in your red blood cells is much greater than in the liquid part of your blood (plasma or serum).

Potassium has many functions in the body. It helps to regulate the activity of all muscle tissue -- smooth muscles (such as the muscles in the intestines), the muscles of the heart, and skeletal muscles. Potassium is part of the enzyme reactions in digestion and metabolism.

It is also part of homeostasis, the mechanism used by the body to maintain a balance between the many electrical and chemical processes of the body.  Tt also helps regulate water (the amount of fluid inside and surrounding all the cells) and electrolyte balance of the body.

Potassium levels can be affected by kidney function and blood pH; the amount of potassium in the diet, hormone levels in the body, excessive vomiting and taking certain medications (including potassium supplements) all has a role to play. Certain cancer therapies designed to rapidly destroy cancer cells may increase blood levels of potassium.

Foods Many foods are rich in potassium including scallops, potatoes, figs, bananas, prune juice, orange juice and squash. A balanced diet generally contains enough potassium for the body's needs. However, potassium is released into urine by the kidneys even when blood potassium level is low. Therefore, blood potassium deficiency can develop quickly if the body is unable to control potassium levels because of a disease or medication.

Abnormal potassium levels may cause symptoms such as muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, confusion, irritability, paralysis and changes in heart rhythm.

Almost all (98%) of potassium in the body is found inside the cells (intracellular). Only about 2% occurs in the fluids outside of the cells (extracellular). Potassium can move into and out of cells.

Blood tests reflect only the extracellular potassium levels and do not indicate the amount of potassium within the cells. Movement of potassium into or out of cells can change the blood potassium level when there is no change in the total amount of potassium in the body.

Why Potassium Tests are Done
A test to measure potassium is done to :

Potassium Test   
A potassium test measures the level of potassium in the blood. It should be acknowledged that normal values may vary from laboratory to laboratory and blood potassium levels vary with age. Many conditions can affect potassium levels. Your GP shoud discuss any significant abnormal results with you in relation to your symptoms and medical history.

Test Results - High values
•    High blood potassium levels (Hyperkalaemia).may be caused by damage or injury to the kidneys that prevents them from removing potassium from the blood normally.
•    High blood potassium levels can also be caused by conditions that release potassium from the body's cells into the blood. These conditions include severe burns, crushing injuries and diabetes.
•    Excessive use of potassium supplements can also cause high levels of potassium in the blood.
•    Excess acid in the blood increases potassium levels by causing the potassium within the body's cells to “leak” out of cells and into the blood.
•    Medication such as angiotensin-converting enzyme (ACE) inhibitors, antibiotics that contain potassium (such as a type of penicillin), NSAIDS (non steroidal anti-inflammatory drugs), heparin, insulin, glucose, corticosteroids, diuretics, medication used to treat high blood pressure, heart disease and natural licorice.
•    Overuse of laxatives
•    Collecting a blood sample immediately after using an elastic band on the arm or while clenching the fist. These actions can damage red blood cells, causing the damaged cells to release potassium into the blood. Therefore, a high blood potassium value should be confirmed through another blood test.
•    Impaired kidney function..  Kidneys control potassium levels
•    Hormone deficiencies, including adrenal failure (Addison's disease)

Sometimes, a report of high potassium isn't true Hyperkalemia. False Hyperkalemia may occur if red blood cells rupture in the blood sample during or shortly after the drawing of the sample. The ruptured cells leak their potassium into the serum. This falsely elevates the amount of potassium in the blood sample even though the potassium level in your body is normal.

Signs and symptoms of true Hyperkalaemia may include muscle fatigue, paralysis and abnormal heart rhythms (arrhythmias).  If you have elevated potassium your doctor may recommend an electrocardiogram to check the effects on your heart rhythm.

Hyperkalemia occurs when the level of potassium in the bloodstream is higher than normal. This may be related to increase in total body potassium or excessive release of potassium from the cells into the bloodstream.

The kidneys normally excrete excess potassium from the body. Therefore, most cases of Hyperkalemia are caused by disorders that reduce the kidneys ability to excrete potassium. Insufficient kidney function may result from disorders including (but not limited to)

Obstructie Uropathy It occurs when urine cannot drain through a ureter because of an obstruction, often ureteral or kidney stones. Urine backs up into the kidney and causes distention of the renal pelvis.  Common causes of obstructive uropathy include Benigh Prostatic Hyperplasia (enlarged prostate).

The prostate gland produces the fluid that carries sperm during ejaculation. As the prostate enlarges, which happens to almost all men as they get older, it can press on the urethra (the tube that empties urine from the bladder) which in turn, causes problems with urination.
Prostate enlargement is often called benign prostatic hypertrophy or hyperplasia (BPH). It is not cancer and it does not put you at increased risk for prostate cancer.

Causes, incidence, and risk factors   
The actual cause of prostate enlargement is unknown. In addition to age, overgrowth of the prostate seems to require normal function of the testicles, which produce testosterone. This is known because men who have had their testicles removed at a young age (for example, for testicular cancer) do not develop BPH. Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.

The likelihood of developing an enlarged prostate increases with age. In fact, BPH is so common that it has been said, "All men will have an enlarged prostate if they live long enough!" A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80. No risk factors have been identified other than having normally functioning testicles.

Symptoms    
Less than half of all men with BPH have symptoms of the disease, which include:
•    Slowed or delayed start of the urinary stream
•    Weak urine stream
•    Dribbling after urinating
•    Straining to urinate
•    Strong and sudden urge to urinate
•    Incomplete emptying of your bladder
•    Needing to urinate 2 or more times per night
•    Urinary retention (complete inability to urinate)
•    Incontinence
•    Pain with urination or bloody urine (these may indicate infection)

SELF-CARE for mild symptoms:
•    Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
•    Avoid alcohol and caffeine, especially after dinner.
•    Don't drink a lot of fluid all at once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime.
•    Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
•    Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
•    Learn and perform pelvic strengthening exercises.
•    Reduce stress. Nervousness and tension can lead to more frequent urination
•    Keep to an alkaline diet to reduce general acidosis
•    Important to drink plenty of water during the day time only

Herbs like Saw palmetto and Juniper will ease prostate symptoms. Look for fat-soluble saw palmetto extract with 85-95% fatty acids and sterols.
Sit in an aisle seat at the theatre or on an airplane. This won't reduce your symptoms, but it may relieve your anxiety about having to urinate often or suddenly.

Symptoms associated with Obstructive Uropathy vary depending on whether the obstruction is acute or chronic, whether it is unilateral or bilateral, whether it is complete or partial, and what caused it. Common symptoms of obstructive uropathy include the following:
•    Flank Pain
o    Bilateral or unilateral
o    Colicky or severe
•    Urinary tract infection
•    Fever
•    Difficulty or pain whilst urinating
•    Nausea or vomiting
•    Renal failure
•    Weight gain or swelling (oedema)
•    Decreased urine output
•    Blood in the urine

Expectations (prognosis)    
If acute obstruction is rapidly diagnosed and repaired, renal damage is minimal or reversible -- regardless of being unilateral or bilateral. If chronic unilateral obstruction is not relieved promptly there could be permanent damage to the kidney. Chronic unilateral obstruction usually does not cause renal insufficiency or failure because most patients have normal function from the other kidney.

Chronic bilateral obstruction may lead to renal insufficiency or failure because both kidneys may become damaged and fail to function even after obstruction is repaired.

Complications
Obstructive Uropathy can cause permanent and severe damage to the kidneys, resulting in renal failure. Obstructive Uropathy caused by bladder outlet obstruction can lead to permanent and severe damage to the bladder, resulting in problems such as incontinence, urinary retention.

The hormone aldosterone regulates kidney excretion of sodium and potassium. Lack of aldosterone can result in Hyperkalemia with an increase in total body potassium. Addison’s Disease is one disorder that causes reduced aldosterone production.

Any time potassium is released from the cells, it may accumulate in the extracellular fluid and the bloodstream. General body acidosis results in the movement of potassium from inside the cells to the extracellular fluid.

Tissue trauma causes the cells to release potassium into the extracellular fluid. This could be from:
•    Traumatic injury
•    Surgery
•    Gastrointestinal bleeding
•    Tumours
•    Burns
•    Hemolytic conditions (disorders that cause blood cells to burst)
•    Rhabdomyolysis from drug ingestion, alcoholism, coma, or certain infections

Kidney function is adequate, and sufficient amounts of aldosterone are present, tissue trauma alone rarely results in Hyperkalemia. A normally functioning kidney will excrete the excess potassium that has been released from the cells.

Increased intake of potassium may cause hyperkalemia if kidney function is poor. Salt substitutes often contain potassium, as do many "low-salt" packaged foods. Hyperkalemia may be caused by medications, including medications that affect kidney function (potassium sparing diuretics, such as spironolactone, amiloride, or triamterene) and potassium supplements (especially intravenous potassium).

Hyperkalemia should be monitored closely, a gradual increase in potassium may be better tolerated by the body than a sudden increase.
Symptoms
Hyperkalemia is often asymptomatic. Occasionally, the following signs or symptoms may be seen:
•    Nausea
•    Irregular heartbeat
•    Slow, weak, or absent pulse

ACUTE TREATMENT
The goal of acute treatment is to protect the body from the effects of Hyperkalemia. This may include protective and preventative measures, dietary changes, herbal and/or homeopathic remedies, encouraging a shift of potassium into the intracellular fluid, and reduction of total body potassium.

Emergency treatment is indicated if the potassium becomes very high, or if severe symptoms are present, including changes in the ECG.
Intravenous calcium may be given to temporarily counteract the muscular and cardiac effects of hyperkalemia.

Intravenous glucose and insulin moves potassium from the extracellular fluids back into the cells. This may reverse severe symptoms long enough to allow correction of the cause of the hyperkalemia.

Sodium bicarbonate causes potassium to shift from extracellular to intracellular fluids. It may reverse Hyperkalemia caused by acidosis with no other treatment required. Prolonged use of sodium bicarbonate should be avoided because it may cause severe complications. 

Nutritional changes are vital.
Diuretic medications cause decrease in total body potassium. They may be prescribed for persons who can tolerate the loss of body fluid that accompanies use of a diuretic.

Cation-exchange resins, such as sodium polystyrene sulfonate (Kayexalate), are medications that bind potassium and cause it to be excreted from the gastrointestinal tract. These medications may be given orally or rectally.

LONG-TERM TREATMENT
Long-term treatment includes treatment of the cause and associated disorders.

Treatment of chronic kidney problems may include dietary potassium restriction. "Loop diuretics" may be prescribed to reduce potassium and fluid levels in persons with chronic renal failure.
Need for potassium supplements and other medications that may cause

Hyperkalemia should be reviewed by the GP. These medications may be stopped, reduced in dose, or substituted by another medication.
Salt substitute, often used by people on a low salt diet, should not be used by those with potential kidney problems or a history of Hyperkalemia.

PREVENTION    
Kidney function should be assessed prior to and during administration of potassium supplements. They should not be given unless the urine output and kidney function is adequate.

Nutritional changes to address acidosis combined with herbal remedies to address proper kidney/bladder and circulatory function may reduce or even halt the progression of high potassium levels combined with appropriate and regular monitoring by the medical profession.

Please call Bromley Health Management on FREEPHONE 0800 093 1178 for a FREE initial consultation if you require more information or if you want to make nutritional changes to support medical advice.

For those who suspect any of the above medical conditions, it is advisable to seek the help of a medical practitioner prior to any consideration of self help or sourcing the services of a complementary and alternative health practitioner.

Information gleaned and reviewed from various sources on the Internet.

Sunday, 6 April 2008

© 2008 Bromley Health Management