Prevention Of Drug-induced Potassium-blood Disorders

Potassium-blood disorders rarely occur due to eating but often occur due to medication, especially in people with "genetic disorders of potassium-blood disorders." Therefore, the prevention of potassium-blood disorders in the drug is very important.
The danger of a blood-potassium disorder
In the body, potassium has a high ratio in intracellular fluid, along with sodium, calcium to generate cellular electrophysiology, plays an important role in neuromuscular conduction. In addition, potassium also helps regulate metabolism of glucids and protid.
Potassium permeates relatively little through the cell membrane, excreted in the urine (80 -90%), a small fraction through the feces, not stored in the body as sodium, tends to escape from the cell during pathology ( dizziness, extensive burns, excessive bleeding, adrenal insufficiency)

. When too much potassium is lost, there will be an increase in sodium in the cell, an increase in bicarbonate in the extracellular fluid.
The average blood-potassium concentration of 5nmol / L (20mg%), depending on the person, diet, the amount of potassium varies from 3.5-5nmol / L; if <3nmol / L is considered to be decreased, if> 5nmol / L is considered to increase potassium - blood Khaki-blood disorders cause serious cardiovascular events such as arrhythmia, heart failure .



.. especially when combined with ventricular arrhythmias. The higher the dose, the greater the severity of the event.
Ways to prevent it
Potassium-blood disorders occur on a case by case basis and there are specific precautions for each. Diuretics used to treat hypertension: Previously, when treating hypertension, thiazide diuretics used to help excrete water, reduce extracellular volume, plasma volume, cause secondary vasodilation leading to hypotension. pressure Therefore, high doses of thiazide must be used, which can cause hypokalemia.




Today, thiazides have been found to inhibit protein transport of sodium-chlorine pairs in the distal tubule, causing indirect vasodilator-mediated vasodilation leading to hypotension, which should be used at low doses (only 12, 5mg / day, when needed just to use 25mg / day) should not cause excretion, reduce potassium-blood significantly. To prevent hypokalemia, it is necessary to understand the mechanism of thiazide diuretics, low doses as directed, no potassium supplementation, only enough vegetables or a few bananas to eat.
Use diuretics in combination with other antihypertensive drugs: One of the ways is to use diuretics with ACE inhibitors (UCMC). UCMC itself reduces aldosteron and causes hyperkalemia. If UCMC is combined with a mild potassium hyperuretic diuretic (thiazide), it is possible to regulate potassium (in a compensatory manner).
If UCMC is combined with potassium-sparing diuretics (spironolactone), it is easy to increase potassium-blood (because of the increase of two drugs). Therefore, depending on the treatment requirements, ability to respond, tolerated by the patient, choose a combination of UCMC and appropriate diuretics to both meet the requirements of lowering blood pressure but not cause sudden lower blood pressure, At the same time does not cause blood potassium disorders.
Physicians usually calculate the dose of each drug, start with a low dose, then increase gradually to meet the above requirements and give the patient a stable dose.



Patients should adhere to the dose, do not arbitrarily increase the number of times the combination drug (will be overdose) nor increase or decrease a single thing (because it will damage the combination).
Diuretics for heart failure: Depending on the type of heart failure, doctors use different types of diuretics. For example, mild and moderate heart failure often use mild potassium excretion (thiazide).
In acute left heart failure, chronic heart failure often uses strong potassium excretion (furosemide), sometimes it is used to increase the group of mild potassium excretion (thiazide) with potassium saving group (spironolactone) to compensate for each other. In addition, depending on the drug being used in heart failure, select appropriate diuretics to avoid adverse interactions.
For example, when people with heart failure are taking UCMC, spironolactone should not be used (because both increase potassium), while potassium-excreting diuretics can be used (because potassium will increase and decrease compensate for each other). This is a delicate selection of physicians, patients need to comply, not arbitrarily change the drug, the dose.
Do not coordinate with torsades de pointes: Potassium-blood disorder is a favorable condition for torsades de pointes.



Therefore, do not use diuretics with medications that have the potential to cause torsades de pointes such as antiallergic drugs (terfenadine, astemisol), cardiovascular drugs (diisopyramid, quinidine, bretylium, amioda ron, vincamin), antibiotics (erythromycin) vein). Some people with hereditary hypokalemia should avoid taking potassium-rich drugs. People with inherited hyperkalemia should avoid medications that increase potassium.
Doctors base on patient history that give medicine, appropriate dosage and patients need to follow. In addition, these people need to have a proper diet such as a balanced diet of lipids, glucids, protid, vegetables. For people with inherited hypokalemia, need to eat more foods rich in potassium, avoid cold infections, avoid overexertion, avoid eating too much glucide (because eating a lot of glucid will have to consume a lot of potassium) leading to hypokalemia - blood..

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