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Hypokalemia can be treated by supplying additional K+ through the diet, drug treatment, or both. Replacement should be gradual, with frequent evaluation of both serum K+ concentrations and cardiac activity (electrocardiographic monitoring). K+ supplements can be administered in several forms. KCl is generally preferred over other forms such as bicarbonate, citrate, or gluconate, since most patients exhibit concurrent metabolic alkalosis. KCl corrects both the hypokalemia and the alkalosis. When hypokalemia is not attended by metabolic alkalosis, other forms of K+ supplementation may be preferred. Since KCl solutions have a rather bitter and unpleasant taste, this salt was formerly given as an enteric-coated tablet. However, the rapid release of KCl from the tablet after it entered the small intestine was responsible for a severe local ulceration, hemorrhage, and stenosis, especially when there was a delay in gut transit time; therefore, the enteric-coated tablets have been withdrawn.

Sugar-coated products have been marketed that contain KCl in a wax matrix (Slow-K and Kaon-Cl) and are purportedly slow- and controlled-release preparations. Available evidence indicates that these slow-release forms of KCl are occasionally capable of causing local tissue damage and therefore probably should be used with caution for K+ supplementation. Solutions of potassium gluconate, like the tablets, also have been associated with intestinal ulceration. Microencapsulated KCl preparations (Micro-K, K-Dur) that are neither enteric coated nor contained within a wax matrix appear to be superior to the wax matrix formulation.

Consumption of potassium-rich foods is the easiest and most generally advised means of counteracting a K+ deficit. Table 21.3 lists foods that are suitable for K+ supplementation.

In general, a normal diet plus about 40 mEq per day of K+ is adequate to prevent hypokalemia. If K+-rich foods prove inadequate in replacing large quantities of the electrolyte or if the increased caloric intake that is part of the dietary supplementation is not desirable, oral liquid therapy is the formulation of choice. A listing of these solutions is given in Table 21.4. Although patients may find many of these products unpalatable, their further dilution with water or fruit juice can be

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