Whole Body Health Sale

POTASSIUM



Table of Contents
image Magnesium and potassium in diabetes and carbohydrate metabolism. Review of the present status and recent results.
image Sudden infant death syndrome (SIDS): oxygen utilization and energy production.
image Prospective study of nutritional factors, blood pressure, and hypertension among US women.
image Association of macronutrients and energy intake with hypertension.
image Potassium depletion and salt-sensitive hypertension in Dahl rats: effect on calcium, magnesium, and phosphate excretions.
image Associations between blood pressure and dietary intake and urinary excretion of electrolytes in a Chinese population.
image Micronutrient effects on blood pressure regulation.
image Community-based prevention of stroke: nutritional improvement in Japan
image Electrolytes and hypertension: results from recent studies.
image The pathogenesis of eclampsia: the 'magnesium ischaemia' hypothesis.
image Intracellular Mg2+, Ca2+, Na2+ and K+ in platelets and erythrocytes of essential hypertension patients: relation to blood pressure.
image A prospective study of nutritional factors and hypertension among US men
image Electrolytes in the epidemiology, pathophysiology, and treatment of hypertension.
image Minerals and blood pressure.
image Attenuated vasodilator responses to Mg2+ in young patients with borderline hypertension.
image Dietary modulators of blood pressure in hypertension
image Daily intake of macro and trace elements in the diet. 4. Sodium, potassium, calcium, and magnesium
image Prospects for nutritional control of hypertension
image The decline in stroke mortality. An epidemiologic perspective
image [Guidelines on treatment of hypertension in the elderly, 1995--a tentative plan for comprehensive research projects on aging and health-- Members of the Research Group for "Guidelines on Treatment of Hypertension in the Elderly", Comprehensive Research Projects on Aging and Health, the Ministry of Health and Welfare of Japan]
image Fish oil and other nutritional adjuvants for treatment of congestive heart failure
image Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables
image Effective water clearance and tonicity balance: The excretion of water revisited
image Elevated myocardial interstitial norepinephrine concentration contributes to the regulation of Na+,K+-ATPase in heart failure
image Concentrations of magnesium, calcium, potassium, and sodium in human heart muscle after acute myocardial infarction.
image [Oral MAGNESIUM supplementation to patients receivingdiuretics -- normalization of MAGNESIUM, POTASSIUM and sodium, and POTASSIUM pumps in the skeletal muscles].
image MAGNESIUM-POTASSIUM interactions in cardiac arrhythmia. Examples of ionic medicine.
image Characterization of inwardly rectifying K+ channel in human cardiac myocytes. Alterations in channel behavior in myocytes isolated from patients with idiopathic dilated cardiomyopathy.
image Muscle and serum magnesium in pulmonary intensive care unit patients.
image Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease.
image Unrecognized pandemic subclinical diabetes of the affluent nations: Causes, cost and prevention
image Vitamin and mineral deficiencies which may predispose to glucose intolerance of pregnancy
image Magnesium and potassium in diabetes and carbohydrate metabolism. Review of the present status and recent results.
image Skeletal muscle magnesium and potassium in asthmatics treated with oral beta2-agonists
image Sino-atrial Wenckebach conduction in thyrotoxic periodic paralysis: a case report.
image Community-based prevention of stroke: nutritional improvement in Japan
image The decline in stroke mortality. An epidemiologic perspective.
image Effects of high K on relaxation produced by drugs in the guinea-pig tracheal muscle
image Frequently nebulized beta-agonists for asthma: effects on serum electrolytes.
image Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease.
image POTASSIUM CITRATE
The lack of influence of long-term potassium citrate and calcium citrate treatment in total body aluminum burden in patients with functioning kidneys

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Magnesium and potassium in diabetes and carbohydrate metabolism. Review of the present status and recent results.

Magnesium. 1984. 3(4-6). P 315-23

Diabetes mellitus is the most common pathological state in which secondary magnesium deficiency occurs. Magnesium metabolism abnormalities vary according to the multiple clinical forms of diabetes: plasma magnesium is more often decreased than red blood cell magnesium. Plasma Mg levels are correlated mainly with the severity of the diabetic state, glucose disposal and endogenous insulin secretion. Various mechanisms are involved in the induction of Mg depletion in diabetes mellitus, i.e. insulin and epinephrine secretion, modifications of the vitamin D metabolism, decrease of blood P, vitamin B6 and taurine levels, increase of vitamin B5, C and glutathione turnover, treatment with high levels of insulin and biguanides. K depletion in diabetes mellitus is well known. Some of its mechanisms are concomitant to those of Mg depletion. But their hierarchic importance is not the same: i.e., insulin hyposecretion is more important versus K+ than versus Mg2+. Insulin increases the cellular inflow of K+ more than that of Mg2+ because there is more free K+ (87%) than Mg2+ (30%) in the cell. The consequences of the double Mg-K depletion are either antagonistic: i.e. versus insulin secretion (increased by K+, decreased by Mg2+) or agonistic i.e. on the membrane: (i.e. Na+K+ATPase), tolerance of glucose oral load, renal disturbances. The real importance of these disorders in the diabetic condition is still poorly understood. Retinopathy and microangiopathy are correlated with the drop of plasma and red blood cell Mg. K deficiency increases the noxious cardiorenal effects of Mg deficiency. The treatment should primarily insure diabetic control.



Sudden infant death syndrome (SIDS): oxygen utilization and energy production.

Med Hypotheses (ENGLAND) Jun 1993, 40 (6) p364-6

Reid found selenium (Se) deficient soils were a common factor in two populations with the highest incidence of SIDS world-wide (Indian population of King County Washington State, USA and the population of Canterbury, New Zealand). Reid compared a map of the selenium responsive livestock areas in New Zealand with areas of low soil iodine (I). She found that the 1989 report of areas of the highest SIDS incidence coincided with Se responsive livestock areas combined with low soil iodine. Foster found the 1983-84 incidence of SIDS in USA has the strongest positive correlation with the incidence of goitre in World War I troops (1916). Sodium and strontium were positively related. Emery found a hypernatraemic SIDS victim in a very cold environment. Robertson and Parker associated increased sodium (Na) (used in Scunthorpe, England, as a water softener) with increased incidence of SIDS. Godwin's study of White Muscle Disease in lambs describes Se protection. Skeletal muscle mitochondria from dystrophic animals showed lowered respiratory rates with palmitoyl-dl-carnitine and acetyl-dl-carnitine as substrate. Dystrophic organelles failed to respond to ADP. Rognun found elevated hypoxanthine and an enhanced immune response in most SIDS victims. A syndrome associated with potassium deficiency has been described as a killer of healthy, young Asian men, most often during sleep. This paper describes the interactions of sodium (Na), potassium (K), selenium (Se), and iodine (I) to some factors affecting the utilization of oxygen and the production of energy. (19 Refs.)



Prospective study of nutritional factors, blood pressure, and hypertension among US women.

Hypertension (UNITED STATES) May 1996, 27 (5) p1065-72

We examined prospectively the relation of nutritional factors with hypertension and blood pressure levels among 41,541 predominantly white US female nurses, aged 38 to 63 years, who completed a detailed semiquantitative food frequency questionnaire in 1984 and were without diagnosed hypertension, cancer, or cardiovascular disease. During 4 years of follow-up, from 1984 to 1988, 2,526 women reported a diagnosis of hypertension. Age, relative weight, and alcohol consumption were the strongest predictors for the development of hypertension. Dietary calcium, magnesium, potassium, and fiber were not significantly associated with risk of hypertension, after adjusting for age, body mass index, alcohol, and energy intake. Among women who did not report hypertension during the follow-up period, calcium, magnesium, potassium, and fiber were each significantly inversely associated with self-reported systolic and diastolic pressures, after adjusting for age, body mass index, alcohol consumption, and energy intake. When the four nutrients were added simultaneously to the regression model, only fiber and magnesium intakes retained significant inverse associations with systolic and diastolic pressures. In analyses of food groups, intakes of fruit and vegetables were inversely associated with systolic and diastolic pressures, and intakes of cereals and meat were directly associated with systolic pressure. These results support hypotheses that age, body weight, and alcohol consumption are strong determinants of risk of hypertension in middle-aged women. They are compatible with the possibilities that magnesium and fiber as well as a diet richer in fruits and vegetables may reduce blood pressure levels.



Association of macronutrients and energy intake with hypertension.

J Am Coll Nutr (UNITED STATES) Feb 1996, 15 (1) p21-35

Hypertension, a major public health problem, becomes more prevalent during aging. Epidemiological studies suggest that environmental factors such as nutrition may play a major role in blood pressure (BP) regulation. It is generally accepted that obesity and sodium/alcohol consumption are important factors, and many believe that calcium, magnesium and potassium consumption are regulatory as well. Less emphasis has been placed on whether macronutrients influence blood pressure significantly. This review focused on the ability of excess calories and consumption of carbohydrates, fats, and proteins to regulate blood pressure. (207 Refs.)



Potassium depletion and salt-sensitive hypertension in Dahl rats: effect on calcium, magnesium, and phosphate excretions.

Clin Exp Hypertens (UNITED STATES) Aug 1995, 17 (6) p989-1008

Weanling male inbred Dahl rats (Jr salt-sensitive (S) and salt-resistant (R) strains) were placed on high (4%, HK) and low (0.2%, LK) potassium diets for 4 weeks. Both diets contained 8% sodium chloride, 2.5% calcium, 0.8% magnesium, and 2.0% phosphorous. Balance studies were carried out during the final week on the diets. Mean arterial blood pressure was determined, and dietary intake and urinary output of water, sodium, chloride, potassium, calcium, magnesium, and phosphate were monitored daily during this period. The data show that blood pressures of S rats were significantly higher than those of R rats on both HK and LK diets; however, reduced dietary potassium was associated with increased blood pressure in both strains. Urinary excretions of calcium and magnesium were higher, and urinary phosphate excretion was lower, in S compared to R rats. Decreased potassium intake was associated with increased excretion of calcium, magnesium and phosphate in both strains. The changes in calcium and magnesium excretion were significantly correlated to blood pressure across strains and diets. We conclude that the effects of a high salt diet on increasing blood pressure can be potentiated by lack of potassium, even in previously salt-resistant rats. Increased blood pressure is associated with increased divalent cation excretion. It is not yet known whether this is a cause-and-effect relationship.



Associations between blood pressure and dietary intake and urinary excretion of electrolytes in a Chinese population.

J Hypertens (ENGLAND) Jan 1995, 13 (1) p49-56

OBJECTIVE: To examine the associations between blood pressure and sodium, potassium, calcium and magnesium in a cross-sectional study by 24-h urine collections and food weighing with 3-day food records in 328 males and 335 females in Tianjin, People's Republic of China. RESULTS: A very high sodium intake and sodium:potassium ratio was confirmed in the study population. After adjusting for confounding variables, both dietary and urinary sodium and sodium:potassium ratio were significantly and positively correlated with blood pressure. Although a negative correlation was found between potassium and blood pressure, the association was significant only between urinary potassium and systolic blood pressure in females and in both sexes combined. No significant associations were found between blood pressure and either intake of or urinary excretion of calcium and magnesium. The dietary intake correlated highly with urinary excretion of electrolytes. In both sexes a strong positive association was found between blood pressure and age, and between blood pressure and body mass index. Higher blood pressure was shown in subjects with higher sodium and alcohol intake, higher body mass index and lower potassium intake. CONCLUSION: The present results indicate that factors contributing to high blood pressure in Tianjin, People's Republic of China, are related to age, body mass index, high sodium intake and sodium:potassium ratio.



Micronutrient effects on blood pressure regulation.

Nutr Rev (UNITED STATES) Nov 1994, 52 (11) p367-75

Five micronutrients have been shown to directly influence blood pressure: sodium, calcium, potassium, magnesium, and chloride. The data presented here are based on accumulated findings from epidemiologic, laboratory, and clinical investigations, many of which focused primarily on a single nutrient. However, as also discussed here, nutrients are not consumed in isolation, and their physiologic interactions and combined effects on blood pressure are the subjects of much of the current research in the area of diet and hypertension. (71 Refs.)



Community-based prevention of stroke: nutritional improvement in Japan

Health Rep (CANADA) 1994, 6 (1) p181-8

OBJECTIVES: (1) To demonstrate the importance of nutrition, especially sodium restriction and increased potassium and protein intakes, in the prevention of hypertension and stroke in a pilot study involving senior citizens. (2) To design a population-based intervention in the Shimane Prefecture of Japan concerning dietary factors such as low sodium and high potassium, protein, magnesium, calcium and dietary fibre in the prevention of stroke. DESIGN AND METHODS: The intervention study was carried out at a senior citizens' residence and included general health education along with a reduction of dietary salt intake and increases in vegetable and protein, especially from seafood. Sixty-three healthy senior citizens (average age: 74.8 +/- 7.7 years) had their daily meals modified to a low sodium/potassium ratio for four weeks without their knowledge by the use of a potassium chloride substitute for salt, soy sauce and bean paste, which contains much less sodium and more potassium. Monosodium L-glutamate monohydrate used for cooking was changed to monopotassium L-glutamate monohydrate. Blood pressure was measured with the patient in the sitting position. Daily dietary sodium and potassium intakes were assessed by flame photometry from 24-hour urine specimens. Extensive intervention programs were introduced into the Shimane Prefecture, which has a population of 750,000, through health education classes for housewives, home visits by health nurses and an educational TV program for dietary improvement. The mortality from stroke was monitored for 10 years and compared with the average in Japan. RESULTS: The blood pressure lowering effect of reducing the dietary sodium/potassium ratio was confirmed through a pilot intervention study at the senior citizens' residence. The mortality rates for stroke in the middle-aged population from the Shimane Prefecture during the 10 years after the introduction of dietary improvement had a steeper decline in hemorrhagic, ischemic and all strokes than the average for Japan.



Electrolytes and hypertension: results from recent studies.

Am J Med Sci (UNITED STATES) Feb 1994, 307 Suppl 1 pS17-20

The effects of dietary electrolytes on blood pressure may start as early as the prenatal period as there is evidence to suggest that a high maternal calcium, magnesium, and potassium intake is reflected in lower infant blood pressure levels. One randomized trial in newborn infants suggested that, in this early phase, high sodium intake is associated with an increased blood pressure change. Such a sodium effect is not present when children grow older, and between 6 and 16 years a high potassium intake appears to limit the increase in blood pressure. Recent observational population studies have shown that the association between dietary sodium intake and blood pressure level in adults is less than initially reported. In randomized trials, the average fall in blood pressure from moderate sodium restriction is small, although benefits may be larger in the elderly. A high potassium intake has consistently been shown to reduce blood pressure levels in treated and untreated hypertensive subjects, although the overall effects are modest. The available data on calcium are difficult to interpret. From observational studies an inverse association between dietary calcium intake and blood pressure levels has repeatedly been reported. Also, several disturbances in calcium metabolism in hypertensive subjects have been demonstrated. Findings in randomized trials are less consistent and indicate a marked heterogeneity in response. (36 Refs.)



The pathogenesis of eclampsia: the 'magnesium ischaemia' hypothesis.

Med Hypotheses (ENGLAND) Apr 1993, 40 (4) p250-6

'Magnesium ischaemia' is a term used to denote the functional impairment of the ATP-dependent sodium/potassium and calcium pumps in the cell membranes and within the cell itself. The production of ATP and the functioning of these pumps is magnesium-dependent and is critically sensitive to acidosis. Zinc and iron deficiencies may secondarily impair these pumps and thus contribute to 'magnesium ischaemia' (as does acidosis). This term is two-dimensional at its simplest; it refers to a functional magnesium deficiency, whether actual or induced. It is argued that chronic acidosis is the most common inducing factor. This simple hypothesis can begin to unify diverse pathophysiologies: some spontaneous abortions, aspects of Type II and gestational diabetes and the curious observation that heroin addicts become diabetic. It can also unify clinical thinking about pregnancy-induced hypertension, pre-eclampsia/eclampsia and acute fatty liver of pregnancy, as well as the coagulopathy of pregnancy. It makes important predictions about perinatal morbidity and suggests that early supplementation might prevent much pregnancy-induced disease.



Intracellular Mg2+, Ca2+, Na2+ and K+ in platelets and erythrocytes of essential hypertension patients: relation to blood pressure.

Clin Exp Hypertens [A] (UNITED STATES) 1992, 14 (6) p1189-209

Alterations in intracellular cation metabolism have been implicated in the pathophysiology of essential hypertension. Total magnesium, calcium, sodium and potassium levels were studied in serum erythrocytes and platelets, from 154 subjects (76 hypertensive and 78 normotensives; 104 blacks and 50 whites). In the combined black and white hypertensive group, platelet sodium and calcium and erythrocyte calcium were elevated and serum potassium, serum magnesium and platelet magnesium decreased. In the black hypertensive patients, platelet sodium and calcium and erythrocyte calcium were increased, whereas serum magnesium, serum potassium, platelet magnesium and erythrocyte magnesium were decreased. In the white hypertensive group, platelet sodium and erythrocyte calcium were raised and platelet magnesium was decreased. In the black hypertensive patients, serum and platelet magnesium and serum calcium were negatively and erythrocyte and platelet calcium positively correlated with mean arterial pressure. In the white hypertensive patients platelet sodium was directly related to mean arterial pressure. These results suggest that intracellular sodium and calcium overload and magnesium depletion may be important in the pathophysiology of hypertension. Magnesium disturbances are more consistent and widespread in black hypertensive patients than in white hypertensive patients.



A prospective study of nutritional factors and hypertension among US men

Circulation (UNITED STATES) Nov 1992, 86 (5) p1475-84

BACKGROUND. An effect of diet in determining blood pressure is suggested by epidemiological studies, but the role of specific nutrients is still unsettled. METHODS AND RESULTS. The relation of various nutritional factors with hypertension was examined prospectively among 30,681 predominantly white US male health professionals, 40-75 years old, without diagnosed hypertension. During 4 years of follow-up, 1,248 men reported a diagnosis of hypertension. Age, relative weight, and alcohol consumption were the strongest predictors for the development of hypertension. Dietary fiber, potassium, and magnesium were each significantly associated with lower risk of hypertension when considered individually and after adjustment for age, relative weight, alcohol consumption, and energy intake. When these nutrients were considered simultaneously, only dietary fiber had an independent inverse association with hypertension. For men with a fiber intake of < 12 g/day, the relative risk of hypertension was 1.57 (95% confidence interval, 1.20-2.05) compared with an intake of > 24 g/day. Calcium was significantly associated with lower risk of hypertension only in lean men. Dietary fiber, potassium, and magnesium were also inversely related to baseline systolic and diastolic blood pressure and to change in blood pressure during the follow-up among men who did not develop hypertension. Calcium was inversely associated with baseline blood pressure but not with change in blood pressure. No significant associations with hypertension were observed for sodium, total fat, or saturated, transunsaturated, and polyunsaturated fatty acids. Fruit fiber but not vegetable or cereal fiber was inversely associated with incidence of hypertension. CONCLUSIONS. These results support hypotheses that an increased intake of fiber and magnesium may contribute to the prevention of hypertension.



Electrolytes in the epidemiology, pathophysiology, and treatment of hypertension.

Prim Care (UNITED STATES) Sep 1991, 18 (3) p545-57

The data regarding the value of manipulating electrolytes in hypertension are controversial. It appears there are subsets of hypertensive patients who respond with lowering of blood pressure in conjunction with changes in intake of sodium, potassium, and calcium. The information regarding phosphorus and magnesium is less convincing. This paper examines current reports regarding these electrolytes and their role in the pathophysiology and treatment of essential hypertension. (52 Refs.)



Minerals and blood pressure.

Ann Med (FINLAND) Aug 1991, 23 (3) p299-305

The mineral elements sodium, potassium, calcium and magnesium play a central role in the normal regulation of blood pressure. In particular, these mineral elements have important interrelationships in the control of arterial resistance. These elements, especially sodium and potassium, also regulate the fluid balance of the body and, hence, influence the cardiac output. Evidence shows that the present levels of intake of mineral elements are not optimum for maintaining normal blood pressure but predispose to the development of arterial hypertension. Research results suggest that without sodium chloride (common salt) and other sodium compounds being added to the diet arterial hypertension would be virtually non existent. Moreover, blood pressure would not rise with age. In communities with a high consumption of added sodium, a high intake of potassium and, possibly, magnesium seem to protect against the development of arterial hypertension and the rise of blood pressure with age. A marked reduction of sodium intake is effective in treating even severe hypertension. A moderate restriction of sodium intake or an increase in potassium intake exert remarkable antihypertensive effects, at least in some hypertensive patients. Magnesium and possibly also calcium supplements may be effective in reducing blood pressure in some hypertensives. In hypertensive patients treated with drugs sodium restriction and potassium and magnesium supplementation enhance the therapeutic effect, reduce the number and dosage, and lessen the adverse effects of prescribed antihypertensive drugs. Hence, a fall in sodium consumption and increases in potassium and magnesium consumption are useful in preventing and treating arterial hypertension. (62 Refs.)



Attenuated vasodilator responses to Mg2+ in young patients with borderline hypertension.

Circulation (UNITED STATES) Aug 1990, 82 (2) p384-93

Limb vascular responses to magnesium (Mg2+) and potassium (K+) ions were studied in 19 young patients with borderline hypertension (BHT) and compared with those of 22 age-matched normotensive subjects (NT) by measuring the forearm blood flow response to intra-arterial infusion of magnesium sulfate and potassium chloride using venous occlusion plethysmography. Percent decrements of forearm vascular resistance with Mg2+ infusions were significantly less in BHT subjects than in NT (-37.2 +/- 4.2% versus -53.0 +/- 2.0%, p less than 0.05, during the infusion of 0.1 meq Mg2+/min, and -52.2 +/- 4.3% versus -65.6 +/- 1.5%, p less than 0.05, during the infusion of 0.2 meq Mg2+/min). Moreover, the relation of the magnitude of Mg2+ response to initial vascular resistance in six of 10 BHT subjects lies above the 95% confidence interval for predicted values calculated for response points in 11 NT subjects, suggesting attenuated vasodilator responses of Mg2+ in a significant proportion of BHT subjects. In contrast, the response points to K+ in eight of nine BHT subjects fall within the 95% confidence interval, suggesting normal vasodilator responses to K+ in the majority of BHT subjects. Furthermore, the effect of small increments in local serum calcium concentrations on Mg2(+)- and K(+)-induced vasodilation was studied in normal volunteers. Isosmolar CaCl2 solution infused into the same brachial artery at a rate of 0.09 meq/min severely blunted the vasodilating actions of Mg2+ (-30.1 +/- 6.5% versus -65.8 +/- 3.2%, p less than 0.01, during the infusion of 0.2 meq Mg2+/min) but did not affect those of K+ (-63.1 +/- 3.1% versus -55.9 +/- 3.8%, NS, during the infusion of 0.154 meq K+/min). It appears that Mg2(+)-induced vasodilation should be due to the antagonistic action of Mg2+ to calcium, but K(+)-induced vasodilation might not be directly related to calcium movement. Thus, these attenuated responses to Mg2+ but normal responses to K+ in BHT subjects may indicate an underlying defect in vascular Mg2+ metabolism, which ultimately may be related to the alterations in calcium handling by plasma membranes rather than to the abnormalities of membrane Na(+)-K+ pump activity.



Dietary modulators of blood pressure in hypertension

Eur J Clin Nutr (ENGLAND) Apr 1990, 44 (4) p319-27

To study the role of diet, 197 patients of essential hypertension were randomized to either experimental diet (group A, 97 cases) or normal diet (group B, 100 cases) with diuretics given to both the groups. The age varied between 25 and 65 years and 154 were males. The study diet included a significantly higher content of potassium (K), magnesium (Mg), calcium (Ca), polyunsaturated fat, and complex carbohydrates compared to the normal diet. At entry to the study, age, sex, risk factors, mean blood pressures, mean serum Mg, K, Ca, and Na, and drug therapy were comparable in both groups. After 1 year of follow-up, there were significantly fewer patients with resistant hypertension in group A (5) than in group B (17). Mean systolic (148.22 +/- 10.1 mm Hg) and diastolic (90.2 +/- 4.84 mm Hg) pressures in group A were lowered compared to mean systolic (160 +/- 12.0 mm Hg) and diastolic (103.3 +/- 5.8 mm Hg) pressures in group B and initial mean systolic (152.2 +/- 12.8 mm Hg) and diastolic (99.8 +/- 7.2 mm Hg) pressures. Mean serum magnesium (1.86 +/- 9.22 mEq/l) and potassium (4.86 +/- 0.39 mEq/l) levels in group A were significantly higher compared to mean levels of 1.56 +/- 0.11 and 4.0 +/- 0.29 mEq/l, respectively, in group B. However compared to initial levels, K and Mg showed no significant changes in groups A and B. There was a significantly lower incidence of complications in group A (58) compared to group B (100). It is possible that a diet low in Na/K ratio and rich in complex carbohydrates, polyunsaturates, K and Mg may cause a significant reduction in blood pressure and its complications.



Daily intake of macro and trace elements in the diet. 4. Sodium, potassium, calcium, and magnesium

Ann Ig (ITALY) Sep-Oct 1989, 1 (5) p923-42

To complete the picture of the daily dietary intake of minerals, sodium, potassium, calcium and magnesium have now been considered. The study has been carried out in the Italian Marches Region after carefully evaluating the food consumption habits of the population. The foodstuffs comprising the 70 diets examined were collected in institutional canteens and private homes immediately prior to meals. The food was sampled ready for consumption as it had thus undergone the various preparation and cooking procedures, during which considerable changes in mineral content occur. In comparison with the various food consumption standards, the amount of sodium found appears excessively high (4.8 g/d) whereas that of magnesium is insufficient (0.24 g/d). A high sodium intake, and more recently a high Na/K ratio, have been associated with hypertension. Also a lack of magnesium and a high Ca/Mg ratio have repeatedly been associated with hypertension risk. The data to emerge from our study: a high sodium intake, an insufficiency of magnesium, and thus high Na/K and Ca/Mg ratios, would appear likely to enhance cardiovascular disease risk. Even though not all Authors agree on the existence of such correlations, a more correct diet as regards mineral intake is undoubtedly something to encourage.



Prospects for nutritional control of hypertension

Med Hypotheses (ENGLAND) Mar 1981, 7 (3) p271-83

Sodium restriction is not the only nutritional measure likely to prove valuable in the treatment and prevention of hypertension. The hypotensive effects of central adrenergic stimulation can be promoted by supplementary tyrosine, insulin potentiation (as with GTF), and (possibly) high-dose pyridoxine. Insulin potentiators (GTF) and prostaglandin precursors (essential fatty acids) should have direct relaxant effects on vascular muscle. A high potassium, low sodium diet, coenzyme Q, and prevention of cadmium toxicity (as with dietary selenium) may act to offset renally-mediated pressor influences. Functional combinations of these measures might prove to be substantially effective, in which case they would offer considerable advantages over potentially toxic drug therapies.



The decline in stroke mortality. An epidemiologic perspective

Ann Epidemiol (UNITED STATES) Sep 1993, 3 (5) p571-5

The evidence that treatment of hypertension prevents stroke is incontrovertible. Several observations, however, suggest that improvements in the prevalence of antihypertensive treatment cannot explain all of the recent decline in stroke mortality. Changes in nutritional patterns may explain some of the observed decline. Prospective studies have demonstrated conclusively an independent, increasing risk of hemorrhagic, but not thrombotic, stroke at higher levels of alcohol use. Stroke mortality is associated inversely with fat and protein intake. Dietary sodium has been linked to stroke in ecologic studies but not in prospective studies. Ecologic studies have suggested that foods high in vitamin C and potassium protect against stroke; an inverse association of potassium intake with fatal stroke has been demonstrated in cohort studies. Two studies in humans also suggest a protective effect of serum selenium against subsequent stroke. Determination of the influence of nutrients on stroke incidence offers tantalizing opportunities for future research and possibly, intervention.



[Guidelines on treatment of hypertension in the elderly, 1995--a tentative plan for comprehensive research projects on aging and health-- Members of the Research Group for "Guidelines on Treatment of Hypertension in the Elderly", Comprehensive Research Projects on Aging and Health, the Ministry of Health and Welfare of Japan]

Nippon Ronen Igakkai Zasshi (JAPAN) Dec 1996, 33 (12) p945-75

We propose the following guidelines for treatment of hypertension in the elderly. 1. Indications for Treatment. 1) Age: Lifestyle modification is recommended for patients aged 85 years and older. Antihypertensive therapy should be limited to patients in whom the merit of the treatment is obvious. 2) Blood pressure: Systolic BP > 160 mmHg, diastolic BP > 90 approximately 10 mmHg. Systolic BP < age + 100 mmHg for those aged 70 years and older. Patients with mild hypertension (140-160/ 90-95 mmHg) associated with cardiovascular disease should be considered for antihypertensive drug therapy. 2. Goal of Therapy for BP: The goal BP in elderly patients is higher than that in younger patients (BP reduction of 10-20 mmHg for systolic BP and 5-10 mmHg for diastolic BP). In general, 140-160/< 90 mmHg is recommended as the goal. However, lowering the BP below 150/85 should be done with caution. 3. Rate of Lowering BP: Start with half the usual dose, observe at the same dose for at least four weeks, and reach the target BP over two months. Increasing the dose of antihypertensive drugs should be done very slowly. 4. Lifestyle Modification: 1) Dietary modification: (1) Reduction of sodium intake is highly effective in elderly patients due to their high salt-sensitivity. NaCl intake of less than 10 g/day is recommended. Serum Na+ should be occasionally measured. (2) Potassium supplementation is recommended, but with caution in patients with renal insufficiency. (3) Sufficient intake of calcium and magnesium is recommended. (4) Reduce saturated fatty acids. Intake of fish is recommended. (2) Regular physical activity: Recommended exercise for patients aged 60 years and older: peak heart rate 110/minute, for 30-40 minutes a day, 3-5 days a week. (3) Weight reduction. (4) Moderation of alcohol intake, smoking cessation. 5. Pharmacologic Treatment: 1) Initial drug therapy. First choice: Long-acting (once or twice a day) Ca antagonists or ACE inhibitors. Second choice: Thiazide diuretics (combined with potassium-sparing diuretic). 2) Combination therapy. (1) For patients without complications, either of the following is recommended. i) Ca antagoinst + ACE inhibitor, ii) ACE inhibitor + Ca antagonist (or low-dose diuretics), iii) diuretic + Ca antagonist (or ACE inhibitor), iv) beta-blockers, alpha 1-blockers, alpha + beta blockers can be used according to the patho-physiological state of the patient. (2) For patients with complications. Drug(s) should be selected according to each complication. 3) Relatively contraindicated drugs. beta-Blockers and alpha 1-blockers are relatively contraindicated in elderly patients with hypertension in Japan. Centrally acting agents such as reserpine, methyldopa and clonidine are also relatively contraindicated beta-Blockers are contraindicated in patients with congestive heart failure, arteriosclerosis obliterans, chronic obstructive pulmonary disease, diabetes mellitus (or glucose intolerance), or bradycardia. These conditions are often present in elderly subjects. Elderly subjects are susceptible to alpha 1-blocker-induced orthostatic hypotension, since their baroreceptor reflex is diminished. Orthostatic hypotension may cause falls and bone fractures in the elderly.



Fish oil and other nutritional adjuvants for treatment of congestive heart failure

Medical Hypotheses (United Kingdom), 1996, 46/4 (400-406)

Published clinical research, as well as various theoretical considerations, suggest that supplemental intakes of the 'metavitamins' taurine, coenzyme Q10, and L-carnitine, as well as of the minerals magnesium, potassium, and chromium, may be of therapeutic benefit in congestive heart failure. High intakes of fish oil may likewise be beneficial in this syndrome. Fish oil may decrease cardiac afterload by an antivasopressor action and by reducing blood viscosity, may reduce arrhythmic risk despite supporting the heart's beta-adrenergic responsiveness, may decrease fibrotic cardiac remodeling by impeding the action of angiotensin II and, in patients with coronary disease, may reduce the risk of atherothrombotic ischemic complications. Since the measures recommended here are nutritional and carry little if any toxic risk, there is no reason why their joint application should not be studied as a comprehensive nutritional therapy for congestive heart failure.



Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables

Heart and Lung: Journal of Acute and Critical Care (USA), 1996, 25/1 (31-36)

Objective: To explore the relationship between fluid and electrolyte variables and the development of supraventricular tachycardia (SVT) after coronary artery bypass grafting (CABG) surgery. Design: Retrospective chart review. Random selection from a list obtained from the medical records department and with use of the International Classification of Diseases code to identify patients undergoing their initial CABG. Setting: Medical records department of a southeastern 600-bed urban referral hospital with a large cardiovascular surgical program. Patients: Forty patients experiencing SVT and 40 patients not experiencing SVT during their stay in an intensive care unit after CABG. Outcome Measures: Fluid and electrolyte variables and the development of SVT in the intensive care unit after CABG. Variables: Data collected included preoperative demographic variables such as age and gender; previous history of SVT, congestive heart failure, cardiac arrest, previous surgery, diabetes, hypertension, valve disease, tobacco use, obesity; preoperative and postoperative medications; postoperative laboratory values of potassium, calcium, and magnesium; intravenous intake; hourly urine output; and chest tube drainage. Results: Demographic variables revealed that patients with SVT were older (p = 0.001) and had a higher incidence of preoperative SVT (p = 0.04). Although groups did not differ by numbers of patients with high or low potassium, calcium, or magnesium, patients receiving additional intravenous potassium by bolus after surgery had a higher incidence of SVT (p = 0.02). Patients who lost blood via the chest tube at a rate greater than 100 ml per hour for at least 1 hour after surgery had a higher incidence of SVT (p = 0.02). Patients with a urine output greater than 300 ml per hour for longer than 9 hours had an increased incidence of SVT (p = 0.02). In the patients experiencing SVT, 62% had it occur 24 to 48 hours after surgery. Conclusions: These data suggest that shifts in fluid and electrolytes may be important characteristics of patients in whom SVT will develop, which could lead to better identification and nursing management of SVT and improve hemodynamic status, patient recovery, and cost after CABG.



Effective water clearance and tonicity balance: The excretion of water revisited

Clinical and Investigative Medicine (Canada), 1997, 20/1 (16-24)

Objective: To demonstrate (1) that hyponatremia is usually due to an inappropriately low rate of excretion of electrolyte-free water and (2) that the measure 'effective water clearance' (EWC) provides better information about renal defence of the body tonicity than does the classic measure free-water clearance, and to provide the rationale for calculating a 'tonicity balance,' which involves using water and sodium plus potassium intakes and their renal excretion to reveal the basis for changes in body tonicity. Design: Prospective study. Participants: Four normal subjects with no conditions affecting excretion, 10 patients with advanced congestive heart failure (CHF) and 5 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Intervention: Normals and patients were administered a standard water load (20 mL per kg of body weight) during 45 minutes, and blood and urine samples were taken before, during and after the load was given. Main outcome measures: Urine and blood sodium and potassium concentrations, osmolar clearance, free-water clearance, electrolyte clearance and EWC. Results: The water load was excreted rapidly by normals, more slowly by patients with CHF, and not at all by patients with SIADH. The EWC was positive in normals and those with CHF, but negative in those with SIADH. In patients with CHF, the EWC, but not the free-water clearance, helped explain why hyponatremia was corrected after the water load was given. Conclusions: In subjects with abnormal water excretion, the EWC provides the physiologic explanation for the renal role in variations in natremia. The authors propose a bedside evaluation of renal water and electrolyte handling that takes into consideration the role of urinary potassium in body tonicity. Changes in body tonicity can be explained by a 'tonicity balance,' a calculation in which the source and the net balance of sodium, potassium and water are considered.



Elevated myocardial interstitial norepinephrine concentration contributes to the regulation of Na+,K+-ATPase in heart failure

European Journal of Pharmacology (Netherlands), 1996, 309/3 (235-241)

Myocardial Na+,K+-ATPase is reduced in congestive heart failure. To study the regulation of Na+,K+-ATPase in congestive heart failure, we performed Western and Northern blot analyses of ventricular myocardium of dogs with pacing-induced congestive heart failure and chronic norepinephrine infusion, using isoform-specific antibodies and cDNA probes. Congestive heart failure and norepinephrine infusion caused similar increases in myocardial interstitial norepinephrine concentration and reductions of myocardial Na+,K+-ATPase alpha3-subunit protein, but differed in their effects on myocardial Na+,K+-ATPase alpha3-subunit gene expression. Chronic norepinephrine infusion produced no changes in the steady-state mRNA level for the alpha3-subunit of Na+,K+-ATPase, suggesting that the changes in Na+,K+-ATPase protein were induced via a post-transcriptional mechanism. In contrast, down-regulation of the Na+,K+-ATPase alpha3-subunit in the failing heart was accompanied by a decreased alpha3-subunit mRNA level, indicating the presence of a transcriptional event. The alpha3-subunit protein content and mRNA level were not affected by either norepinephrine infusion or rapid ventricular pacing. We conclude that, while elevated myocardiaI interstitial norepinephrine levels may contribute substantially to the down-regulation of the Na+,K+-ATPase alpha3-subunit in the failing myocardium, additional regulatory factors are responsible for the decreased myocardial alpha3-subunit mRNA expression in congestive heart failure.



Concentrations of magnesium, calcium, potassium, and sodium in human heart muscle after acute myocardial infarction.

Clin Chem (UNITED STATES) Nov 1980, 26 (12) p1662-5

Atomic absorption spectrometry was used to measure magnesium, calcium, and sodium, and emission spectrometry to measure potassium, in myocardium (left and right ventricles) of 26 control subjects who died of acute trauma. Results were expressed in mumol/g of proteins. Mg/Ca and K/Na ratios were also determined. The same measurements were made in 24 patients who died from acute myocardial infarction. Samples were also taken from the necrotic area. Mg/Ca and K/Na ratios were significantly higher in the left ventricle of both populations, thus providing evidence of anatomical and physiological differences between the two ventricles. As a result of cytolysis and anoxia, the Mg/Ca ratio was very significantly inverted, and the K/Na ratio very significantly smaller, In these clinical conditions arrhythmias could certainly be considered likely, and there is reason to believe that magnesium depletion may be a cause of arrhythmias.



[Oral MAGNESIUM supplementation to patients receivingdiuretics -- normalization of MAGNESIUM, POTASSIUM and sodium, and POTASSIUM pumps in the skeletal muscles].

Ugeskr Laeger (DENMARK) Jul 4 1994, 156 (27) p4007-10, 4013

In 76 consecutive patients who had received diuretics for 1-17 years for arterial hypertension or congestive heart failure, muscle concentrations of MAGNESIUM, POTASSIUM, and sodium-POTASSIUM pumps were significantly reduced compared to 31 age- and sex-matched controls. Thirty-six patients with muscle MAGNESIUM and/or POTASSIUM below the control level received oral MAGNESIUM hydroxide supplement for 2-12 weeks (N = 20) or 26 weeks (N = 16). After short term (2-12 weeks) MAGNESIUM supplementation muscle parameters were increased, but far from normalized. After MAGNESIUM supplementation for 26 weeks, the muscle concentrations of MAGNESIUM, POTASSIUM and sodium-POTASSIUM pumps were normalized in most cases. Oral MAGNESIUM supplementation may restore diuretic-induced disturbances in the concentrations of MAGNESIUM, POTASSIUM and sodium-POTASSIUM pumps in skeletal muscle. A supplemental period of at least six months seems required before complete normalization can be expected.



MAGNESIUM-POTASSIUM interactions in cardiac arrhythmia. Examples of ionic medicine.

Magnes Trace Elem (SWITZERLAND) 92 1991, 10 (2-4) p193-204

Ionic biology involving Ca2+, Na+, K+ and Mg2+ across the cell membrane and in the development of the action potential is reviewed with reference to cardiac arrhythmia. K+ and Mg2+ deficiency which frequently occur together lead to abnormal ionic transfer of Na+, K+ and Ca2+ with development of automaticity, triggered impulses and reentrant tachycardia. Tachycardia occurring in acute myocardial ischemia, congestive heart failure, hypertensives on diuretics and digitalis toxicity is examined according to the concept of ionic imbalance. A protocol for prevention and treatment of cardiac tachyarrhythmia is proposed with this concept in mind.



Characterization of inwardly rectifying K+ channel in human cardiac myocytes. Alterations in channel behavior in myocytes isolated from patients with idiopathic dilated cardiomyopathy.

Circulation (UNITED STATES) Jul 15 1995, 92 (2) p164-74

BACKGROUND: Little is known about the characteristics of the inwardly rectifying K+ channel (IK1) and the influence of preexisting heart disease on the channel properties in the human heart. METHODS AND RESULTS: We studied the characteristics of cardiac IK1 in freshly isolated adult human atrial and ventricular myocytes by using the patch-clamp technique. Specimens were obtained from the atria and ventricles of 48 patients undergoing cardiac surgery or transplantation and from four explanted donor hearts. The action potential in ventricular myocytes exhibited a longer duration (391.4 +/-30.2 milliseconds at 90% repolarization, n = 10) than in atrium (289.4 +/- 23.0 milliseconds, n = 18, P < .001) and had a fast late repolarization phase (phase 3). The final phase of repolarization in ventricle was frequency independent. Whole-cell IK1 in ventricle exhibited greater slope conductance (84.0 +/- 7.9 nS at the reversal potential, EK; n = 27) than in atrium (9.7 +/-1.2 nS at EK; n = 8, P < .001). The steady-state current-voltage (I-V) relation in ventricular IK1 demonstrated inward rectification with a region of negative slope. This negative slope region was not prominent in atrial IK1. The macroscopic currents were blocked by Ba2+ and Cs+. The channel characteristics in ventricular myocytes from patients with congestive heart failure after idiopathic dilated cardiomyopathy (DCM) exhibited distinct properties compared with those from patients with ischemic cardiomyopathy (ICM). The action potential in ventricular myocytes from patients with DCM had a longer duration (490.8 +/- 24.5 milliseconds, n = 11) compared with that for ICM (420.6 +/- 29.6 milliseconds, n = 11, P < .01) and had a slow repolarization phase (phase 3) with a low resting membrane potential. The whole-cell current slope conductance for DCM was smaller (41.2 +/- 9.0 nS at EK, n = 7) than that for ICM (80.7 +/- 17.0 nS, n = 6, P < .05). In single-channel recordings from cell-attached patches, ventricular IK1 channels had characteristics similar to those of atrial IK1; channel openings occurred in long-lasting bursts with similar conductance and gating kinetics. In contrast, the percent of patches in which IK1 channels were found was 34.7% (25 of 72) of patches in atrium and 88.6% (31 of 35) of patches in ventricle. Single IK1 channel activity for DCM exhibited frequent long-lasting bursts separated by brief interburst intervals at every holding voltage with the open probability displaying little voltage sensitivity (approximately 0.6). Channel activity was observed in 56.2% (18 of 32) of patches for DCM and 77.4% (24 of 31) of patches for ICM. Similar results were obtained from atrial IK1 channels for DCM. In addition, channel characteristics were not significantly different between ICM and explanted donor hearts (donors). IK1 channels in cat and guinea pig had characteristics virtually similar to those of humans, with the exception of lower open probability than that in humans. CONCLUSIONS: These results suggest that the electrophysiological characteristics of human atrial and ventricular IK1 channels were similar to those of other mammalian hearts, with the possible exception that the channel open probability in humans may be higher, that the whole-cell IK1 density is higher in human ventricle than in atrium, and that IK1 channels in patients with DCM exhibited electrophysiological properties distinct from IK1 channels found in patients with ICM and in donors.



Muscle and serum magnesium in pulmonary intensive care unit patients.

Crit Care Med (UNITED STATES) Aug 1988, 16 (8) p751-60

Muscle specimens by means of quadriceps femoris needle biopsy and blood samples were obtained in 32 patients consecutively admitted to a pulmonary ICU for chronic obstructive pulmonary disease and acute respiratory failure, and in 30 age and sex-matched healthy control subjects. Muscle magnesium (Mg) and potassium (K) content was assessed by atomic absorption spectrophotometry; serum electrolytes were also measured. The presence of clinical and biochemical correlates of low serum and muscle Mg was investigated. Three (9.4%) out of 32 patients had hypomagnesemia (Mgs less than or equal to 0.7 mmol/L) with normal muscle Mg values, whereas low muscle Mg values were found in 15 (47%) of 32 patients, with no alterations of serum Mg levels. Muscle Mg was decreased significantly in pulmonary ICU patients as compared to control subjects. No significant correlation was present between serum and muscle Mg, or between serum and muscle K. Significant relationships between muscle Mg and both muscle and intracellular K concentrations were also found. Lower values for muscle and intracellular K and a higher incidence of both more prolonged ICU stays and ventricular extrasystolic beats characterized the ICU patients with altered muscle Mg levels. We conclude that, given the serious complications of Mg metabolism derangements, the presence of altered cell Mg content should be taken into account in pulmonary ICU patients. Moreover, in these patients, serum Mg levels are of little value in the diagnosis of intracellular Mg deficits.



Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease.

Arch Intern Med (UNITED STATES) Jan 1986, 146 (1) p129-33

When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. beta-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.



Unrecognized pandemic subclinical diabetes of the affluent nations: Causes, cost and prevention

Journal of Orthomolecular Medicine (Canada), 1996, 11/2 (95-99)

Regarding populations on the industrialized 'western affluent diet', arguments are made that: (1) plasma glucose values commonly seen and accepted as normal are abnormal; (2) their glucose tolerance is innately unstable; (3) most of their morbidity and mortality is produced by hyperglycemia far below glycosuria and/or arteriosclerosis which can occur independently or together; (4) simple low cost methods for preventing and treating both have been in the literature for decades (correction of the sugar, fat and protein excesses; and controlled supplementation of pyridoxine (vitamin B6). Mg, Cr and coenzyme Q10); and (5) these lessons were missed by main stream medicine because of the vast size of the literature, enforcement of 'treatment of choice', and lack of computer aided diagnosis. Cited as striking evidence of this tragic situation is the failure of mainstream clinical medicine to understand the cause of the remarkable decline in CVD in the 1960s and 1970s that followed U.S. enrichment of cereals with pyridoxine (vitamin B6). Recommendations are made for correction of unnecessary costly delays between publication and implementation of such research findings.



Vitamin and mineral deficiencies which may predispose to glucose intolerance of pregnancy

Journal of the American College of Nutrition (USA), 1996, 15/1 (14-20)

There is an increased requirement for nutrients in normal pregnancy, not only due to increased demand, but also increased loss. There is also an increased insulin resistant state during pregnancy mediated by the placental anti-insulin hormones estrogen, progesterone, human somatomammotropin; the pituitary hormone prolactin; and the adrenal hormone, cortisol. If the maternal pancreas cannot increase production of insulin to sustain normoglycemia despite these anti-insulin hormones, gestational diabetes occurs. Gestational diabetes is associated with excessive nutrient losses due to glycosuria. Specific nutrient deficiencies of chromium, magnesium, potassium and pyridoxine may potentiate the tendency towards hyperglycemia in gestational diabetic women because each of these four deficiencies causes impairment of pancreatic insulin production. This review describes the pathophysiology of the hyperglycemia and the nutrient loss in gestational diabetes and further postulates the mechanism whereby vitamin/mineral supplementation may be useful to prevent or ameliorate pregnancy-related glucose intolerance.



Magnesium and potassium in diabetes and carbohydrate metabolism. Review of the present status and recent results.

Magnesium (SWITZERLAND) 1984, 3 (4-6) p315-23

Diabetes mellitus is the most common pathological state in which secondary magnesium deficiency occurs. Magnesium metabolism abnormalities vary according to the multiple clinical forms of diabetes: plasma magnesium is more often decreased than red blood cell magnesium. Plasma Mg levels are correlated mainly with the severity of the diabetic state, glucose disposal and endogenous insulin secretion. Various mechanisms are involved in the induction of Mg depletion in diabetes mellitus, i.e. insulin and epinephrine secretion, modifications of the vitamin D metabolism, decrease of blood P, vitamin B6 and taurine levels, increase of vitamin B5, C and glutathione turnover, treatment with high levels of insulin and biguanides. K depletion in diabetes mellitus is well known. Some of its mechanisms are concomitant to those of Mg depletion. But their hierarchic importance is not the same: i.e., insulin hyposecretion is more important versus K+ than versus Mg2+. Insulin increases the cellular inflow of K+ more than that of Mg2+ because there is more free K+ (87%) than Mg2+ (30%) in the cell. The consequences of the double Mg-K depletion are either antagonistic: i.e. versus insulin secretion (increased by K+, decreased by Mg2+) or agonistic i.e. on the membrane: (i.e. Na+K+ATPase), tolerance of glucose oral load, renal disturbances. The real importance of these disorders in the diabetic condition is still poorly understood. Retinopathy and microangiopathy are correlated with the drop of plasma and red blood cell Mg. K deficiency increases the noxious cardiorenal effects of Mg deficiency. The treatment should primarily insure diabetic control.(ABSTRACT TRUNCATED AT 250 WORDS)



Skeletal muscle magnesium and potassium in asthmatics treated with oral beta2-agonists

European Respiratory Journal (Denmark), 1996, 9/2 (237-240)

Dietary magnesium has been shown to be important for lung function and bronchial reactivity. Interest in electrolytes in asthma has so far mainly been focused upon serum potassium, especially linked to beta2-agonist treatment. It is known that serum levels of magnesium and potassium may not correctly reflect the intracellular status. We therefore investigated whether asthmatics treated with oral beta2-agonists had low magnesium or potassium in skeletal muscle and serum, and whether withdrawal of the oral beta2-agonists would improve the electrolyte levels. Magnesium and potassium levels in skeletal muscle biopsies, serum and urine were analysed in 20 asthmatics before and 2 months after withdrawal of long-term oral beta2-agonists, and for comparison in 10 healthy subjects. Skeletal muscle magnesium in the asthmatics was lower both before (3.62plus or minus0.69 mmol-100 g-1 (meanplus or minusSD)) and after (3.43plus or minus0.60 mmol.100 g-1) withdrawal of oral beta2-agonists compared with the controls (4.43plus or minus0.74 mmol-100 g-1) Skeletal muscle potassium and serum magnesium did not differ between the groups. Serum potassium was significantly lower both before (4.0plus or minus0.2 mmol.L-1) and after (3.9plus or minus0.2 mmol.L-1) the withdrawal of oral beta2-agonists compared with the control group (42plus or minus0.2 mmol.L-1). The asthmatics had lower skeletal muscle magnesium and lower serum potassium than the healthy controls, both with and without oral beta2-agonists. Whether the findings are related to asthma pathophysiology or treatment is currently being investigated.



Sino-atrial Wenckebach conduction in thyrotoxic periodic paralysis: a case report.

Int J Cardiol (IRELAND) Jan 6 1995, 47 (3) p285-9

A 28-year-old male presented with thyrotoxic periodic paralysis. On admission to hospital the serum potassium level was 1.4 mmol/l. The ECG showed classical features of hypokalaemia. In addition, sino-atrial block with Wenckebach conduction was also present. With the normalization of the serum potassium, the ECG became completely normal and showed no evidence of any arrhythmia .



Community-based prevention of stroke: nutritional improvement in Japan

Health Rep (CANADA) 1994, 6 (1)

OBJECTIVES: (1) To demonstrate the importance of nutrition, especially sodium restriction and increased potassium and protein intakes, in the prevention of hypertension and stroke in a pilot study involving senior citizens. (2) To design a population-based intervention in the Shimane Prefecture of Japan concerning dietary factors such as low sodium and high potassium, protein, magnesium, calcium and dietary fibre in the prevention of stroke. DESIGN AND METHODS: The intervention study was carried out at a senior citizens' residence and included general health education along with a reduction of dietary salt intake and increases in vegetable and protein, especially from seafood. Sixty-three healthy senior citizens (average age: 74.8 +/- 7.7 years) had their daily meals modified to a low sodium/potassium ratio for four weeks without their knowledge by the use of a potassium chloride substitute for salt, soy sauce and bean paste, which contains much less sodium and more potassium. Monosodium L-glutamate monohydrate used for cooking was changed to monopotassium L-glutamate monohydrate. Blood pressure was measured with the patient in the sitting position. Daily dietary sodium and potassium intakes were assessed by flame photometry from 24-hour urine specimens. Extensive intervention programs were introduced into the Shimane Prefecture, which has a population of 750,000, through health education classes for housewives, home visits by health nurses and an educational TV program for dietary improvement. The mortality from stroke was monitored for 10 years and compared with the average in Japan. RESULTS: The blood pressure lowering effect of reducing the dietary sodium/potassium ratio was confirmed through a pilot intervention study at the senior citizens' residence. The mortality rates for stroke in the middle-aged population from the Shimane Prefecture during the 10 years after the introduction of dietary improvement had a steeper decline in hemorrhagic, ischemic and all strokes than the average for Japan.



The decline in stroke mortality. An epidemiologic perspective.

Ann Epidemiol (UNITED STATES) Sep 1993

The evidence that treatment of hypertension prevents stroke is incontrovertible. Several observations, however, suggest that improvements in the prevalence of antihypertensive treatment cannot explain all of the recent decline in stroke mortality. Changes in nutritional patterns may explain some of the observed decline. Prospective studies have demonstrated conclusively an independent, increasing risk of hemorrhagic, but not thrombotic, stroke at higher levels of alcohol use. Stroke mortality is associated inversely with fat and protein intake. Dietary sodium has been linked to stroke in ecologic studies but not in prospective studies. Ecologic studies have suggested that foods high in vitamin C and potassium protect against stroke; an inverse association of potassium intake with fatal stroke has been demonstrated in cohort studies. Two studies in humans also suggest a protective effect of serum selenium against subsequent stroke. Determination of the influence of nutrients on stroke incidence offers tantalizing opportunities for future research and possibly, intervention.



Effects of high K on relaxation produced by drugs in the guinea-pig tracheal muscle

RESPIR. PHYSIOL. (NETHERLANDS), 1985, 61/1 (43-55)

In the guinea-pig tracheal smooth muscle, effects of various relaxants were compared in normal (5.9 mM) and excess (40 mM) K media. The relaxing efect of calcium-channel blockers, nifedipine and verapamil (group I) was potentiated by increasing the external K concentration. The effect of the drugs which are supposed to increase intracellular cyclic AMP, such as isoprenaline, forskolin, isobutylmethylxanthine, theophylline, dibutyryl cyclic AMP (group II) was moderately reduced by excess K. Nitroprusside, 8-bromo-cyclic GMP and sodium nitrite (group III) are generally considered to increase intracellular cyclic GMP and their effect was markedly reduced by excess K. When the tension development was made the same at 5.9 mM K and 40 mM K by adjusting the Ca concentration, the relaxing effect was similar and independent of the K concentration both for group II and group III drugs. It seems that the group II drugs can better overcome a large influx of Ca than group III drugs.



Frequently nebulized beta-agonists for asthma: effects on serum electrolytes.

Ann Emerg Med (UNITED STATES) Nov 1992, 21 (11) p1337-42

STUDY OBJECTIVE: To determine the magnitude of the changes in serum potassium, magnesium, and phosphate during the treatment of acute bronchospasm with repeated doses of beta-adrenergic agonists. DESIGN: Prospective study of a convenience sample of asthmatic patients. SETTING: University teaching hospital emergency department. TYPE OF PARTICIPANTS: Twenty-three patients met the inclusion criteria of age of more than 16 years; a history of asthma or chronic obstructive pulmonary disease; and an acute exacerbation. INTERVENTIONS: Baseline peak expiratory flow rate and serum potassium, magnesium, and phosphate levels were measured. Nebulized albuterol (2.5 mg) was administered every 30 minutes until the patient was discharged from the ED. Before each albuterol treatment, repeat serum levels of potassium, magnesium, and phosphate were determined. MEASUREMENTS AND MAIN RESULTS: Baseline peak expiratory flow rate averaged 188 +/- 119 L/min. Serum potassium levels decreased significantly (P = .0001 by repeated-measures analysis of variance) from 4.10 +/- 0.468 (baseline) to 3.55 +/- 0.580 mmol/L (90 minutes) and 3.45 +/- 0.683 mmol/L (180 minutes). Potassium decreased to less than 3.0 mmol/L in 22% of patients at some point during the study. Magnesium decreased from 1.64 +/- 0.133 mmol/L (baseline) to 1.48 +/- 0.184 mmol/L (90 minutes) and 1.40 +/- 0.219 mmol/L (180 minutes) (P = .0001). Phosphate levels also decreased, from 3.74 +/- 1.029 (baseline) to 2.84 +/- 0.957 mmol/L (90 minutes) and 2.55 +/- 0.715 mmol/L (180 minutes) (P = .0001). CONCLUSION: Aggressive administration of nebulized albuterol during the emergency treatment of acute bronchospasm is associated with statistically significant decreases in serum potassium, magnesium, and phosphate. The mechanism and clinical significance of these findings are unknown and warrant further study.



Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease.

Pharmacotherapy (UNITED STATES) Nov-Dec 1994, 14 (6) p729-33

STUDY OBJECTIVE. To evaluate the metabolic and cardiopulmonary effects of nebulized albuterol in patients suffering moderate to severe exacerbations of asthma or chronic obstructive pulmonary disease. DESIGN. Open-label, prospective study. SETTING. The emergency department of a university medical center. PATIENTS. Ten patients with moderate to severe exacerbation of asthma. INTERVENTIONS. Each patient received nebulized albuterol 2.5 mg for approximately 10 minutes. MEASUREMENTS AND MAIN RESULTS. Serum potassium, heart rate and rhythm, blood pressure, and pulmonary function were measured before treatment and every 15 minutes for 2 hours after treatment. Serum potassium concentrations decreased significantly (p < 0.05) within 75 minutes after initiation of treatment, from a baseline value of 4.5 +/- 0.6 mEq/L (range 3.5-5.5 mEq/L) to 3.7 +/- 0.5 mEq/L (range 2.8-4.4 mEq/L) at the end of the collection period (120 minutes). Forced expiratory volume in 1 second significantly increased over time in patients with asthma (p < 0.05). No statistically significant changes in blood pressure, heart rate, or corrected QT intervals occurred. Pre-emergency department use of a beta 2-agonist by metered-dose inhaler was not associated with a decreased serum potassium on admission. CONCLUSIONS. Nebulized beta 2-agonists are generally efficacious and safe in patients with acute bronchospasms. However, close monitoring of serum electrolytes, heart rate, and rhythm in patients at risk (elderly, those with pre-existing cardiac disease) is advised before these individuals receive repeat doses by continuous aerosol administration.



The lack of influence of long-term potassium citrate and calcium citrate treatment in total body aluminum burden in patients with functioning kidneys

Journal of the American College of Nutrition (USA), 1996, 15/1 (102-106)


Background: It has been suggested that citrate salts might enhance aluminum (Al) absorption from a normal diet, posing a threat of Al toxicity even in subjects with normal renal function. We have recently reported that in normal subjects and patients with moderate renal failure, short-term treatment with tricalcium dicitrate (Ca,Cit2) does not significantly change urinary and serum Al levels. However, we have not assessed total body Al stores in patients on long-term citrate treatment. Objective: The objective of this study was to ascertain body content of Al non-invasively using the increment in serum and urinary Al following the intravenous administration of deferoxamine (DFO) in patients with kidney stones and osteoporotic women undergoing long-term treatment with potassium citrate (K3Cit) or Ca3Cit2, respectively. Methods: Ten patients with calcium nephrolithiasis and five with osteoporosis who were maintained on potassium citrate (40 mEq/day or more) or calcium citrate 800 mg calcium/day (40 mEq citrate) for 2 to 8 years, respectively, and 1 h normal volunteers without a history of regular aluminum-containing antacid use participated in the study. All participants completed the 8 days of study, during which they were maintained on their regular home diet. Urinary Al excretion was measured during a two-day baseline before (Days 5, 6) and for 1 day (Day 7) immediately following a single intravenous dose of DFO (40 mg/kg). Blood for Al was obtained before DFO administration, and at 2, 5 and 24 hours following the start of the infusion. Results: The median 24-hour urinary Al excretion (microg/day) at baseline versus post-DFO value was 15.9 vs. 44.4 in the normal subjects and 13.3 vs. 35.7 in the patients. These values were all within normal limits and did not change significantly following DFO infusion (p = 0.003 and p = 0.0001, respectively). The median change of 17.1 microg/day in urinary Al in the normal subjects was not significantly different from the 18.7 microg/day change measured in the patient group (p 0.30). Similarly, no change in the mean serum Al was detected at any time following the DFO infusion, either in the patient or control group (patients 4.1 to 4.3 ng/ml, controls 7.4 to 4.6 ng/ml). Conclusion: The results suggest that abnormal total body retention of Al does not occur during long term citrate treatment in patients with functioning kidneys.