[ Diabetes Type 2 ]

A 74-year-old woman with type 2 diabetes and recurrent hyperkalemia – B3


With reference to the article by Wei and Macdonald about trimethoprim and spiranolactone causing hyperkalemia, it is also worth mentioning one of the commonest drugs used in hospital that can cause hyperkalemia. Many clinicians are interested in learning where these agents fit into the armamentarium of medications used to manage type 2 diabetes, key differences within the class, and appropriate patient selection. Therefore diseases of the adrenal gland, such as Addison’s disease, that lead to decreased aldosterone secretion can decrease kidney excretion of potassium, resulting in body retention of potassium, and hence hyperkalemia. Thus, in patients with high fasting blood glucose, sodium and magnesium tend to be lower while potassium is higher. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. They typically are composed of potassium chloride and may be viewed by the public as a healthy alternative to standard table salt [1]. Clinical signs are related to disturbances in skeletal (weakness) and cardiac (arrhythmia) muscles.

The prevalent hypothesis, however, favors the free penetrance of the organic anion into cells without creating a gradient for the hydrogen ions and, thus, obviating the efflux of intracellular potassium. At the end of the randomized phase, serum potassium levels were significantly lower with all three doses of ZS-9 compared with placebo (4.8 mEq/L, 4.5 mEq/L, and 4.4 mEq/L for 5 g, 10 g, and 15 g, respectively, versus 5.1 mEq/L for placebo; P < 0.001 for all comparisons). The blood pressure is 140/90 supine and 145/95 upright. A repeat potassium the same day is 5.9 mEq/L with a glucose value of 181 mg/dL (10.1 mmol/L). The investigators observed significant changes in plasma renin activity only in the placebo group. Tolerance for a rapid potassium load is impaired in ESRD, not only because of lack of renal excretion, but also as a result of impaired cellular distribution of potassium [5]. She has been following the low potassium diet and counting carbohydrates with care, especially in view of the recent emergency hospitalization for hyperkalemia.

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