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Clinical Journal of the American... Oct 2023A potassium replete diet is associated with lower cardiovascular risk but may increase the risk of hyperkalemia, particularly in people using... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A potassium replete diet is associated with lower cardiovascular risk but may increase the risk of hyperkalemia, particularly in people using renin-angiotensin-aldosterone system inhibitors. We investigated whether intracellular uptake and potassium excretion after an acute oral potassium load depend on the accompanying anion and/or aldosterone and whether this results in altered plasma potassium change.
METHODS
In this placebo-controlled interventional cross-over trial including 18 healthy individuals, we studied the acute effects of one oral load of potassium citrate (40 mmol), potassium chloride (40 mmol), and placebo in random order after overnight fasting. Supplements were administered after a 6-week period with and without lisinopril pretreatment. Linear mixed effect models were used to compare blood and urine values before and after supplementation and between the interventions. Univariable linear regression was used to determine the association between baseline variables and change in blood and urine values after supplementation.
RESULTS
During the 4-hour follow-up, the rise in plasma potassium was similar for all interventions. After potassium citrate, both red blood cell potassium-as measure of the intracellular potassium-and transtubular potassium gradient (TTKG)-reflecting potassium secretory capacity-were higher than after potassium chloride or potassium citrate with lisinopril pretreatment. Baseline aldosterone was significantly associated with TTKG after potassium citrate, but not after potassium chloride or potassium citrate with lisinopril pretreatment. The observed TTKG change after potassium citrate was significantly associated with urine pH change during this intervention ( R =0.60, P < 0.001).
CONCLUSIONS
With similar plasma potassium increase, red blood cell potassium uptake and kaliuresis were higher after an acute load of potassium citrate as compared with potassium chloride alone or pretreatment with lisinopril.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER
Potassium supplementation in patients with chronic kidney disease and healthy subjects: effects on potassium and sodium balance, NL7618.
Topics: Humans; Potassium; Potassium Citrate; Potassium Chloride; Chlorides; Lisinopril; Aldosterone
PubMed: 37382933
DOI: 10.2215/CJN.0000000000000228 -
Neuroscience Dec 2020
Topics: Potassium Chloride; Sodium Chloride
PubMed: 33234225
DOI: 10.1016/j.neuroscience.2020.08.027 -
The Veterinary Clinics of North... Aug 2021Barbiturate overdose as a method of euthanasia is becoming unacceptable. This has made alternative methods of euthanasia very important. Gunshot or captive bolt... (Review)
Review
Barbiturate overdose as a method of euthanasia is becoming unacceptable. This has made alternative methods of euthanasia very important. Gunshot or captive bolt euthanasia is among methods that are acceptable, but they may not be esthetically acceptable. This has led to the use of other methods of euthanasia. Inducing anesthesia prior to euthanasia offers an easier method of control. Adjunctive techniques using intravenous potassium or magnesium salts administered intravenously and intracardiac administration of potassium chloride or intrathecal lidocaine offer alternatives that work well and are more environmentally safer than barbiturates. Pithing and exsanguination are also environmentally safer but may not be as esthetically acceptable as the other methods.
Topics: Animals; Barbiturates; Euthanasia, Animal; Horse Diseases; Horses; Lidocaine; Magnesium Chloride; Potassium Chloride
PubMed: 34243883
DOI: 10.1016/j.cveq.2021.04.014 -
Journal of the Science of Food and... Aug 2022Sodium chloride (NaCl) is an enjoyable condiment. However, evidence is accumulating to indicate that an excessive intake of Na in food may lead to an increased risk of... (Review)
Review
Sodium chloride (NaCl) is an enjoyable condiment. However, evidence is accumulating to indicate that an excessive intake of Na in food may lead to an increased risk of cardiovascular and cerebrovascular diseases. Previous systematic reviews have focused on replacing NaCl with other metal salts (e.g. KCl). However, new salty flavor enhancers (yeast extract, taste peptides, and odor compounds) have yet to be reviewed. This systematic review evaluates the methods for, and feasibility, of NaCl reduction. It defines NaCl reduction and considers the methods used for this purpose, especially the use of flavor enhancers (yeast extract, taste peptides, and odor compounds). © 2022 Society of Chemical Industry.
Topics: Flavoring Agents; Odorants; Potassium Chloride; Sodium; Sodium Chloride; Sodium Chloride, Dietary; Taste
PubMed: 35266156
DOI: 10.1002/jsfa.11859 -
Cells Oct 2020The SLC12 family of cation-chloride-cotransporters (CCCs) is comprised of potassium chloride cotransporters (KCCs), which mediate Cl extrusion and sodium-potassium... (Review)
Review
The SLC12 family of cation-chloride-cotransporters (CCCs) is comprised of potassium chloride cotransporters (KCCs), which mediate Cl extrusion and sodium-potassium chloride cotransporters (N[K]CCs), which mediate Cl loading. The CCCs play vital roles in cell volume regulation and ion homeostasis. The functions of CCCs influence a variety of physiological processes, many of which overlap with the pathophysiology of cardiovascular disease. Although not all of the cotransporters have been linked to Mendelian genetic disorders, recent studies have provided new insights into their functional role in vascular and renal cells in addition to their contribution to cardiovascular diseases. Particularly, an imbalance in potassium levels promotes the pathogenesis of atherosclerosis and disturbances in sodium homeostasis are one of the causes of hypertension. Recent findings suggest hypothalamic signaling as a key signaling pathway in the pathophysiology of hypertension. In this review, we summarize and discuss the role of CCCs in cardiovascular disease with particular emphasis on knowledge gained in recent years on NKCCs and KCCs.
Topics: Animals; Cardiovascular Diseases; Evolution, Molecular; Humans; Hypothalamus; Models, Biological; Signal Transduction; Sodium-Potassium-Chloride Symporters
PubMed: 33066544
DOI: 10.3390/cells9102293 -
Contraception Sep 2021To describe effectiveness of funic potassium chloride (KCl) injection for fetal demise during intact dilation and evacuation (D&E).
OBJECTIVE
To describe effectiveness of funic potassium chloride (KCl) injection for fetal demise during intact dilation and evacuation (D&E).
STUDY DESIGN
We abstracted medical records of patients who underwent standard or intact D&E to identify those who had intact D&E from 20 weeks 0 days through 23 weeks 6 days from February 2016 to August 2017 at one academic center. We extracted data on time to asystole following KCl injection, as well as incidents including hemorrhage, infection, uterine perforation, and unplanned admissions for up to 6 months following each procedure.
RESULTS
Of 57 procedures, 32 (56%) were intact. Median time from KCl injection to fetal asystole was 48 seconds (interquartile range [IQR] 34-100). Median time to asystole at weeks 20 and 21 (46 seconds [IQR 34-60 seconds]) did not differ significantly from weeks 22 and 23 (85 seconds [IQR 34-200 seconds]), p = 0.15. Asystole occurred in less than four minutes in all cases but one. No adverse events occurred with either the funic KCl injections or the intact D&E procedures.
CONCLUSION
Funic KCl injection for intact D&E usually causes fetal asystole in less than 4 minutes.
IMPLICATIONS
Funic KCl injection under direct visualization is a feasible method to induce fetal asystole at the time of intact dilation and evacuation.
Topics: Abortion, Induced; Dilatation; Female; Fetal Death; Humans; Injections; Potassium Chloride; Pregnancy; Pregnancy Trimester, Second
PubMed: 33831443
DOI: 10.1016/j.contraception.2021.03.029 -
Acta Medica Portuguesa Mar 2023Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute... (Review)
Review
Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.
Topics: Humans; Furosemide; Diuretics; Heart Failure; Sodium Potassium Chloride Symporter Inhibitors; Albumins
PubMed: 36762993
DOI: 10.20344/amp.17714 -
Medicina Clinica Jan 2024
Topics: Humans; Diuretics; Heart Failure; Drug Resistance; Sodium Potassium Chloride Symporter Inhibitors
PubMed: 37919121
DOI: 10.1016/j.medcli.2023.10.001 -
Clinical and Experimental Nephrology Oct 2019Potassium (K) intake is intrinsically linked to blood pressure. High-K intake decreases hypertension and associated lower mortality. On the other hand, hyperkalemia... (Review)
Review
INTRODUCTION
Potassium (K) intake is intrinsically linked to blood pressure. High-K intake decreases hypertension and associated lower mortality. On the other hand, hyperkalemia causes sudden death with fatal cardiac arrhythmia and is also related to higher mortality. Renal sodium (Na)-chloride (Cl) cotransporter (NCC), expressed in the distal convoluted tubule, is a key molecule in regulating urinary K excretion. K intake affects the activity of the NCC, which is related to salt-sensitive hypertension. A K-restrictive diet activates NCC, and K loading suppresses NCC. Hyperpolarization caused by decreased extracellular K concentration ([K]) increases K and Cl efflux, leading to the activation of Cl-sensitive with-no-lysine (WNK) kinases and their downstream molecules, including STE20/SPS1-related proline/alanine-rich kinase (SPAK) and NCC.
RESULTS
We investigated the role of the ClC-K2 Cl channel and its β-subunit, barttin, using barttin hypomorphic (Bsnd) mice and found that these mice did not show low-K-induced NCC activation and salt-sensitive hypertension. Additionally, we discovered that the suppression of NCC by K loading was regulated by another mechanism, whereby tacrolimus (a calcineurin [CaN] inhibitor) inhibited high-K-induced NCC dephosphorylation and urinary K excretion. The K loading and the tacrolimus treatment did not alter the expression of WNK4 and SPAK. The depolarization induced by increased [K] activated CaN, which dephosphorylates NCC.
CONCLUSIONS
We concluded that there were two independent molecular mechanisms controlling NCC activation and K excretion. This review summarizes the clinical importance of K intake and explains how NCC phosphorylation is regulated by different molecular mechanisms between the low- and the high-K condition.
Topics: Animals; Blood Pressure; Humans; Potassium; Potassium, Dietary; Sodium-Potassium-Chloride Symporters
PubMed: 31317362
DOI: 10.1007/s10157-019-01766-x -
Trends in Pharmacological Sciences Dec 2021The chloride importer NKCC1 and the chloride exporter KCC2 are key regulators of neuronal chloride concentration. A defective NKCC1/KCC2 expression ratio is associated... (Review)
Review
The chloride importer NKCC1 and the chloride exporter KCC2 are key regulators of neuronal chloride concentration. A defective NKCC1/KCC2 expression ratio is associated with several brain disorders. Preclinical/clinical studies have shown that NKCC1 inhibition by the United States FDA-approved diuretic bumetanide is a potential therapeutic strategy in preclinical/clinical studies of multiple neurological conditions. However, bumetanide has poor brain penetration and causes unwanted diuresis by inhibiting NKCC2 in the kidney. To overcome these issues, a growing number of studies have reported more brain-penetrating and/or selective bumetanide prodrugs, analogs, and new molecular entities. Here, we review the evidence for NKCC1 pharmacological inhibition as an effective strategy to manage neurological disorders. We also discuss the advantages and limitations of bumetanide repurposing and the benefits and risks of new NKCC1 inhibitors as therapeutic agents for brain disorders.
Topics: Brain Diseases; Bumetanide; Chlorides; Humans; Nervous System Diseases; Sodium Potassium Chloride Symporter Inhibitors; Solute Carrier Family 12, Member 2
PubMed: 34620512
DOI: 10.1016/j.tips.2021.09.005