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    Old 04-14-2007, 07:44 AM   #1
    flowergirl2day
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    Potassium question

    Hello,

    I am on a potassium-sparing diruretic, Spironolactone. I also take Ramipril (Altace), an ACE inhibitor, at maximum dose. Ramipril decreases aldosterone secretion (that is the hormone produced by adrenal glands to regulate the balance of salt and water in the body). As a result of this, the potassium is elevated. I have been worried about taking these two meds together for quite some time, but figured they had been prescribed for a reason. (Altace has a few other uses besides lowering blood pressure).
    I take a daily vitamin with minerals, which contains a bit of potassium as well. I have been eating one or two bananas a day.

    My most recent bloodwork is back. My potassium level is 4.5 with the normal range given as (3.6-5.0) mmol/L. I do not have my previous numbers so am not sure whether there has been an increase.
    No one has mentioned anything about that and I had two doctors going over my numbers in just as many days. Should I be concerned?
    I do not want a change in my medications. Everytime that happens, I get more nausea than usual and it takes me two weeks to get used to it.

     
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    Old 04-14-2007, 09:01 AM   #2
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    Re: Potassium question

    My potassium is usually at 4.5 & I'm on HCTZ which decreases potassium.
    I would say just monitor the lab results & know the symptoms of high potassium. Fam

     
    Old 04-14-2007, 03:06 PM   #3
    leea1206
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    Re: Potassium question

    Flowergirl-

    You are asking very smart questions and I am surprised your doctor's haven't said, you've got 2 meds that DO affect potassium, one at a maximum dose, and this is how often we will monitor your k+ and this is why. Having said, that, it appears at least from your last #, your K+ is falling perfectly in the middle range, even on the 2 meds, supplements and diet.

    The scary part about k+ is it DOES affect your heartbeat, and to my knowledege, there are no warnings of a too high/low K. If these meds are working for you and not causing alot of SEs, I would just keep monitoring, and try not to worry, if poassible. I would bring up your concern, though to your Dr.

    Sometimes when I don't want to consult the doc, about meds, I just call our pharmacist, and she is a great help. I did this my self as a new BP pt, starting on a low dose Altace. - Even on a low dose, I was also worried about k+.

    Good luck
    Leea

     
    Old 04-14-2007, 03:37 PM   #4
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    Re: Potassium question

    Quote:
    Originally Posted by leea1206 View Post
    Flowergirl-

    Sometimes when I don't want to consult the doc, about meds, I just call our pharmacist, and she is a great help. I did this my self as a new BP pt...
    Leea,

    This is EXCELLENT advice and often overlooked. Pharmacists are members of our health care TEAM and they can offer a fresh/unbiased perspective! We need to involve them more in our care...thanks for the insights. How did you get to be so smart as a new BP pt? I had to learn that little tidbit in school and I had forgotten it as a new BP pt, .

    Bethsheba

     
    Old 04-14-2007, 03:49 PM   #5
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    Re: Potassium question

    Quote:
    Originally Posted by flowergirl2day View Post
    Hello,

    My most recent bloodwork is back. My potassium level is 4.5 with the normal range given as (3.6-5.0) mmol/L. I do not have my previous numbers so am not sure whether there has been an increase..
    Flowergirl,

    I contacted one doctor who did not give me my medical results/records and he sent me this information in the mail. All I had to do was sign a release for the kind of information I wanted. I keep these records in my health care folder along with the med sheets and any other relevant info. That way I can monitor the changes myself...it's too easy for those docs to overlook things on the chart when they glance at it the minute before they enter the exam room, If I hadn't done this, I wouldn't have known about my cholesterol level rising 100+ points in a year while on bp meds.

    Bethsheba

     
    Old 04-14-2007, 06:50 PM   #6
    flowergirl2day
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    Re: Potassium question

    Thanks everyone!

    Your opinions are much appreciated! It's so wonderful being able to discuss various issues with those who understand.
    I think my doctor does not like changing the meds prescribed by a specialist, though he has done it in the past. None of the meds prescribed to me by my GP proved effective at all initially and all had to be discontinued and I ended up in the hospital for a couple of weeks (enter the BP specialist). He would not be the best person to ask about this. Will go to the pharmacist.

     
    Old 06-13-2007, 01:16 PM   #7
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    Re: Potassium question

    Hello everyone!

    I am back with yet another potassium question. This is something that's on my mind a lot. It really scares me; much more than not having my BP well controlled.

    I have a kidney disease as yet to be diagnosed. This often results in excess potassium. On top of that, THREE of my blood pressure medications are potassium-sparing/building. (Spironolactone, Ramipril, Micardis).

    -How long does it take for the potassium levels to get dangerously high?

    -What should the frequency of testing of the potassium levels be?

    -Is testing once every two/three months ADEQUATE?

    I worry about these issues daily. I do know what to watch for regarding side effects. However, if the potassium levels get too high, unreversable events can happen instantaneously without any warning.

    I read that the actual potassium contained within our cells is not measured by a regular serum potassium test. What the blood test shows is a value on an extracellular level. What other test is there? I am thinking the electrolytes but am not sure. I don't have electrolytes tested very often at all.
    If there is another test for potassium levels, I'd appreciate hearing which one so that I can ask for it.

    No one else seems to share my concerns. I don't want to become a statistic due to something totally preventable. I would appreciate any insight.

    Thank you,

    Flowergirl

     
    Old 06-13-2007, 05:31 PM   #8
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    Re: Potassium question

    Quote:
    Originally Posted by flowergirl2day View Post
    I have a kidney disease as yet to be diagnosed. This often results in excess potassium. On top of that, THREE of my blood pressure medications are potassium-sparing/building. (Spironolactone, Ramipril, Micardis).

    -How long does it take for the potassium levels to get dangerously high?

    -What should the frequency of testing of the potassium levels be?

    -Is testing once every two/three months ADEQUATE?

    I worry about these issues daily. I do know what to watch for regarding side effects. However, if the potassium levels get too high, unreversable events can happen instantaneously without any warning.

    Flowergirl
    Hello Flowergirl,

    Am sorry to learn of your distress as you've weathered so much in these past few months.

    My first thought is "Who told you that you have a kidney disease that has yet to be diagnosed?" Was it a doctor? If so, what exactly did s/he say?" I ask because under stressful conditions messages may get "rearranged" or we come to our own conclusions, and we fret about things that may or may not be applicable to our situations. We've both read posts on this board of similar scenarios.

    My second thought is that I suspect that your potassium levels were originally very low and that is why your doctors are treating you with potassium (k) sparing/building medications. But you need to check that out with your doctors...ask them what your potassium levels were BEFORE you started taking the potassium sparing/building meds...and you might also ask them "why" they prescribed 3 potassium sparing/building meds....according to one of your posts that I remember, despite being on these potassium sparing/building meds, you were still within normal k ranges, which to me, indicates your potassium levels were unacceptably low to begin with.

    My third thought is the treatment you are receiving is similar to treatment for an overproduction of aldosterone which is secreted by the 2 adrenal glands, glands that "tell" the kidneys to get rid of more sodium and less potassium. I have read that sometimes there is a tumor on one of these glands and if it is removed, blood pressure returns to normal (at least it did for about 70 percent of the people with a similar condition).

    As for your questions regarding k testing, I am only familiar with one k test. As far as frequency goes, I've read that one reason they'll test more often is when there is temporary paralysis, as this is a symptom of either too much or too little potassium.

    The only other info I recall is that the accuracy of the k test can be impaired by the way the blood is drawn. I remember this little tidbit after researching the accuracy of one of my tests, .

    I wish I had more info for you but I've given you what I remember....but I would encourage you to get more info from your doctors. You have a right to know what they "know" and what they "suspect". Use your energy to gather more info instead of concerning yourself about what may or may not be true.

    Take care flowergirl,

    My instincts tell me you are going to be just fine!

    Bethsheba

    Last edited by bethsheba; 06-13-2007 at 05:33 PM.

     
    Old 06-13-2007, 06:42 PM   #9
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    Re: Potassium question

    Hello Beth,

    How wonderful to see your post!

    I was diagnosed with a kidney disease way back in December of last year. There were two possibilities,given the supporting evidence. It remained to be determined which one of the two diseases I had. I'd had every kidney test there is with the exception of the biopsy. It was decided at the last minute not to proceed with it, because certain things might have been missed and another, more suitable test was performed instead. It is an indisputable fact. The only problem is that neither one of the initial "diagnosis" is consistent with the most recent test I had. That's what I meant by "not diagnosed yet".
    Basically, the only thing missing is the name of what I've got. My kidney function is pretty good and for that I am grateful.

    I wonder how I'd go about finding out what my pre-med potassium levels were. I like your way of thinking, Beth, because it makes sense! How could I tap into the hospital records? Somehow I cannot picture my GP's eagerness to get this sort of information for me...unless I could come up with a very good reason for needing it. This guy is not at all forthcoming with information. He tells me the absolute minimum.

    Likewise, earlier suggestions regarding thyroid problems as possible causes of high BP make sense to me. I would very much like to get my hands on this info. I do believe I was screened for all kinds of things and the above mentioned would have been the very first my specialists would have looked for. Aldosteronism, tumors etc. I know I should not assume anything. Perhaps something was missed.

    I just had the bloodwork done. I am quite anxious to see the results but will have to wait a week. I hope this potassium issue does not develop into an obsession with me. I feel that the doctors can miss a lot of things, being as busy as they are, so we, the patients, need to stay on top of things by keeping ourselves well informed.

    Thank you for your excellent suggestions and your concern. It's great to hear from you again!

    Flowergirl

    Last edited by flowergirl2day; 06-13-2007 at 06:44 PM. Reason: spelling

     
    Old 06-14-2007, 08:16 AM   #10
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    Re: Potassium question

    Call the medical records dept of your hospital to get your lab results. You have to go in & sign a release form (I always do that after having lab work done). Your results on most tests are back the next day. Given your situation I would ask to be tested monthly. You are entitled to a copy of your medical records at your Dr's office as well. My potassium levels have varied from 3.5-4.9. My only source of potassium is food. One time when I was sick from dental work & didn't eat, my potassium was very low but I didn't go to the ER because it responded to increased food intake. You need to keep a record of your potassium record. Fam

     
    Old 06-14-2007, 09:56 AM   #11
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    Re: Potassium question

    Hi Flowergirl,

    Thanks for the warm welcome! I couldn't stay away for long knowing there were people out there like myself who are battling bp trials and tribulations.

    My apologies as I was not aware that your doctors have zeroed in on your kidneys as a possible cause of your condition(s). Am glad to hear the kidneys are functioning "good"...as it is my understanding that normal functioning kidneys excrete postassium on a daily basis (I don't think the body "stores" potassium, but I could be wrong)...If that's so, perhaps that is why a potassium test isn't done more often than with the physical. Just thoughts...they need to be checked out and not taken for fact.

    I would encourage you to obtain copies of your medical records. You may not need or want to get copies of all of them. When I request med records after a health care vist, they give me a form that lets me check off what records I want whether it be for lab work, xrays, etc. Medical records laws vary but I would think that you should be able to get your own in Canada. It's very important to do so. As I mentioned in a previous post, I discovered some concerning inaccuracies in mine that needed to be corrected. Like a credit report, I think it very helpful to review one's medical records at least once a year.

    Last but not least, listen to what your doctors have to say but get more than one opinion from another health care provider in another health care clinic, if possible. Different points of view are imperitive. You can always go back to your original providers for their recommended treatments. I say this because if I'd listened to my family doctor, and had not challenged the treatment, I believe I'd be dead today due to the severity of the side effects I experienced on minimal doses of medication. At my physical last Feb (?), I questioned my doctor as to why he didn't address diet and exercise for treatment, in addition to medications, and he said that someone with my bps would always be on meds (my pressures were slightly high 3 years ago but crept up while on bp medication). I disagreed with him on this and other statements he made. I took myself off of bp medication and my numbers have been CONSISTENTLY less than 120/75 which is ironic because when I was on medication, I was very happy to see a 140/90!!!---no I haven't lost more weight, no, I haven't changed my diet (except for switching to skim milk and margerine), and no, I'm not engaging in any addtitional physical activities. I am fully aware that the effects of medication "linger" so will need to see if the "normal" trend continues again next month. I will write more later about this but my point is that it is wise to rely on more than one source of information!

    Must get back to work.

    Take care...and keep us posted!

    Bethsheba

    Last edited by bethsheba; 06-14-2007 at 10:12 AM.

     
    Old 06-14-2007, 11:09 AM   #12
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    Re: Potassium question

    Hi Beth,

    Glad to see you had a minute to check in. Potassium isn't stored in the body although the body can made do for a day or two. FG you need to call the lab about that blood test for potassium in the cells. I didn't even notice you are in Canada. I can call my lab if you can't get an answer. They are used to me asking questions. Dr. Dean talked about Calcium & Phos. in the blood versus in the cells & the possibilities of differences in values on Sat. Time for my beta blocker Nap!!! I'm like a little kid who doesn't want to go to bed for a nap!!! Fam

     
    Old 06-14-2007, 02:04 PM   #13
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    Re: Potassium question

    Fam,

    I hope you had a good nap!

    Thanks for the suggestion to call a lab. All they can say is no if they are not willing to divulge any information regarding the potassium testing. It's worth a try! If all else fails, I will ask my doctor about these tests.(that's if he gives me a chance instead of rushing through the appointment in record time). My next appointment is his first one of the day, so I should get more of his time.
    I will also ask whether I should be on aspirin. I mentioned that the other doctor was surprised to hear I was not on it and advised me to start immediately.

    I did read some studies on the aspirin-a-day issue and, depending on whom you believe, women under 65 do not benefit from taking it daily. (Because the risk of internal bleeding outweighs any potential benefits.) In one of my cardio books it says women over 55 at high risk and with past cardio events should be on it. Just this morning I was reading a library book whose authors (MDs) recommended that women at high risk over the age of 50 take it on daily basis. Either one baby aspirin a day (81mg) or an adult strength(325mg) every other day. So the answer as to at what age the aspirin "therapy" should begin is somewhat unclear. You said you've been on it and I'll probably go on it also.
    I did obtain some of the medical records in my doctor's office - one at a time, but always feel it's too much bother when I ask. (does your doctor make you feel that way?) Anyway, I'll ask him for more.
    Thank you so much for your help!

    Flowergirl

    Last edited by flowergirl2day; 06-14-2007 at 09:38 PM. Reason: spelling

     
    Old 06-14-2007, 02:36 PM   #14
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    Re: Potassium question

    Hello Beth,

    Quote:
    As I mentioned in a previous post, I discovered some concerning inaccuracies in mine that needed to be corrected. Like a credit report, I think it very helpful to review one's medical records at least once a year.

    I agree with you. In my case, there have been differences of opinion on some cardiological issues between the doctors and I don't feel very confident or reassured after my last visit. I wish they'd repeat some of the tests but will have to wait several months. Those are the ones I'd like to get copies of besides the bloodwork. (I have partial records). My doctor tried repeatedly (faxed and phoned and sent a message with me once when I went for a test) to obtain the missing test results with no luck. It takes forever, everyone is so busy!

    Quote:
    I say this because if I'd listened to my family doctor, and had not challenged the treatment, I believe I'd be dead today due to the severity of the side effects
    You would not believe how many people told me I must change doctors, that, given my circumstances, I need someone who's more "with it". I am reluctant to do that, especially now that he's been through all this with me. (I hope he does not lose many patients through neglect.) He seems to keep up with the latest and always tries to make me feel better, joking around.

    Quote:
    I took myself off of bp medication and my numbers have been CONSISTENTLY less than 120/75 which is ironic because when I was on medication, I was very happy to see a 140/90!!!---
    All I have to say is...this is incredible! How very lucky you are! I think you must have willed your numbers back to normal!
    Thanks to you and Fam, I have less anxiety now regarding my potassium levels - another thing I hope to be able to discuss with the doc, given enough time. Thanks for your help!

    Flowergirl

    Last edited by flowergirl2day; 06-14-2007 at 02:38 PM.

     
    Old 06-15-2007, 05:50 AM   #15
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    Re: Potassium question

    To cut to the chase, I think that taking spironolactone and high dose ramipril together is a terrible idea.

    FG,
    Ask you doctor why he is not prescribing thiazide or Lasix as your diuretic...tell him you'd like to try one and then monitor your K+ in a month unless he has a good reason not to. Wh knows, he may say that you suffered from LOW K+ some time back?

    A 4.5 potassium level is okay though. There are ways to measure cellular potassium that are complex but suffice to say that it really is only SERUM potassium that is dangerous (becasue an excess can stop your heart instantaneously <That's how they execute a prisoner on death row.>)

     
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