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Diuretics and the Institutional Elderly: A Case against Routine Potassium Prescribing
Author(s) -
HENSCHKE PHILIP J.,
SPENCE J. DAVID,
CAPE RONALD D. T.
Publication year - 1981
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1981.tb01756.x
Subject(s) - medicine , hypokalemia , diuretic , hydrochlorothiazide , spironolactone , heart failure , potassium , aldosterone , chlorthalidone , terazosin , gastroenterology , endocrinology , chemistry , organic chemistry , hyperplasia , blood pressure
In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K‐sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic‐induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K‐sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely .