Hello,

Are there any steps that can be taken to lower potassium levels OTHER than taking KAYEXALATE, which is a very nasty medicine to swallow?

Patient is on a 1K, 2.5Ca bath, the lowest Potassium level available at the clinic. He is Type 1 diabetic and his glucose does fluctuate, but is usually under 300. He DOES avoid high potassium foods. No citrus juices, no bananas, and no tomatoes. Small portion of potato once or twice a week but potatos are cubed and soaked for several hours before boiling. He does have cereal with milk in the morning, but other than that he avoids milk and cheese products. Once in a while he will have a handful of peanuts. He also avoids the high potassium vegetables like brocholli and spinach.

He is on hemodialysis three times a week for three hours per session and his Qb runs from 400 to 450 on 15 gauge needles. Still, his potassium is consistantly around 5.9 to 6.5. Any suggestions from dieticians or others would be greatly appreciated. His other labs and his clearances are all very good.

Thank you for any information!
Don Sunnerberg

Don,

Has the patient been checked for GI bleeding? Even a mild GI bleed (not enough to affect hct or hgb) could result in enough potassium being absorbed.

Has blood work been sent out to check for hemolysis?

Chuck

I would ask if he eats chocolate--my favorite food group!!! also, ask about salt substitutes (KCl). KCl is used in low sodium products like soups etc. What about ace inhibitors? On coumadin?--bleeding? I had a pt high K+, not diet related and when d/c'd coumadin, not only did the ecchymotic patches improve/disappear--so did the high K+. Three hours of HD doesn't sound like alot of time.

Chuck - Thanks for your reply. We spoke with the Nephrologist last night and she checked his labs. She doesn't believe that hemolysis is the problem. She also said that she isn't overly concerned unless the level starts to get up around 7. Diet, meds, glucose monitoring, insulin injections, time on dialysis - she says that quality of life comes into the equation too and she doesn't want to be overly aggressive when the level isn't approaching dangerous levels.

Ruth - Thank you too! We took a closer look at his eating habits and he really does do good. He will occasionally have some chocolate, but it's rare. We DID find though, and didn't realize that diet orange soda is high in K. We thought it only had artificial orange flavoring without the K. So he will avoid that and see if it helps. He doesn't take coumadin and is not on an ACE Inhibitor. No salt substitutes are used and we don't use processed/packaged low salt foods in our meals.

Even though his levels are only at a point that is considered "caution", we would like to achieve a consistently lower level so that he DOES have some wiggle room for an occasional treat. At least one week before his next monthly labs he is going to totally avoid the orange soda, all chocolate, all nuts and see if that has an effect. If this doesn't do any good then the Dr feels that his glucose is too high enough times to keep his K elevated.

All I can say is that a diabetic/renal diet has to be one of the toughest diets to get right! We try to be so careful but it certainly doesn't take much to throw things out of whack!

Thanks again!
Don

[This message has been edited by DESunny (edited 01-15-2003).]

Most of the lists that I see pertaining to high potassium and low potassium foods state that MOST foods contain some potassium. Are there ANY foods that contain no potassium at all? If so, where can I find a list of these foods that contain no potassium?

Thanks!

Is the patient taking renagel as a binder. The sevalamer hydrochloride lowers the co2 which raises serum potassium. If you maintain the co2 above 20 you should see a drop in K.

m micone,
I have been on Renagel since it came out. Recently, my CO2 starting dropping. My neph said, after time, the kidneys filter less and the CO2 drops. My potassium has also run a little on the high side for months when it seems like I'm barely consuming my daily limit. Are you saying that Renagel could be causing my potassium to be high? My neph has put me on sodium bicarb for the low CO2. My CO2 was up to 23 this month, but my potassium was 5.7.

Low CO@ is directly linked to raised K potassium. If yyour CO2 is back up to 23, you should see a drop in K. It is directly linked to renagel.

m micone,
Do you have an article on this I can show my doctor and dietitian?