Background: Low-molecular-weight heparins (LMWHs) are being preferred to unfractionated heparin (UFH) because of their superior convenience and a comparable or slightly better toxicity profile. Whether LMWH has an inhibitory effect on aldosterone that causes hyperkalemia is yet uncertain. Methods: Twenty-eight patients (all male; mean age: 70 years, range 52–87 years) placed on LMWH therapy (40 mg subcutaneously every 12 h) for deep venous thrombosis prophylaxis after an operation were included in the study. Transtubular potassium concentration gradient (TTKG) was calculated 1 day prior to LMWH therapy and again after 4 days of treatment. Of the 28 patients enrolled in the study, we were able to calculate the TTKG in only 19 patients: 9 had a urinary osmolarity (either before or after LMWH therapy) less than the serum osmolarity, making the TTKG calculation unreliable. The Wilcoxon signed-rank test was used to analyze differences in the median serum potassium levels and TTKG before and after LMWH therapy. Results: All patients had adequate renal function (creatinine clearance >90 ml/min). Mean (± SD) serum potassium concentration before LMWH was 4.25 (± 0.40) mmol/dl. It increased to 4.35 (± 0.41) mmol/dl after initiating LMWH therapy (p = 0.09). Similarly, the mean (± SD) TKKG calculated was 5.52 (± 2.33) before and 5.97 (± 3.06) after 4 days of LMWH (p = 0.54). Conclusions: Unlike UFH, LMWH (Lovenox^®) in doses used for postoperative prophylaxis against deep venous thrombosis does not seem to have a significant effect on potassium homeostasis.

Introduction Obesity is a major comorbidity that compounds the health consequences of diabetes. Effective weight control through behavior modification is an effective component for diabetic management, and can easily be counseled and implemented through primary care visits. Setting self-management Support (SMS) goals, which incorporates the needs, goals, and life experiences of patients, may improve clinical outcomes, health status, and quality of life. We hypothesized that setting SMS goals in primary care visits empowers diabetic patients to lose weight. Methods A chart review was conducted on a total of 205 diabetic patients. SMS goals of weight-control plan (diet and/or exercise) were incorporated into patients’ electronic medical records. A total of 115 (56%) patients included SMS goals in their treatment plan, and 90 (44%) patients did not contain SMS goals. Body weights of these patients were assessed at baseline and after 6 months of follow up. Results 35 (17 %) diabetic patients were overweight and 152 (74 %) were obese in our practice. During 6 months of follow up, 64/115 (56%) patients with SMS goals documented lost weight ( ≥ 5 lb weight loss), compared to 9/31 (29 %) in patients with no SMS goal set. When comparing effect of diet only with the combination of diet and exercise, we found that 47/73 (64 %) patients with the combination SMS goal settings lost weight, while only 17/42 (40 %) of patients with the diet only SMS plans lost body weight. Discussion Our study highlights the importance of educating patients to maintain physical activity and healthy diet, but more importantly shows that empowering patients to agree upon and be active in goal setting is a powerful tool for disease management. Setting SMS goals may assist providers in giving patients their self-defined circle of support, so that patients can manage their conditions on a daily basis, and develop the confidence to sustain healthy behaviors for a lifetime. In addition, SMS goal-setting and progress-monitoring during each encounter help providers to assess the motivation and engagement of patients for behavior modification. Last, the dynamic physician-patient relationship during goal setting and assessment facilitates patient compliance and eventually successful weight loss.