Pathophysiology of potassium absorption and secretion by the human intestine

Agarwal, Rajiv; Afzalpurkar, Rekha; Fordtran, John S.

doi:10.1016/0016-5085(94)90184-8

Cited by 156 publications

(113 citation statements)

References 131 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…Ca rather than sodium (Na) was chosen to prevent additional Na administration and the potential for Na absorption and volume overload when treating patients who are hyperkalemic, many of whom have heart failure or CKD (2,3). K binding by patiromer may occur in proximal segments of the gastrointestinal (GI) tract but is greatest in the colon, where active K secretion results in high luminal K concentrations, the pH is optimal for ion exchange, and the polymer has the longest residence time (1,(4)(5)(6). Patiromer encounters a series of different cation environments as it traverses the GI tract (1,7).…”

Section: Introductionmentioning

confidence: 99%

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Bushinsky

Spiegel²,

Gross³

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives Patiromer is a nonabsorbed potassium-binding polymer that uses calcium as the counterexchange ion. The calcium released with potassium binding has the potential to be absorbed or bind phosphate. Because binding is not specific for potassium, patiromer can bind other cations. Here, we evaluate the effect of patiromer on urine ion excretion in healthy adults, which reflects gastrointestinal ion absorption.Design, setting, participants, & measurements We analyzed the effect of patiromer on urine potassium, sodium, magnesium, calcium, and phosphate in two studies. Healthy adults on controlled diets in a clinical research unit were given patiromer up to 50.4 g/d divided three times a day for 8 days (dose-finding study) or 25.2 g/d in a crossover design as daily or divided (two or three times a day) doses for 18 days (dosing regimen study). On the basis of 24-hour collections, urinary ion excretion during the baseline period (days 5-11) was compared with that during the treatment period (days 13-19; dose-finding study), and the last 4 days of each period were compared across regimens (dosing regimen study). ResultsIn the dose-finding study, patiromer induced a dose-dependent decrease in urine potassium, urine magnesium, and urine sodium (P,0.01 for each). Patiromer at 25.2 g/d decreased urine potassium (mean6SD) by 11406316 mg/d, urine magnesium by 4561 mg/d, and urine sodium by 2256145 mg/d. Urine calcium increased in a dose-dependent manner, and urine phosphate decreased in parallel (both P,0.01). Patiromer at 25.2 g/d increased urine calcium by 73623 mg/d and decreased urine phosphate by 64640 mg/d. Urine potassium, urine sodium, and urine magnesium were unaffected by dosing regimen, whereas the increase in urine calcium was significantly lower with daily compared with three times a day dosing (P=0.01). Urine phosphate also decreased less with daily compared with two or three times a day dosing (P,0.05).Conclusions In healthy adults, patiromer reduces urine potassium, urine sodium, urine magnesium, and urine phosphate, while modestly increasing urine calcium. Compared with divided dosing, administration of patiromer once daily provides equivalent reductions in urine potassium, urine sodium, and urine magnesium, with less effect on urine calcium and urine phosphate.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Bushinsky

Spiegel²,

Gross³

et al. 2016

CJASN

View full text Add to dashboard Cite

show abstract

“…Hypokaelemia due to vomiting is only partly due to direct loss of potassium, because vomiting has a further effect of provoking an increased potassium loss in the urine to compensate for blood alkalosis [4].…”

Section: Introductionmentioning

confidence: 99%

Pseudo Bartter Syndrome from Surreptitious Purging Behaviour in Anorexia Nervosa

Gentile¹

2012

J Nutrition Disorder Ther

View full text Add to dashboard Cite

Pseudo Bartter syndrome is a rare disorder characterized by metabolic alkalosis, hypokalaemia, hyperaldosteronism, hyperreninism, normal blood pressure and hyperplasia of the juxtaglomerular apparatus.The most dangerous complication of Pseudo Bartter syndrome is hypokalemia.Hypokalemia caused by vomiting, diarrhea, prolonged fasting, abuse of potassium-depleting drugs, may be present in patients with binge /purging form of anorexia or bulimia nervosa.We report a case of a 19-year-old girl with anorexia nervosa (BMI 16.15 kg/m 2 ) and severe prolonged hypokalemia (1.9 mEq/l), metabolic alkalosis and severe protracted secondary hyperaldosteronism (i.e. Pseudo Bartter's syndrome) from surreptitious purging behaviour (vomit and laxative abuse).An intensive multidisciplinary day-hospital treatment including long-term potassium supplementation, a potassiumsparing diuretic was necessary to resolve the case and to allow the young girl to admit her previous purging behaviour and after three months to get at a normal kalemia without any potassium supplementation and BMI at a normal value (20 kg/m 2 ).Given the dangers to the heart electrical and mechanical functions set by severe potassium deficiency, it is mandatory to find out the true cause so that a proper treatment can be started.

show abstract

“…Potassium uptake takes place principally in the jejunum, with an estimated uptake of about 60 mEq/day. [8] However, studies performed in patients with ileostomy, with or without partial ileal resection, indicate that some potassium uptake takes place along this intestinal segment as well. [9] By contrast, net colonic handling of potassium is negative, presumably due to active potassium excretion, as well as loss by mucosal shedding and mucous excretion.…”

Section: Discussionmentioning

confidence: 99%

“…[9] By contrast, net colonic handling of potassium is negative, presumably due to active potassium excretion, as well as loss by mucosal shedding and mucous excretion. [8] In the presence of urine in contact with the gut mucosa these factors may lead to dramatic diverse changes, depending upon the gut segment involved. Indeed, ureterosigmoidostomy has often been associated with hypokalemia, [10] which might be intensified by renal losses, mediated by protracted metabolic acidosis, [11] with effective volume depletion and activated renin-angiotensin-aldosterone axis.…”

Section: Discussionmentioning

confidence: 99%

Severe hyperkalemia following ureteroileostomy: A case report and literature review

Qasum

Heyman

Khateeb

et al. 2018

CRIM

View full text Add to dashboard Cite

Metabolic complications, including hyponatremia and metabolic acidosis have been reported following urinary diversion operations, occasionally together with hyper-or hypokalemia, depending on the bowel segment used. While Hypokalemia often accompanies ureterosigmoidostomy and may develop following ileal conduits, we report a rare case of recurrent life threatening hyperkalemia following this procedure, associated with hyponatremia and acidosis. Reviewing the English literature (1973 to 2016) we found 25 cases of hyperkalemia complicating ureteral diversion procedures, mostly after jejunal conduits. Only five cases of hyperkalemia were described after ileal conduit surgeries, including the current report. We discuss the nature of the metabolic and electrolyte disturbances following urinary diversion and debate possible reasons for the rare cases of hyperkalemia complicating ileal conduits.

show abstract

Pathophysiology of potassium absorption and secretion by the human intestine

Cited by 156 publications

References 131 publications

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Pseudo Bartter Syndrome from Surreptitious Purging Behaviour in Anorexia Nervosa

Severe hyperkalemia following ureteroileostomy: A case report and literature review

Contact Info

Product

Resources

About