Hypokalemia Medication

  • Author: Eleanor Lederer, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Aug 5, 2009
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to correct the deficiency.

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Electrolytes

Class Summary

Oral or parenteral therapy for potassium replacement.

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Potassium chloride (K-Dur, K-Lyte Cl, Kay Ciel)

 

Essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function. Gradual potassium depletion occurs via renal excretion, through GI loss, or because of low intake. Most respond well to small supplements. Unflavored liquid replacement has an unpleasant taste, and pills may be conducive to better compliance. Long-acting supplements often are not as well absorbed, but microencapsulated forms often are better tolerated. Tailor dose to patient's needs.

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Potassium citrate (Urocit K, Polycitra, Bicitra)

 

Oral preparation with a base instead of an acid anion. Generally used for patients who form calcium stones or for severe metabolic acidosis. Not as effective as potassium chloride for replacement in the general population. Tailor dose to patients' needs.

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Angiotensin-converting enzyme inhibitors

Class Summary

Inhibit production of aldosterone and decrease renal potassium losses. All the drugs in this category work in the same way. Differences are in the duration of action and the ability to inhibit locally produced and circulating ACE.

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Captopril (Capoten)

 

Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. Shortest acting and requires bid or tid dosing. Others in class can be taken qd.

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Enalapril (Vasotec)

 

Competitive inhibitor of ACE. Reduces angiotensin II levels, decreasing aldosterone secretion.

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Fosinopril (Monopril)

 

Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

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Ramipril (Altace)

 

Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion.

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Potassium-sparing diuretics

Class Summary

Excellent adjunct therapy when ongoing renal losses are anticipated. May be used in conjunction with thiazide or loop diuretics.

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Triamterene (Dyrenium)

 

Potassium-sparing diuretic with relatively weak natriuretic properties. Exerts diuretic effect on distal renal tubule to inhibit reabsorption of sodium in exchange for potassium and hydrogen. Not a competitive antagonist of mineralocorticoids, and potassium-conserving effect is observed in patients with Addison disease (ie, without aldosterone).

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Amiloride (Midamor)

 

Pyrazine-carbonyl-guanidine unrelated chemically to other known antikaliuretic or diuretic agents. Potassium-sparing (antikaliuretic) drug that, compared to thiazide diuretics, possesses weak natriuretic, diuretic, and antihypertensive activity.

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Spironolactone (Aldactone)

 

For management of edema resulting from excessive aldosterone excretion. Competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.

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Angiotensin II receptor blockers

Class Summary

These agents competitively inhibit the ability of angiotensin II to interact with and stimulate angiotensin II receptors. This action results in decreased aldosterone secretion and, consequently, decreased renal potassium excretion.

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Valsartan (Diovan)

 

Prodrug that produces direct antagonism of angiotensin II receptors. Displaces angiotensin II from AT1 receptor and may lower blood pressure by antagonizing AT1-induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses. May induce more complete inhibition of renin-angiotensin system than ACE inhibitors, does not affect response to bradykinin, and is less likely to be associated with cough and angioedema. Can be used as alternative therapy, especially in patients unable to tolerate ACE inhibitors.

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Candesartan (Atacand)

 

Produces direct antagonism of angiotensin II receptors. Displaces angiotensin II from AT1 receptor and may lower blood pressure by antagonizing AT1-induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses. May induce more complete inhibition of renin-angiotensin system than ACE inhibitors, does not affect response to bradykinin, and is less likely to be associated with cough and angioedema. Can be used as alternative therapy, especially in patients unable to tolerate ACE inhibitors.

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Losartan (Cozaar)

 

Angiotensin II receptor antagonist that blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. May induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors, does not affect the response to bradykinin, and is less likely to be associated with cough and angioedema. Angiotensin II receptor antagonists can be used as alternative therapy, especially in patients who cannot tolerate ACE inhibitors.

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Selective aldosterone blockers

Class Summary

These agents selectively block aldosterone binding at mineralocorticoid receptors.

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Eplerenone (Inspra)

 

Selectively blocks aldosterone at the mineralocorticoid receptors in epithelial (eg, kidney) and nonepithelial (eg, heart, blood vessels, and brain) tissues; thus, decreases blood pressure and sodium reabsorption. More selective for mineralocorticoid receptors than spironolactone, thus has lesser incidence of side effects associated with androgen antagonism, such as gynecomastia.

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Contributor Information and Disclosures
Author

Eleanor Lederer, MD  Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Rosemary Ouseph, MD  Professor of Medicine, Director of Kidney Transplant, University of Louisville School of Medicine

Rosemary Ouseph, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society of Nephrology, and American Society of Transplant Surgeons

Disclosure: Nothing to disclose.

Leslie Ford, MD  Assistant Professor of Medicine, Kidney Disease Program, University of Louisville School of Medicine

Leslie Ford, MD is a member of the following medical societies: American Medical Association, American Society of Nephrology, and Kentucky Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Lohr, MD  Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Christie P Thomas, MBBS, FRCP, FASN, FAHA  Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics

Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians

Disclosure: Genzyme Grant/research funds Other

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

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