內容目錄
Author: Chen Can
Source: Cardiovascular Channel span>
The potassium salts we are more familiar with are potassium chloride, potassium citrate, potassium glutamate and potassium magnesium aspartate. What is the difference, and how to choose in clinical practice? I. Different potassium contentDifferent potassium supplementation preparations form different salts during the preparation process, so the amount of potassium per gram is also different. Not the same, as shown in Table 1. The potassium content is shown in Table 1.
1 packet of potassium citrate granules> 1 tablet of potassium chloride buffer Release tablet>1 potassium aspartate tablet>1 potassium magnesium aspartate tablet
1 potassium glutamate injection> 1 vial of potassium chloride injection>1 vial of potassium aspartate injection>1 vial of potassium magnesium aspartate
Table 1 Different potassium supplements Potassium content of formulations
II. Different indications There is no doubt that potassium supplements can be used for the treatment and prevention of hypokalemia, and potassium supplements can also be used for arrhythmia caused by digitalis poisoning. Let’s take a look at the following three “special functions” in addition to potassium supplementation:
1
Citrate Potassium citrate
As an alkaline potassium salt,on the one hand can < /span>Increasing urinary citrate excretion is beneficial to preventing and treating urinary calculi formation; on the other hand, it can significantly reduce urinary calcium excretion and offset the phosphate saturation caused by elevated pH Lithogenesis due to increased degree of lithogenesis.
Potassium Citrate Oral Solution: Used for the prevention and treatment of various causes of of hypokalemia. Potassium Citrate Sustained-Release Tablets:Used for renal tubular acidosis with calcium calculi, hypocitraturia due to any etiology Calcium oxalate kidney stones, uric acid stones with or without calcium stones.
2
Potassium Magnesium Aspartate
< span>Potassium and magnesium aspartate injection is a mixture of potassium aspartate and magnesium salt. Aspartate has a strong affinity with cells and can be used as K+, Mg2+The carrier that enters the cell, makes K+ return to the cell, and promotes cell depolarization Mg2+ is essential for the formation of glycogen and high-energy phosphate or lack of substances, can enhance the therapeutic effect of potassium aspartate. It can be used for heart diseases such as arrhythmia, heart failure and coronary heart disease. Aspartate participates in the cycle of ornithine, promotes urea production, and reduces blood ammonia and CO2< /span>, improve liver function, can be used for hepatobiliary diseases such as viral hepatitis, liver cirrhosis and hepatic encephalopathy, jaundice, etc. Potassium Magnesium Aspartate:for hypokalemia, hypokalemia And the treatment of arrhythmia caused by digitalis poisoning, viral hepatitis, cirrhosis and hepatic encephalopathy.
3
Potassium Glutamate
It is an alkaline potassium salt, which can be used for the treatment of hepatic encephalopathy. Because glutamate can combine with excess ammonia in blood to become harmless glutamine, which is excreted in urine, thereby reducing the concentration of blood ammonia and making symptoms To alleviate or temporarily relieve, potassium ions can correct potassium deficiency at the same time. It is often used in combination with sodium glutamate (1:2~3) to achieve the purpose of maintaining electrolyte balance. Potassium glutamate for injection:For hepatic encephalopathy, hepatic coma and other psychiatric symptoms caused by hyperammonemia. Table 2 Indications of different potassium supplementation preparations
3. For patients with hypokalemia, how to choose potassium supplements?
1
General situation – potassium chloride is preferred
Yes, that’s it, Potassium chloride you are most familiar with, “cheap and big bowl”There are two main reasons to prefer potassium chloride: ①Patients with hypokalemia and metabolic alkalosis often have chlorine consumption, such as hypokalemia caused by diuretic therapy or vomiting. In these patients, chloride depletion contributes to the persistence of metabolic alkalosis by enhancing renal reabsorption of bicarbonate and the secretion of potassium (but not chloride) in exchange when sodium is reabsorbed, which may contribute to potassium loss. It is estimated that in patients with metabolic alkalosis, using potassium salts that do not contain chlorine results in only 40% of the potassium retained in the body when potassium chloride is given. ②Potassium chloride increased serum potassium concentration rapidly. Chloride is an anion predominantly present in the extracellular fluid and promotes the maintenance of supplemental potassium in the extracellular fluid. In addition, if metabolic alkalosis is present, alkaline potassium preparations may partially offset the benefits of potassium supplementation by exacerbating metabolic alkalosis.
2
Special Circumstances – “Each to Its Own”
For hypokalemia with hyperchloremia and metabolic acidosis (eg, renal tubular acidosis) or diarrhea), alkaline potassium citrate and potassium glutamate are preferred;
For patients with hypokalemia with liver cirrhosis, ascites or hepatic encephalopathy, potassium glutamate or potassium magnesium aspartate which can improve liver function are preferred;
for combined hypokalemia Potassium magnesium aspartate, which improves cardiac function, is preferred in patients with hypomagnesemia or cardiac disease such as arrhythmia, heart failure or myocardial disease.
PS:
- Hyperkalemia can cause cardiac depression, so close follow-up of serum potassium ion concentration is required when using potassium salts.
- Potassium salts should not be administered intravenously.
References:1. “The Pharmacopoeia of the People’s Republic of China · Instructions for Clinical Medication (2015 Edition)” (Chemistry Medicine and Biological Products Volume)2. Meng Jing, Jiang Linlan. Clinical application of potassium citrate and research progress of its preparations [J]. China Pharmacy, 2011, 22(02): 179-181. 3. Lan Chuangxin, Chen Kang, Xu Shaohong, et al. Research progress of potassium citrate in prevention and treatment of urinary calculi[J]. Journal of Clinical Urology,
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