To much sodium = Hypokalemia?

[lilmissposey8088]

Hello once again Friends. Sorry I'm always so full of questions. But this has been bugging me and I just know you guys will know the answers!

I'm having a hard time understanding how hypokalemia is not a big issue for us ADers? I'm taking the Florinef now and adding tons of sodium and fluids. This from my understanding of anatomy is a dangerous combo. Doesn't high sodium + Florenif = disaster for potassium? I'm not having any problems or anything yet, but I have never had low sodium levels that I know of. I understand the need for the sodium to help retain the fluids for the BP and HR. But is this a fine line that is just something we have to deal with because of the need for the tons and tons of sodium? Does anyone have to take potassium to keep level in check? Just worried that my potassium will bottom out and then what do you know I'll have more tacy and stomach problems. How would I even know of the difference between my POTS symptoms and hypokalemia? They have lots of similarities. Any thoughts on this anyone?

[Heiferly]

I think what you're talking about re: where the sodium and potassium are with regard to the extracellular fluid may be what I mentioned above to lilmissposey when I was joking about flashbacks to my coursework years ago (I won't say how many years, haha):  the sodium-potassium pump:

http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/animation__how_the_sodium_potassium_pump_works.html

Is that it?  

[Kavbear]

When I was just hospitalized one of my symptoms was diarrhea, it was so bad they tested for C. Diff because I had been on antibiotics for.......yes you guessed it diarrhea.
They also tested my electrolytes several times, I guess if your diarrhea is so bad that it might be C. Diff it can make you dehydrated, that's what I was told at least by the nurse who seemed to have a clue....

[enzymelover]

Hmmm....  When my son was in the hospital for his pituitary surgery he was kept on IV saline for several days, taken off, and put back on again when he developed C.Diff. Then they said his potassium was low and added IV potassium, but he was immediately taken off of it, because it burned like ****!
I didn't ask why his potassium went low. I thought it might be because of the diarrhea from the C. Diff though.

[Kavbear]

I will look, I did not think they were right because if so my potassium would always be off being that I supposed to have at least 10 grams of sodium a day.  I really think they were just trying to blow smoke where the sun does not shine.
What I read (if my mind is working at all today) has to do more with if where the sodium and potassium are (Ex the extracellular fluid).

[Heiferly]

Can you find where you saw this?  I asked a cardiologist at my hospital specifically and he said sodium intake does not push out potassium.  (In fact, I sometimes need large volumes of IV fluids—6 liters last time I had to get IV saline on top of the oral fluid and salt loading I was already doing that day—and they have no reservations whatsoever about doing that for me despite the fact that I already have preexisting hypokalemia which is regulated with Rx potassium supplementation.  If the IV saline were expected to throw off my potassium levels, they would be upping my supplementation temporarily accordingly.)

Also, Merck manual which is one of the go-to physician references makes no mention of it:

http://www.merck.com/pubs/mmanual_ha/sec3/ch18/ch18d.html

The wikipedia article on hypokalemia notes that "Rare hereditary defects of renal salt transporters, such as Bartter syndrome or Gitelman syndrome, can cause hypokalemia, in a manner similar to that of diuretics. As opposed to disease states of primary excesses of aldosterone, blood pressure is either normal or low in Bartter's or Gitelman's."  But this has nothing to do with excess sodium intake; rather patients with Bartter's need a high-salt diet just as we do (and potassium supplementation as well, obviously).  

http://en.wikipedia.org/wiki/Hypokalemia

[Kavbear]

I was going to "attempt" to say something about this since I have recently been told if they give me too much IV saline they will mess up my potassium.  Since that was what I was being fed I read about it and there is something right about what you said.
I can't remember what it was but I think if you look up hypovolemia it will explain the sodium vs potassium exchange and how its not equal.


If something can't be found send me a PM and hopefully I marked the page that made me understand (at the moment at least)....

[Heiferly]

Are you trying to give me flashbacks of exams on organelles and the sodium-potassium pumps?!  :-p  Hahaha, I may read textbooks "for funsies," but there are definitely some things that it's been a looooooooooooooong time since I've last studied them.  It's definitely been over a decade since my last biology or physiology class.  

When I went to pick up my glasses, there was a banner on the building that said "Welcome Class of 2014."  I really, really wanted that to be a joke.  Maybe I just need better glasses.  ;-)

[lilmissposey8088]

Thanks guys!!!!!
Heiferly - I think the confusion with the sodium/potassium levels comes with the electrolyte balance, positive negative charge equaliberium that happens in the cellular level. If that makes sense. I'm pretty sure that's what I was thinking anyway. To many Micro biology and anatomy and physiology classes all squished in my poor brain.

[evo123]

I have on/off low Potassium levels and am only suplemented for this if they go quite low.  At the moment the are slightly low at 3.3 but I haven't been put on anything to correct this.

My levels were like this before I started Fludrocortisone and taking this med has not made it any worse.  My sodium levels are the top end of normal but have not never been high.  

When my levels drop I become more tachy and experience more palpatations than usual, but apart from that I do not notice any other symptoms.

[Heiferly]

Don't worry about the brain fog.  I had the two issues conflated in my mind once before, too, and I think for me it happened because of knowing that fludrocortisone poses the potential side effect of hypokalemia and my brain short-circuiting on the salt-loading being irrespective of that.  So apparently it's a common thing to trip up on with the brain fog, LOL.

Yeah, I believe when I first started fludrocortisone they monitored me quite frequently because I already had a history of problems with my potassium levels.  I'm on Klor-Con M20 (20 milliquivalents) 2x daily to keep my levels optimal; we re-check periodically, particularly if I feel any symptoms or if I'm having a flare-up and am fluid-depleted, and temporarily boost supplementation as needed.  I know halbashes and I compared our supplementation in another thread a while back (no small feat because all this is done in milliquivalents ... with brain fog it feels like rocket science trying to figure out how much you're actually getting ... sometimes I wish I'd picked up a BS in math along the way).  I'm not sure who else here in the forum has hypokalemia bad enough to be on Rx supplementation.  (I may know but have forgotten; sorry if that's the case!!)

Ooh, found it.  Here you go:

http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/Salt--Potassium-supplements/show/1281473

As for symptoms of hypokalemia, at least in my personal experience, when my levels get especially bad I can tell that something is different form my normal dysauto symptoms.  Last time my levels were too low (despite my Klor-Con), I called my doc's office before I heard back about my blood test results because I was having suspicious symptoms such as muscle cramps/twitches that were unusual for me.  I think that while the symptoms can be similar to POTS/dysautonomia symptoms, if it gets bad enough, you notice that your symptoms are flared up more or are slightly different in nature.  (The call to the doc's office confirmed that my levels were too low at the time and my doc just ordered me to temporarily up my dosage and the symptoms resolved.  Easy fix!)  

On the other hand, minor fluctuations might not show any symptoms, which is why it's important to monitor this periodically especially if you are on fludrocortisone or have problems with hydration in general, which can affect electrolyte levels (and really, what dysauto patient *doesn't* have a problem with hydration sometimes-HA!).  As I mention in the other post I linked, it's also nice to get a history of a few data points for historical levels as a reference point so you have a good idea of what is "normal" for you.  

[lilmissposey8088]

Nope I haven't yet but I will talk to the doc about it next month. I just realized that my "brain fog" must be kicking today. I know that there is no correletation between high sodium and low potassium. I don't know what I was thinking when I wrote that. Maybe I heard that somewhere or something. But the Florinef does pose a threat on Hypokalemia. The sodium is just a watch out for edema thing. Just one of those brain not working right moments. sorry.

[CHRISTYDRAKE]

Have you had your potassium checked?  My son has had it checked a couple of times since starting fludrocortisone 16 months ago.  So far everything has been fine.