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Electrolytes in Kidney Disease – Elevations in Mg+ and K+

Electrolytes in kidney disease

One of the most important complications to remember in kidney disease is electrolyte abnormalities. Strategic monitoring of electrolytes in kidney disease is essential. When I think about chronic kidney disease, the accumulation of electrolytes becomes something that we need to pay attention. Phosphorus, potassium, and magnesium are a few of the electrolytes that can be thrown out of whack in chronic kidney disease as well as in acute renal failure.  I’m going to focus on potassium and magnesium and here’s a few medications that can complicate hyperkalemia and hypermagnesemia.

  1. ACE Inhibitors/ARBs – these drugs are very commonly used for the management of blood pressure and have numerous compelling indications.  That can raise the risk of hyperkalemia in CKD and acute renal failure.  Be sure to monitor potassium closely in these higher risk patients when started or increased.  If you’d like the full breakdown on ACE Inhibitors, you can check out this recent podcast.
  2. Spironolactone is an aldosterone antagonist that can elevate potassium.  It is most often used in CHF or cirrhosis with ascites.
  3. Potassium supplements can often be necessary in patients taking diuretics, but if changes in kidney function happen and potassium levels go up, those supplements may need to be reduced.
  4. One other unique drug that can raise potassium levels is trimethoprim.  You have to check out this case!
  5. Magnesium supplements.  I do keep an eye on these as many patient will take these over the counter for leg cramps or overall health maintenance.  Depending upon the dose of what they are taking, there is potential for them to contribute to elevated magnesium levels.
  6. Milk of Mag.  Patients with constipation may use this over the counter on a regular basis.  If they have significant kidney disease or acute renal failure, it would be important to think about checking a magnesium level and/or potentially avoiding it for constipation.

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Written By Eric Christianson

June 27, 2018

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