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What Causes Elevated Levels Of Potassium And Decreased Levels Of Sodium?
Question: My father is aged 72 years and is a cardiac patient. He had suffered an attack in 1986, had undergone a CABG in 2001 and is currently under medication. He is also a diabetic. Recently we underwent tests for potassium and sodium levels. The reports show an elevated levels of potassium (5.8) and decreased level of sodium (128). The pulse rate taken in ECG showed 56. The concerned cardiologist advised for a change in diet like avoiding of fruits and high starch content items. Further he advised taking K'Bind power two times a day for three days. His current medications are 1) Pantakind DSR and Glycomet GP 1 Forte before breakfast. 2) Ismo Retard 40 and Korandil 5 after breakfast and 3) Zyrova C 10, Riomet OD 1000, Korandil 5 and Amlodac 5 after dinner.
The concerned cardiologist completely stopped some previous medicines which he was taking like Ranx 500, Concor 2.5 and Sartel AM 40/5 saying that it might not be suiting him and might be a reason for the out of range readings of Potassium and Sodium levels. My father did feel some of the symptoms as feeling lightheaded while trying to get up, general fatigue and low pulse levels. He has been advised a further follow up tests of Potassium and Sodium and ECG after 10 days.
Please advise as to whether his cardiologist is correct in his diagnosis and what home remedies are avail for bringing down the potassium levels and simultaneously increasing the sodium levels.
The concerned cardiologist completely stopped some previous medicines which he was taking like Ranx 500, Concor 2.5 and Sartel AM 40/5 saying that it might not be suiting him and might be a reason for the out of range readings of Potassium and Sodium levels. My father did feel some of the symptoms as feeling lightheaded while trying to get up, general fatigue and low pulse levels. He has been advised a further follow up tests of Potassium and Sodium and ECG after 10 days.
Please advise as to whether his cardiologist is correct in his diagnosis and what home remedies are avail for bringing down the potassium levels and simultaneously increasing the sodium levels.
Brief Answer:
Avoid sartel, small changes in diet, some further evaluation & rpt repor
Detailed Answer:
Hello, I do second your concern , off all the drugs you mentioned, the most common culprit is sartel am, now the sartel component is the reason his potassium is on the higher side, so sartel group is most commonly used in combination oh hydrochlorthiazide, which is a diuretic which will balance potassium. But simultaneously it will decrease the sodium, so not the best drug for your father right now. All the above will be confusing so I will briefly put my recommendation and concern
1)The drug responsible for increase potassium is sartel
2)no drug you mentioned really brings the sodium down, maybe as it's a common practice to advice low salt diet for heart patient when the pumping is not optimum. At your father's age when we are very stringent in cutting the salt, the sodium may go on lower side.
3) 128 is not really low , if previously also it's in this range not to actively treat, however if your father has symptoms we should try maintaining around 135.
4) your doctor Is right in giving k bind for 3 days
5) however I am pretty convinced that the reason for increasing in potassium was the drug as stopping the drug and increase in normal salt intake(for sosium) should bring it to normal in less than a week, after which you should be good to go normal in diet and may include fruit s and everything in diet as benefits from them are far more. Till than just avoid coconut water, fruits and pulses from the diet for just a week.
6) because all hypertensive has been stopped and and I don't know how substituted, plz keep on monitoring the blood pressure as he may need some other medication
7) a 2d echo for Ef as if low pumping dilution may be reason of decreased sodium as so plain water should be restricted to bring sodium up , urine sodium, serum and urine creatinine may be done Which will help us find other rarer cause for decreased sodium.
7) I will be happy with the pulse in range of 50-60 and would try adding concor back to the medicine list
Lastly I will impress upon the fact that don't treat report s, find the cause and Treat the cause.
Hoping I could help
Regards
Dr. Priyank Mody.
XXXX Hospital, XXXXXXX
Avoid sartel, small changes in diet, some further evaluation & rpt repor
Detailed Answer:
Hello, I do second your concern , off all the drugs you mentioned, the most common culprit is sartel am, now the sartel component is the reason his potassium is on the higher side, so sartel group is most commonly used in combination oh hydrochlorthiazide, which is a diuretic which will balance potassium. But simultaneously it will decrease the sodium, so not the best drug for your father right now. All the above will be confusing so I will briefly put my recommendation and concern
1)The drug responsible for increase potassium is sartel
2)no drug you mentioned really brings the sodium down, maybe as it's a common practice to advice low salt diet for heart patient when the pumping is not optimum. At your father's age when we are very stringent in cutting the salt, the sodium may go on lower side.
3) 128 is not really low , if previously also it's in this range not to actively treat, however if your father has symptoms we should try maintaining around 135.
4) your doctor Is right in giving k bind for 3 days
5) however I am pretty convinced that the reason for increasing in potassium was the drug as stopping the drug and increase in normal salt intake(for sosium) should bring it to normal in less than a week, after which you should be good to go normal in diet and may include fruit s and everything in diet as benefits from them are far more. Till than just avoid coconut water, fruits and pulses from the diet for just a week.
6) because all hypertensive has been stopped and and I don't know how substituted, plz keep on monitoring the blood pressure as he may need some other medication
7) a 2d echo for Ef as if low pumping dilution may be reason of decreased sodium as so plain water should be restricted to bring sodium up , urine sodium, serum and urine creatinine may be done Which will help us find other rarer cause for decreased sodium.
7) I will be happy with the pulse in range of 50-60 and would try adding concor back to the medicine list
Lastly I will impress upon the fact that don't treat report s, find the cause and Treat the cause.
Hoping I could help
Regards
Dr. Priyank Mody.
XXXX Hospital, XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
Thank you very much for your valuable input. My father has also got severe problems of constipation and gas blotting in his stomach specially in the evening. It causes a lot of chest discomfort at that point of time. Is it because of the medicines which he is taking which I had mentioned before. They are 1) Pantakind DSR and Glycomet GP 1 Forte before breakfast. 2) Ismo Retard 40 and Korandil 5 after breakfast and 3) Zyrova C 10, Riomet OD 1000, Korandil 5 and Amlodac 5 after dinner.
To get relief from constipation he takes Duphalac Syrup at night which works quite well and for gas relief he takes Pudin XXXXXXX Liquid of the Carmozyme syrup at times. Does the K'Bind powder have any effect on these symptoms?
Lastly what diet or herbal medicine would you suggest to get relief from gas?
Thank you very much for your valuable input. My father has also got severe problems of constipation and gas blotting in his stomach specially in the evening. It causes a lot of chest discomfort at that point of time. Is it because of the medicines which he is taking which I had mentioned before. They are 1) Pantakind DSR and Glycomet GP 1 Forte before breakfast. 2) Ismo Retard 40 and Korandil 5 after breakfast and 3) Zyrova C 10, Riomet OD 1000, Korandil 5 and Amlodac 5 after dinner.
To get relief from constipation he takes Duphalac Syrup at night which works quite well and for gas relief he takes Pudin XXXXXXX Liquid of the Carmozyme syrup at times. Does the K'Bind powder have any effect on these symptoms?
Lastly what diet or herbal medicine would you suggest to get relief from gas?
Brief Answer:
Do continue the meds, My logic more number of meds more side effects.
Detailed Answer:
Hello, The medication he takes may cause constipation (ismo); however it is far more beneficial to his heart and stopping is not justified.
Kbind does increases nausea and constipation and should be taken only when prescribed.
In diet, more of fruits vegetables, beans, will increase the bulk of food and less of
AVOID :pure carbohydrates like potatoes, rice, white bread, red meat. Also coffee, chocolate s, smoking should be avoided.
To the regime you may add sucralfil O 2 tsf before food, howeaver other medication should not be taken with it
Lastly for constipation 'soft vac granules' are available which are not habit forming are safe and can be taken when he feels constipated.
Do continue the meds, My logic more number of meds more side effects.
Detailed Answer:
Hello, The medication he takes may cause constipation (ismo); however it is far more beneficial to his heart and stopping is not justified.
Kbind does increases nausea and constipation and should be taken only when prescribed.
In diet, more of fruits vegetables, beans, will increase the bulk of food and less of
AVOID :pure carbohydrates like potatoes, rice, white bread, red meat. Also coffee, chocolate s, smoking should be avoided.
To the regime you may add sucralfil O 2 tsf before food, howeaver other medication should not be taken with it
Lastly for constipation 'soft vac granules' are available which are not habit forming are safe and can be taken when he feels constipated.
Above answer was peer-reviewed by :
Dr. Prasad
Dear sir,
Thank you once again for your valuable input. My father's problem of gas and stomach bloating occurs in the evening. One thing I forgot to mention is that previously he was taking another medicine UNISTAR 75 which has also been stopped. He is now on ZYROVA C 10 which In understand is blood thinner too. I have read that this causes a lot of chest discomfort, heart burning and gas. Would it be right to replace it my Ecosprin drug and whether before meals one Rantac 150 can be taken to ease the digestion process?
As i mentioned earlier that my father's problem is with high potassium (5.8) and low sodium (128). Would it be right to take the medicines I suggested taking onto account these things?
Thank you once again for your valuable input. My father's problem of gas and stomach bloating occurs in the evening. One thing I forgot to mention is that previously he was taking another medicine UNISTAR 75 which has also been stopped. He is now on ZYROVA C 10 which In understand is blood thinner too. I have read that this causes a lot of chest discomfort, heart burning and gas. Would it be right to replace it my Ecosprin drug and whether before meals one Rantac 150 can be taken to ease the digestion process?
As i mentioned earlier that my father's problem is with high potassium (5.8) and low sodium (128). Would it be right to take the medicines I suggested taking onto account these things?
Brief Answer:
Continue zyrova c, take rantac 15 before dinner
Detailed Answer:
Hello, unitarian contains aspirin whose common side effect us gastritis and acidity. Now zyrova c contains clopidogrel which is another blood thinner, which causes less acidity as compared to aspirin, so for your father it is a better alternative.
Ecosprin contains aspirin so going back to same drug is not recommended.
Take pantocid dsr in morning and ransacked 150 at night, both 15 mins before meal.
None if these drugs interfere with your electrolytes. So don't worry.
Regards Dr XXXXXXX mody
Continue zyrova c, take rantac 15 before dinner
Detailed Answer:
Hello, unitarian contains aspirin whose common side effect us gastritis and acidity. Now zyrova c contains clopidogrel which is another blood thinner, which causes less acidity as compared to aspirin, so for your father it is a better alternative.
Ecosprin contains aspirin so going back to same drug is not recommended.
Take pantocid dsr in morning and ransacked 150 at night, both 15 mins before meal.
None if these drugs interfere with your electrolytes. So don't worry.
Regards Dr XXXXXXX mody
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
My father was not able to tolerate the new medicines which the doctor had prescribed and was therefore advised by him to stop them immediately and revert back to the old medicines as he had immense chest discomfort and heaviness. His potassium level has come down to 4.8 from 5.8 a month back and sodium level has increased to 129 from 128.
The medicines the doctor has prescribe now are Pantakind DSR 40, Glycoment GP1 Forte, Monit SR 30, Concor 2.5 and Unistar 75. For blood pressure he has been prescribed Amlodac 2.5 at night and Apresol 25 thrice a day. Ranx 500 has been stopped completely which was previously been taken twice daily. The problem is now the swelling of feet due to the pressure medicines though the chest heaviness and congestion has decreased considerably which was taking place when the new medicines were previously prescribed.
Is the line of treatment correct and whether it is safe to take Apresol 25 thrice a day?
My father was not able to tolerate the new medicines which the doctor had prescribed and was therefore advised by him to stop them immediately and revert back to the old medicines as he had immense chest discomfort and heaviness. His potassium level has come down to 4.8 from 5.8 a month back and sodium level has increased to 129 from 128.
The medicines the doctor has prescribe now are Pantakind DSR 40, Glycoment GP1 Forte, Monit SR 30, Concor 2.5 and Unistar 75. For blood pressure he has been prescribed Amlodac 2.5 at night and Apresol 25 thrice a day. Ranx 500 has been stopped completely which was previously been taken twice daily. The problem is now the swelling of feet due to the pressure medicines though the chest heaviness and congestion has decreased considerably which was taking place when the new medicines were previously prescribed.
Is the line of treatment correct and whether it is safe to take Apresol 25 thrice a day?
Brief Answer:
Electrolytes are normal and subtle change in meds should be great
Detailed Answer:
Hello
As previously we would be brief and to the point.
1) two things from your side I still await, his blood pressure recordings during the period and what was his 2 d echo report last, as I wanted to know the heart pumping.
2) as discussed previously,, more the medication, more are the side effects and so maintenance at minimum dose of minimum meds is important.
3) no problem shifting to the previous medication list and if he tolerates it, it perfectly ok
Now to the problems
1)lower leg swelling - I strongly suggest if if ejection fraction is normal, the most probable cause if apresol (hydralazine) , it's a areteriolar vasodilator and in itself can cause swelling in legs and 3rd space. You may read online about the same. I would recommend you may have a discussion with your doctor and may use alternative medicine for the same.
2) amlodac is another medication which may cause leg swelling, however your doctor has decreased the dose already to 2.5 from previous 5 he was taking. So it should be ok
If swelling persist s do have a talk with your doctor about hydralazine.
Alternative meds would be clinidipine for both amlodac /apresol, restarting sartel but with H component instead of Am, however monitor sodium after 3 weeks, increase dose of concor to 5mg, watching the pulse. Or as your doctor would prefer.
3)also for initial 2-3 weeks, I would suggest you take pantakind dsr in morning and plain pantakind at night, so his stomach completely heals.
Let me know if any further assistance @
Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
Hoping I could help
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX
Electrolytes are normal and subtle change in meds should be great
Detailed Answer:
Hello
As previously we would be brief and to the point.
1) two things from your side I still await, his blood pressure recordings during the period and what was his 2 d echo report last, as I wanted to know the heart pumping.
2) as discussed previously,, more the medication, more are the side effects and so maintenance at minimum dose of minimum meds is important.
3) no problem shifting to the previous medication list and if he tolerates it, it perfectly ok
Now to the problems
1)lower leg swelling - I strongly suggest if if ejection fraction is normal, the most probable cause if apresol (hydralazine) , it's a areteriolar vasodilator and in itself can cause swelling in legs and 3rd space. You may read online about the same. I would recommend you may have a discussion with your doctor and may use alternative medicine for the same.
2) amlodac is another medication which may cause leg swelling, however your doctor has decreased the dose already to 2.5 from previous 5 he was taking. So it should be ok
If swelling persist s do have a talk with your doctor about hydralazine.
Alternative meds would be clinidipine for both amlodac /apresol, restarting sartel but with H component instead of Am, however monitor sodium after 3 weeks, increase dose of concor to 5mg, watching the pulse. Or as your doctor would prefer.
3)also for initial 2-3 weeks, I would suggest you take pantakind dsr in morning and plain pantakind at night, so his stomach completely heals.
Let me know if any further assistance @
Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
Hoping I could help
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Sir,
Thank you for your valuable inputs. My father's BP stays in the range of 140-150/70 at home normally. The pulse count is around 60-65. Though his doctor has stopped Ranx 500, he takes it normally once a day since he feels that it relieves him from angina. If he takes the following medications would it be ok for him?
Before Breakfast- Pantakind DSR 40 and Glycomet GP 1 Forte
After Breakfast- Monit Sr 30, Concor 2.5, Apresol 25
After Lunch- Unistar 75 and Apresol 25
After Dinner- Ranx 500, Apresol 25 and Metlong DS
Thank you for your valuable inputs. My father's BP stays in the range of 140-150/70 at home normally. The pulse count is around 60-65. Though his doctor has stopped Ranx 500, he takes it normally once a day since he feels that it relieves him from angina. If he takes the following medications would it be ok for him?
Before Breakfast- Pantakind DSR 40 and Glycomet GP 1 Forte
After Breakfast- Monit Sr 30, Concor 2.5, Apresol 25
After Lunch- Unistar 75 and Apresol 25
After Dinner- Ranx 500, Apresol 25 and Metlong DS
Brief Answer:
All seams to be in normal limits
Detailed Answer:
Hi, the pressure and pulse rate both sound optimum, we need not decrease the pressure more than this for time being, with the new meds regime the pressure should come to less than 140 consistently by 2-3 weeks. So continue the same.
Also if the edema is persistent you may take tab lasix 40 mg in the morning, but never more than two - three days without asking your doctor.
Similarly other anti anginal that would help is tab Nikoran 5 mg, which contains nicorandil, and tab flavedon MR 35 mg which contains trimetazidine if the angina is bad. Taking ranz 500 once is ok if he feels better with it.
Hopefully everything should be good in some days.
Take care. Any further assistance you may always axcess me through HCM Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Regards
All seams to be in normal limits
Detailed Answer:
Hi, the pressure and pulse rate both sound optimum, we need not decrease the pressure more than this for time being, with the new meds regime the pressure should come to less than 140 consistently by 2-3 weeks. So continue the same.
Also if the edema is persistent you may take tab lasix 40 mg in the morning, but never more than two - three days without asking your doctor.
Similarly other anti anginal that would help is tab Nikoran 5 mg, which contains nicorandil, and tab flavedon MR 35 mg which contains trimetazidine if the angina is bad. Taking ranz 500 once is ok if he feels better with it.
Hopefully everything should be good in some days.
Take care. Any further assistance you may always axcess me through HCM Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Sir,
Thanks for your valuable inputs. I am not attaching the scanned copied of his angiogram report conducted 4 years back along with the latest ECG and prescription given by the concerned doctor.
Kindly study the same and give your valuable inputs.
Dear Sir,
I made a spelling mistake in the previous mail. I have attached the relevant reports. Kindly review the same and give your feeedback
Thanks for your valuable inputs. I am not attaching the scanned copied of his angiogram report conducted 4 years back along with the latest ECG and prescription given by the concerned doctor.
Kindly study the same and give your valuable inputs.
Dear Sir,
I made a spelling mistake in the previous mail. I have attached the relevant reports. Kindly review the same and give your feeedback
Brief Answer:
Continue the prescription you has last mentioned.
Detailed Answer:
Hello, I did go through the angiogram and other reports in detail. My inference
1) the pain he has is angina, though the only way it should be managed is medically
2) the report s :
Now the angiogram shows that the graft ro ecg is completely blocked. However the main branch of RCA is the PDA, which has good collateral supply. It means there is natural bypass formed where the left arteries are supplying the right side. It's God s way of helping your father. Now the lcx is 70 blocked, here to the important branch om2 is bypassed with a graft. So just a small territory of the lcx has lesser supply which has resulted in the changes in the ecg, correlating well with the angiogram
3) in this condition there is just no need of another bypass and angioplasty, we just need to fine titrate the medication
4) because your father has a weak stomach, we have to go slow with the meds. So as of now he has just started feeling OK with the meds. Let's continue with the same for time being. Afterwards If angina is still persistent, I would suggest adding tab nicorandil 5mg twice a day to the above regime.
Hoping I could help.
Regards Dr Priyank Mody
Any further assistance you may approach me through HCM Http:// Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
Do rate the conversation for reference.
Continue the prescription you has last mentioned.
Detailed Answer:
Hello, I did go through the angiogram and other reports in detail. My inference
1) the pain he has is angina, though the only way it should be managed is medically
2) the report s :
Now the angiogram shows that the graft ro ecg is completely blocked. However the main branch of RCA is the PDA, which has good collateral supply. It means there is natural bypass formed where the left arteries are supplying the right side. It's God s way of helping your father. Now the lcx is 70 blocked, here to the important branch om2 is bypassed with a graft. So just a small territory of the lcx has lesser supply which has resulted in the changes in the ecg, correlating well with the angiogram
3) in this condition there is just no need of another bypass and angioplasty, we just need to fine titrate the medication
4) because your father has a weak stomach, we have to go slow with the meds. So as of now he has just started feeling OK with the meds. Let's continue with the same for time being. Afterwards If angina is still persistent, I would suggest adding tab nicorandil 5mg twice a day to the above regime.
Hoping I could help.
Regards Dr Priyank Mody
Any further assistance you may approach me through HCM Http:// Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
Do rate the conversation for reference.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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