Test: Electrolytes

Electrolytes test is described here.

• carbon dioxide (CO2)
• chloride
• potassium
• factors influencing accuracy of test

As you all may know, a good lab will note the lysis of cells in its report and request a re-draw if the K is high. Given the nature of this churn-it-out industry, we can only assume some lab workers will not bother to do so all of the time.

An article detailing things that can go wrong in the blood draw and lab, leading to pseudohyperkalemia: Investigating Elevated Potassium Values. The article reports that common lab factors that can result in falsely elevated serum potassium values include: - fist clenching or excessive tourniquet during the blood draw - hemolysis from a small needle or traumatic venipuncture - migration of potassium across a compromised gel barrier - recentrifugation or - blood sample clotted

The Merck Manual gives further information by advising that fasting can cause elevated serum potassium by suppression of insulin secretion.

Elevated serum potassium is called hyperkalemia. Hyperkalemia is common; it is diagnosed in up to 8% of hospitalized patients in the U.S. Most patients have mild hyperkalemia which is usually well tolerated.

The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L are mild hyperkalemia. Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia. Potassium levels above 7 mEq/L are severe hyperkalemia.

Because failure to promptly separate serum from cells in a clot tube is a notorious source of falsely elevated potassium, you may want to have your test repeated to rule out lab error. There are other factors that can result in faulty test results (pseudohyperkalemia), such as fist clenching during the blood draw. See Factors That Influence Test Accuracy.

The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is an electrical reading of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating.

As with other electrolyte disturbances, the speed of onset of hyperkalaemia is very important. A relatively small increase, if it occurs over a short time, can precipitate a fatal arrhythmia where a much higher level may be tolerated (for instance, in the insidious onset of renal failure) if it has developed over a longer period.

Consider the risk/benefit ratio

If continued elevated potassium concerns your doctor, point out to him/her that treatment is a matter of risk/benefit and you are determined to resolve your Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens. and kidney inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. with the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. while regularly monitoring serum potassium and evaluating the risk.

Refer your doctor to this article (click here), Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and/or serum potassium concentration rises, which explains that long-term benefits have to be the focus when using ARBs.

Potassium is a mineral naturally found in many fruits and vegetables, like oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in your blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium, resulting in hyperkalemia.

Disorders that decrease kidney function, such as Th1 inflammatory diseases, can result in elevated potassium. This can happen when chronic inflammation has damaged tiny blood vessels (glomeruli) in the kidney. See My kidney function tests are worse since I started the MP. What should I do?

Some sources of information about hyperkalemia list ARBS (Benicar is an ARBA drug which is an angiotensin receptor blocker. One of the ARBs is olmesartan (Benicar). Not all ARBs activate the Vitamin D Receptor.) as causing elevated potassium without any references to confirming scientific studies.

However, in the Center for Drug Evaluation and Research Approval Package for Olemesartan (Benicar) (Application #21-286) and the Clinical Pharmacology, including the Pharmacodynamics of the drug, there is no mention of hyperkalemia. In fact, on page 4, under the pharmacodynamics in the distributed eleven page document summarizing Olmesartan (Benicar)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor., it clearly states the following:

“Repeated administration of up to 80mg olmesartan medoxomil (Benicar) had minimal influence on aldosterone levels and no effect on serum potassium”. It is also highly bound to plasma proteins (99%) and does not penetrate red blood cells where K+ is found.

It is important to continue the Benicar blockade while treating kidney inflammation (even in the presence of mild to moderate hyperkalemia) because it will protect all your organs, including the kidneys and heart from the damage caused by inflammation and it will reduce inflammatory symptoms.

Renoprotective effects of an ultrahigh dose of olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar.

Benicar decreases myocardial inflammation

Benicar protects liver function

Managing your immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed. should reduce elevated potassium. An increase in potassium (and variations in other electrolytes) while on the Marshall Protocol can occur due to the expected immune system reaction. See My immune system reaction is too strong. What should I do?

Do not use thiazide diuretics because they are too hard on the kidneys. See Thiazide diuretics are contraindicated in kidney disease

The following diuretics are contraindiated because they are potassium-sparing and might result in hyperkalemia:

-spironolactone (Aldactone, Novospironton, Spiractin) -triamterene (Dyrenium) -amiloride (Midamor)

Any condition causing mild hyperkalemia should be monitored to prevent progression into more severe hyperkalemia. If your doctor remains concerned about your elevated potassium, ask if taking a diuretic that is known to deplete potassium is an option for you.

Lasix (furosemide) is potassium-depleting and is compatible with the MP. Anyone on Lasix with cardiorespiratory sx exacerbation should be evaluated periodically by their Dr for CHF to see if their cardiac medications need to be adjusted.

Taking in too much potassium (either through foods, supplements, or salt substitutes containing potassium) can cause hyperkalemia if there is kidney dysfunction.

If you have a tendency to have elevated potassium while on the MP, you should avoid foods high in potassium, potassium supplements, salt substitutes containing potassium and other medications that tend to increase potassium. including some sports drinks. We do not recommend the use of Gatorade or similar products. Even the ones that are low in sugar contain extra potassium which you may not need.

Other medications that are reported to decrease urine potassium excretion and increase serum potassium should be avoided. These include NSAIDs, amiloride, aminocaproic acid, antineoplastic agents, β-blockers, epinephrine, heparin, histamine, indomethacin, isoniazid, lithium, mannitol, methicillin, potassium salts of penicillin, phenformin, propranolol, salt substitutes, spironolactone (Aldactone), succinylcholine, triamterene (Dyrenium), and tromethamine.

These days, in all my presentations to physicians, I make a point of helping them to understand that it is the immune system which is doing the germ-killing in the MP, not the drugs. They tend to make the mistake of focusing on the drugs.

The problem is that even after you stop taking the Benicar and abx, the immune system will keep killing the bacteria. Since you no longer are taking the Benicar to protect your kidneys, and your other organs, from damage, you are now fully exposed to the liklihood that real damage will be done by the immunopathology.

Even though hyperkalemia may not harm your body when your body is protected by the Benicar, it is quite another matter altogether when you stop taking the Benicar.

It is also logically incorrect reasoning to assume that because a particular level of hyperkalemia, say 6.4, might be harmful in folks who are not taking Benicar, that this same level will also be harmful in the presence of the drug. This is a non-sequitur. As your physician noted, your own cardiac response didn't seem to be adversely affected by the measured hyperkalemia.

Please look after yourself, and understand that although your physicians are the only people licensed by the State to make decisions about your health, their training is clearly inadequate to help them manage situations like you are currently experiencing.

..Trevor..

Rarely folks develop low sodium (hyponatremia) due to the unavoidable immunopathology experienced during recovery from Th1 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. on the Marshall Protocol.

If you doctor is concerned, share with him/her the following comprehensive article on diagnosing and treating hyponatremia. Hyponatremia (click here for pdf version suitable for printing) by Horacio J. Adrogue & Nicolaos E. Madias New England Journal of Medicine May, 2006

Measure serum sodium

Do not assume your sodium is low unless it has been measured by a lab test. Values on the low end of the normal range are still considered normal. Low sodium is rarely cause for immediate concern but your doctor will want to monitor your sodium level to be sure it doesn't go too low.

Are you drinking too much water? Please see Water. If your fluid intake has been high (more than 2 Liters/day) drinking a little less may bring your sodium up to normal. If fluid intake has not been excessive, consult your doctor before you restrict fluids to increase your serum sodium level.

You may increase your serum sodium by increasing your intake of salt (sodium) but consult your doctor before you increase your salt intake to be sure it is safe for you to do.

Foods that are canned, pickled, processed or cured are high in salt. You can also drink 1/4 tsp of salt in a large glass of water to increase sodium. There are some foods high in sodium, like canned soups and canned vegetable juice drinks (V-8). These are sometimes used to bring sodium up quickly in certain circumstances. Maybe your doctor wants you to increase sodium slowly, so check to be sure. Here is a list of sodium values in foods.

Numerous drugs can cause hyponatremia by increasing the release of AVP from the neurohypophyseal system, by enhancing AVP action on the kidney, or by acting directly on the kidney.In particular, Selective Serotonin Reuptake Ihibitors (SSRIs) such as citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline and opiods, NSAIDs, barbiturates, carbamazepine, orinase and diabinese.

If your doctor wants you to stop the MP, ask if you can first try to slow down immunopathology by adjusting the MP meds as instructed in My immune system reaction is too strong. What should I do?

Then recheck serum sodium in a week or two to see if these measures have been successful.

Stopping the MP is rarely the answer because once the immune system is 'turned on' with the MP, it may continue to function effectively with continuing immune system reactions.

Ask your doctor if fluid restriction is appropriate for you since dilutional hyponatremia is the most common form of this disorder. If Doc thinks your hyponatremia is caused by fluid retention, remind him/her that thiazide diuretics are contraindicated on the MP.

Rarely, high dose demeclocycline (a form of tetracycline) is used to manage chronic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) only. This antibiotic is not contraindicated on the MP.

Electrolytes, especially sodium and potassium, are frequently measured in the office laboratory. The predominant methodology in use for these analytes is that of potentiometry as employed by the ion selective electrode. The potentiometry may be either direct or indirect. In indirect methods, the sample is first mixed with a diluent before measurement. Direct methods usually involve whole blood; the sample is untreated before contacting the electrode.

Indirect methods show interference from factors which change the ratio of plasma water to non-water elements. Elevated lipids and proteins reduce the amount of plasma water in a sample and since the electrolytes are dissolved only in the water phase an effectively smaller sample is mixed without diluent prior to measurement. Normal plasma is about 93% water while samples with elevated lipid or protein may contain only 80-85% water. This can cause pseudohyponatremia since sodium is most notably affected in these samples; minimizing pre-analytical variation is an important element in accurate electrolyte measurements.

My kidney function tests are worse since I started the MP. What should I do?

My potassium is elevated. What should I do?

Do I need to take extra salt because of Benicar?

Do I need to take extra salt if my blood pressure is low?

Most people who take Benicar do not have Symptoms of low sodium are not usually apparent until the level is quite low.

Do not assume your sodium is low because your blood pressure is low. If you are concerned, ask your doctor to test your sodium level.

If you salt your food to taste and eat any processed foods, you should be getting enough sodium.

Some folks have reported they were able to increase their very low blood pressure by increasing their fluid intake (6-8 cups per day of any fluids is usually enough) to maintain adequate hydration and increasing their salt intake.

Consult your doctor before you increase your salt (sodium) intake to be sure it is safe for you to do.

Foods that are canned, pickled, processed or cured are high in salt. You can also drink 1/4 tsp of salt in a large glass of water to increase sodium. There are some foods high in sodium, like canned soups and canned vegetable juice drinks (V-8). These are sometimes used to bring sodium up quickly in certain circumstances. Maybe the doctor is wanting to increase sodium slowly, so check to be sure. Here is a list of sodium values in foods.

Consult your doctor about the need to restrict fluids to increase your serum sodium level.

Baking soda