Top INDEX
• Profile : Chemical Properties of Potassium.
• Explore: Potassium in the environment.
• Benefits: Health effects of Potassium.
• Cautions: Health detriments of Potassium.
• Diagnostic Procedures & Laboratory Tests ...
• Antagonists and Agonists to Potassium.
• -- Article : Potassium Metabolism & Shifts.
• - Journal : An Overlooked Cause of Hypokalemia.
• Perspective: Personal realities and findings.

• Article : The Effect of Potassium Deficiency on Intestinal Motility ....
• Article : Intestinal Peristalsis & Magnesium.
• Article : Magnesium and Potassium Interaction.
• -Study : Potassium and Magnesium drug interactions ....
• Article : Hypokalemia and How It Works !
• Article : Does Cooking a Banana Eliminate Potassium?
• Article : Cooking Methods For High Potassium Foods.
• Article : Low-Potassium Meat & Fish.
• Article : Kitchen Losses of Potassium.
• Article : How can potassium disappear after cooking?

  Product Possibilities, NOT Recommendations.

  Product: Taking Supplements, Yes, No, Variables.

  Product: Table Salt, Windsor.

  Product: Iodized Salt, Diamond Crystal Brand.

  Product: Foods HIGH in Potassium.

  Product: Foods LOW in Potassium.

• Insight: Potassium is an essential macromineral for life on the Earth.
• Insight: Medications, including antibiotics, can cause potassium toxicity.
• Insight: Salt substitutes, instant coffee, prepared foods ... are sources of K.
• Insight: K deficiency can produce abdominal distention from loss of peristalsis.
• Insight: Intracellular compartment storage buffers large swings in serum K.
• Insight: Neurological changes from hypokalemia include abdominal distention ...
• Insight: How one cooks their food determines potassium availability.
• Insight: Perception, ignorance, and faulty testing encourage endemic low K.
• Insight: Potassium deficiency can induce symptoms from physical damages.
• Insight: Insulin influences potassium levels in cells vs serum blood.
• Insight: False potassium readings can arise from air/temperature/clotting.
• Insight: Potassium deficiency greatly reduces motility in intestines and bladder.
• Insight: High potassium food sources can dietarily raise potassium levels.
• Insight: Risk factors ... include abdominal distention, paralysis of bowel wall, ....

• -LINKS: from Lenntech, and others.

• -Focus-: Monographs on Toxins and Enhancers.

Profile: Chemical Properties of Potassium. INDEX
https://www.lenntech.com/periodic/elements/k.htm
LINK 2:

The name is derived from the English word potash.
The chemical symbol K comes from kalium, the Mediaeval Latin for potash, which may have derived from the Arabic word qali, meaning alkali.

Potassium is a soft, silvery-white metal, member of the alkali group of the periodic chart.
Potassium is silvery when first cut but it oxidizes rapidly in air and tarnishes within minutes, so it is generally stored under oil or grease.
It is light enough to float into water with which it reacts instantly to release hydrogen, which burns with a lilac flame.

Applications:
Most potassium (95 %) goes into fertilizers and the rest goes mainly into making potassium hydroxide (KOH), by the electrolysis of potassium chloride solution, and then converting this to potassium carbonate (K2CO3).

Potassium carbonate goes into glass manufacture, especially the glass used to make televisions, while potassium hydroxide is used to make liquid soaps and detergents. A little potassium chloride goes into pharmaceuticals, medical drips and saline injections.

Other potassium salts are used in baking, photography and tanning leather, and to make iodize salts.
In all cases it is the negative anion, not the potassium, which is the key to their use.

Explore: Potassium in the environment. INDEX
https://www.lenntech.com/Periodic-chart-elements/
K-en.htm#Environmental%20effects%20of%20potassium
LINK 2: https://www.lenntech.com/periodic/water/potassium/potassium-and-water.htm

Most potassium occurs in the Earth's crust as minerals, such as feldspars and clays.
Potassium is leached from these by weathering, which explains why there is quite a lot of this element in the sea (0.75 g/liter).

Minerals mined for their potassium are pinkish and sylvite, carnallite and alunite.
The main mining area used to be Germany, which had a monopoly of potassium before the first World War.
Today most potassium minerals come from Canada, USA and Chile.
The world production of potassium ores is about 50 million tonnes, and reserves are vast (more than 10 billion tonnes).

Potassium is a key plant element.
Although it is soluble in water, little is lost from undisturbed soils because as it is released from dead plants and animal excrements, it quickly become strongly bound to clay particles, and it is retained ready to be reabsorbed by the roots of other plants.

Together with nitrogen and phosphorous, potassium is one of the essential macrominerals for plant survival.
Its presence is of great importance for soil health, plant growth and animal nutrition.
Its primary function in the plant is its role in the maintenance of osmotic pressure and cell size, thereby influencing photosynthesis and energy production as well as stomatal opening and carbon dioxide supply, plant turgor and translocation of nutrients. As such, the element is required in relatively large proportions by the growing plant.

The consequences of low potassium levels are apparent in a variety of symptoms:
restricted growth, reduced flowering, lower yields and lower quality produce.

High water soluble levels of potassium cause damage to germinating seedlings, inhibits the uptake of other minerals and reduces the quality of a crop.

Potassium reacts rapidly and intensely with water, forming a colourless basic potassium hydroxide solution and hydrogen gas.
This is an exothermal reaction and potassium is heated to such an extend that it burns a purple flame.
Additionally, hydrogen released during the reaction strongly reacts with oxygen and ignites.
Potassium reacts with water more slowly than does rubidium, which is placed under potassium in the periodic chart.
It reacts with water more rapidly than does sodium, which is placed higher in the periodic chart.

Potassium compounds may end up in wastewater through urine.
An unusual application is increasing the amount of rain in dry regions by potassium chloride.
It is released just below the clouds from planes, rises up and doubles the amount of moist in clouds, causing it to start raining harder.

As potassium release from landfills for domestic waste is usually exceptionally high, this compound may be applied as an indicator for other toxic compounds in groundwater.

Potassium is a dietary requirement for nearly any organism except a number of bacteria, because it plays an important role in nerve functions.

Potassium plays a central role in plant growth, and it often limits it.
Potassium from dead plant and animal material is often bound to clay minerals in soils, before it dissolves in water. Consequently, it is readily taken up by plants again. Ploughing may disturb this natural process. Consequently, potassium fertilizer are often added to agricultural soils. Plants contain about 2% potassium (dry mass) on average, but values may vary from 0.1-6.8%.

Mosquito larvae contain between 0.5 and 0.6% potassium, and beetles contain between 0.6 and 0.9% potassium (dry mass).
Potassium salts may kill plant cells because of high osmotic activity.

Benefits: Health effects of Potassium. INDEX
https://www.lenntech.com/Periodic-chart-elements/
K-en.htm#Health%20effects%20of%20potassium
LINK 2: https://www.lenntech.com/periodic/water/potassium/potassium-and-water.htm

Potassium can be found in vegetables, fruit, potatoes, meat, bread, milk and nuts.
It plays an important role in the physical fluid system of humans and it assists nerve functions.

Potassium, as the ion K+, concentrates inside cells, and 95% of the body's potassium is so located.
When our kidneys are malfunctioning, an accumulation of potassium will accumulate.
This can lead to disturbing heartbeats.

Potassium is a dietary requirement for us, and we take up about 1-6 g per day at a requirement of 2-3.5 g per day.
The total potassium amount in the human body lies somewhere between 110 and 140 g and mainly depends upon muscle mass.
The muscles contain most potassium after red blood cells and brain tissue.

Whereas its opponent sodium is present in intracellular fluids, potassium is mainly present within cells.
It preserves osmotic pressure. The relation of potassium in cells to potassium in plasma is 27:1, and is regulated by means of sodium-potassium pumps.

Vital functions of potassium include its role in
• nerve stimulus,
• muscle contractions,
• blood pressure regulation and
• protein dissolution
• protects the heart and arteries

Potassium shortages are relatively rare, but may lead to

• depression,
• muscle weakness,
• heart rhythm disorder,
• confusion.

Cautions: Health detriments of Potassium. INDEX
https://www.lenntech.com/periodic/water/potassium/potassium-and-water.htm

Potassium loss may be a consequence of chronic diarrhoea or kidney disease, because the physical potassium balance is regulated by the kidneys. When kidneys operate insufficiently, potassium intake must be limited to prevent greater losses.

The intake of a number of potassium compounds may be particularly harmful.

Potassium can affect you when breathed in.
Inhalation of dust or mists can irritate the eyes, nose, throat, lungs with sneezing, coughing and sore throat.
Higher exposures may cause a build up of fluid in the lungs, this can cause death.
Skin and eye contact can cause severe burns leading to permanent damage.

At high doses potassium chloride interferes with nerve impulses, which interrupts with virtually all bodily functions and mainly affects heart functioning.

Potassium alum may cause stomach complaints and nausea at concentrations as low as 2 g, and may be corrosive and even lethal in higher concentrations.

Potassium carbonate is lethal to adults at doses above 15 g.

... potassium tartrate at 1 g,

... potassium cyanide at only 50 mg.

Potassium dichromate is lethal at between 6 and 8 g, and 30 g of potassium nitrate causes severe intoxication, which may result in death.

... potassium hydroxide concentrations between 10 and 12 ml in a 15% caustic may be lethal.

Potassium permanganate is applied in bleaches and disinfection, and is lethal at between 5 and 8 g.

Diagnostic Procedures & Laboratory Tests INDEX
with Nursing Diagnoses, 8th Edition (2013)
by Jane Vincent Corbett, RN, EdD & Angela Denise Banks, RN, PhD
Pearson Education, Inc., Upper Saddle River, New Jersey, 07458

(p 114) ... Potassium ... is essential for normal neuromuscular and cardiac function. ...
Small changes ... can have profound effects on cardiac muscle. ... the kidneys continue to excrete 40 - 80 mEq/day, even when there is no intake. ... Potassium can also be lost in gastrointestinal drainage ... Either a potassium or a hydrogen ion is excreted when a sodium ion is reabsorbed by the kidney. ...

(p 115) ... Pseudohyperkalemia (increased serum potassium level) can be caused by fist clenching ....
The intake of too much potassium in medications can ... cause an increased serum potassium level. ...
medications, such as penicillin K, which contains potassium ions, can cause hyperkalemia if renal output is not adequate.

Because potassium is primarily an intracellular ion, anything that causes massive cell destruction increases the serum potassium level, Thus, massive tissue injury or a burn causes the release of potassium from damaged cells.

(p 116) Because aldosterone and other steroids cause a retention of sodium and an increased excretion of potassium, conditions in which hormones are decreased may cause an increased serum potassium level. ...

Hyperkalemia is often associated with metabolic acidosis states.
In acidosis the kidney must excrete more hydrogen ions, which means less secretion of potassium ions by the renal selection mechanism. In addition, an abundance of hydrogen ions in the serum means that some of these ions go into the cells, which drive potassium out of the cells.

probably the most important thing to remember about checking for symptoms of increasing serum potassium levels is that many of the symptoms are nonspecific. Potassium is important to nerve and muscle function, but so are most of the other electrolytes. Early symptoms of hyperkalemia may be

irritability, 
nausea, 
diarrhea, 
Abdominal cramping, 
(followed by) 
skeletal muscle weakness,
flaccid-type paralysis, ... 
difficulty in speaking, 
difficulty in breathing ... 
cardiac arrhythmias,
cardiac arrest. 

(p 117) ... Sometimes calcium gluconate is given intravenously to lessen cardiac toxicity ... not used if the client is taking digitalis ...

... chronically high potassium levels caused by renal failure, ...

... most salt substitutes are composed of large amounts of potassium.
Instant coffee and other prepared foods may have potassium as one of the ingredients.

... if the serum potassium level increases because of cell damage, the potassium lost from injured cells results in a total body deficit. Always consider that the possibility that the hyperkalemia of today could result in the hypokalemia tomorrow.

(p 118) ... potassium is not conserved well in the body, ...
in fasting ... the breakdown of cells for energy causes the release of potassium.
... Any loss of fluid from the gastrointestinal tract causes a loss of potassium. The most common cause of hypokalemia worldwide is diarrhea. Almost all diuretics ... Certain hormonal changes ... corticosteroids ... Certain tumors may produce hormones that act much like the steroids and ... increase potassium excretion. Drugs, such as ... epinephrine, can cause a transient hypokalemia.

... In alkalosis, hydrogen ions shift out of the cell in an attempt to lower the pH of the serum to normal. When hydrogen shifts out of the cell, more potassium shifts into the cell to replace missing positive ions. ... When serum potassium levels are low, the kidneys must excrete more hydrogen ions in exchange for the resorption of sodium ....

(p 119) Although certain clinical symptoms are caused by hypokalemia, these symptoms can also be caused by other clinical abnormalities. Clients with a low serum potassium level may have

• anorexia,
• muscle weakness,
• a decrease in bowel sounds, and
• abdominal distention due to decreased peristalsis (ileus). **

Ileus and lethargy are key symptoms of hypokalemia in newborns.

Flaccid paralysis may develop with more severe hypokalemia, as well as with hypokalemia, because bot potassium imbalances alter the resting potential of muscle cells. Low serum potassium levels may make respiratory effort difficult.

Most potassium supplements also contain chloride, which may be a needed replacement in metabolic alkalosis.
The most important problem with oral supplements of potassium is the gastrointestinal upsets they can cause.
Liquids should be diluted. Orange juice is a good vehicle because it has a high potassium level.
Overdoses of oral potassium are not common, but it is important that the urinary output always be adequate.

Potassium replacements can also be accomplished with a relatively inexpensive salt substitute that contains potassium chloride. Many salt substitutes contain more than 50 mEq (milliequivalents) per teaspoon (4 mL).

(p 120) The amount of potassium in the urine varies with the diet.
It also varies with an increased amount of serum aldosterone or cortisol which causes an increased excretion of potassium.
Renal failure causes a decreased excretion of potassium. ...

Foods high in potassium include
avocado, banana, cantaloupe, dates, figs, molasses, orange juice, potato, prunes, salt substitutes and tomato juice.

(p 181) A lack of insulin causes an increase in blood glucose levels and a potassium imbalance because glucose and potassium cannot get into the cells. ... hormones that cause an elevation of blood glucose levels are corticosteroids, epinephrine, and growth hormone. ...

In pregnancy, human placental lactogen (HPL) promotes increased blood glucose levels.
Other hormones in pregnancy, progesterone, estrogen, and prolactin, are insulin antagonists.

(p 245) in addition to the amount of protein in the diet, other factors that contribute to the development of hepatic coma include hypokaolemia and the use of sedatives and opiods. The body is less able to handle ammonia when the potassium level is low or when alkalosis is present.

Antagonists and Agonists to Potassium. INDEX
http://www.return2health.net/articles/vitamin-mineral-antagonists/
20/01/2015

LINK 2:

When applied to nutrients (like vitamins and minerals),
an agonist is actually something that enhances either nutrient absorption or metabolic function inside your body.

... antagonist means that something either decreases or blocks the absorption or metabolic function of the nutrient.

In other words, certain vitamins and minerals can either inhibit or enhance the absorption or function of other vitamins and minerals.

... Some nutrients are great buddies when the right amounts of each are taken, but they can fall out with each other when one massively out numbers the other.

Article: Potassium Metabolism & Shifts. INDEX
https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/
electrolyte-disorders/overview-of-disorders-of-potassium-concentration
By James L. Lewis, III, MD, Attending Physician,
Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham
Last full review/revision March 2018 by James L. Lewis, III, MD

Potassium metabolism
Dietary potassium intake normally varies between 40 and 150 mEq/day.
In the steady state, fecal losses are usually close to 10% of intake.
The remaining 90% is excreted in the urine, so alternations in renal potassium secretion greatly affect potassium balance.

When potassium intake is > 150 mEq/day, about 50% of the excess potassium appears in the urine over the next several hours. Most of the remainder is transferred into the intracellular compartment, thus minimizing the rise in serum potassium. When elevated potassium intake continues, aldosterone secretion is stimulated and thus renal potassium excretion rises. In addition, potassium absorption from stool appears to be under some regulation and may fall by 50% in chronic potassium excess.

When potassium intake falls, intracellular potassium again serves to buffer wide swings in serum potassium concentration. Renal potassium conservation develops relatively slowly in response to decreases in dietary potassium and is far less efficient than the kidneys’ ability to conserve sodium. Thus, potassium depletion is a frequent clinical problem. Urinary potassium excretion of 10 mEq/day represents near-maximal renal potassium conservation and implies significant potassium depletion.

Acute acidosis impairs potassium excretion, whereas chronic acidosis and acute alkalosis can promote potassium excretion.
Increased delivery of sodium to the distal nephrons, as occurs with high sodium intake or loop diuretic therapy, promotes potassium excretion.

Potassium shifts
Factors that shift potassium in or out of cells include the following:

Insulin concentrations
    Beta-adrenergic activity
    Acid-base status

Insulin moves potassium into cells;
high concentrations of insulin thus lower serum potassium concentration.
Low concentrations of insulin, as in diabetic ketoacidosis, cause potassium to move out of cells, thus raising serum potassium, sometimes even in the presence of total body potassium deficiency.

Beta-adrenergic agonists, especially selective beta 2-agonists, move potassium into cells, whereas beta-blockade and alpha-agonists promote movement of potassium out of cells.

Acute metabolic acidosis causes potassium to move out of cells, whereas acute metabolic alkalosis causes potassium to move into cells. However, changes in serum bicarbonate concentration may be more important than changes in pH; acidosis caused by accumulation of mineral acids (nonanion gap, hyperchloremic acidosis) is more likely to elevate serum potassium. In contrast, metabolic acidosis due to accumulation of organic acids (increased anion gap acidosis) does not cause hyperkalemia. Thus, the hyperkalemia common in diabetic ketoacidosis results more from insulin deficiency than from acidosis.

Acute respiratory acidosis and respiratory alkalosis affect serum potassium concentration less than metabolic acidosis and metabolic alkalosis. Nonetheless, serum potassium concentration should always be interpreted in the context of the serum pH (and bicarbonate concentration).

False potassium concentrations
Pseudohypokalemia, or falsely low serum potassium, occasionally is found when blood specimens from patients with chronic myelogenous leukemia and a WBC count > 105/µL remain at room temperature before being processed because abnormal leukocytes in the sample take up serum potassium. It is prevented by prompt separation of plasma or serum in blood samples.

Pseudohyperkalemia, or falsely elevated serum potassium, is more common, typically occurring due to hemolysis and release of intracellular potassium. To prevent false results, phlebotomy personnel should not rapidly aspirate blood through a narrow-gauge needle or excessively agitate blood samples. Pseudohyperkalemia can also result from platelet count > 400,000/µL due to release of potassium from platelets during clotting; in these cases, the plasma potassium (unclotted blood), as opposed to serum potassium, is normal.

Journal: An Overlooked Cause of Hypokalemia. INDEX
https://www.amjmed.com/article/S0002-9343(17)30635-6/pdf
by Cherng Jye Seow, MBBS, MRCPS (Glas), FRCP (Edin), William Francis Young Jr, MD, MSc,
Department of Endocrinology, Tan Tock Seng Hospital, Singapore;
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn.
The American Journal of Medicine, Vol 130, No 10, October 2017

PRESENTATION
Hypokalemia is a commonly encountered clinical problem.
The underlying pathophysiology can be attributed to the following 3 mechanisms:

insufficient potassium intake, 
excessive urinary or gastrointestinal losses, and 
transcellular shifts.

A 57-year-old woman was referred to the endocrinology clinic for poorly controlled diabetes mellitus. ...
(Various drugs were prescribed without any benefits. ) ... Her other medical problems included chronic hepatitis B, hypertension, and dyslipidemia; the latter 2 conditions were diagnosed around the onset of diabetes mellitus. Other medications included enalapril, simvastatin, and entacavir. There was no significant family history of note, and she was not taking any supplements.

ASSESSMENT
On examination, the patient had a rounded countenance, prominent truncal obesity, and thin limbs.
Her body mass index was 19.1 kg/m. Her heart rate was 70 beats/min, and blood pressure was 130/70 mm Hg. ...
Initial laboratory results revealed an unexpected potassium level of 2.6 mmol/L (normal, 3.5-5 mmol/L) despite treatment with enalapril. Further history was directed at elucidating the cause of the hypokalemia.

There were no symptoms of recent or chronic vomiting or diarrhea.
She did not experience any symptoms of thyrotoxicosis and was not taking any medications, such as beta-adrenergic agonists, which could account for transcellular potassium shifts. She had hypertension that was well controlled. She had a significant background history of hepatitis B but had never taken adefovir or tenofovir, which are associated with proximal tubulopathy. There was no significant family or personal history of autoimmune disorders, such as Sjögren’s syndrome or systemic lupus erythematosus, which could result in renal tubular acidosis.

She was not taking long-term diuretics and did not consume excessive licorice.
She also denied treatment with corticosteroids. Additional investigations of the hypokalemia suggested a renal loss of potassium. Her spot urine potassium level was 68 mmol/L, spot urine creatinine level was 8.4 mmol, and urinary potassium/creatinine ratio was 8.1. In addition, she was alkalotic with a bicarbonate level of 35 mmol/L (normal, 19-31 mmol/L).

Magnesium was normal at 0.7 mmol/L (normal, 0.7-1.0 mmol/L).
Plasma renin activity and plasma aldosterone concentration were both suppressed at <0.13 ng/ mL/h and 1.7 ng/dL, respectively.
At this time, the possibility of Cushing syndrome was considered. >

Further evaluation showed the following:
baseline 8 am cortisol 44.3 g/dL (normal, 7-25 g/dL) with paired serum corticotrophin 55 pg/mL (normal, 10-60 pg/mL).
The 24-hour urinary free cortisol excretion was more than 4-fold elevated at 1811 nmol/day (normal, 59-413 nmol/day, urine volume 1000 mL). An overnight 8 mg dexamethasone suppression test revealed an early morning cortisol that suppressed by 71.3% to 12.7 g/dL. Magnetic resonance imaging of the pituitary gland was performed, and a 3.8 × 2.5 × 4.9-cm macroadenoma was seen, with extension into the left and right cavernous sinuses and completely encasing the left intracavernous carotid artery.

Computed tomography of the thorax, abdomen, and pelvis revealed a small liver cyst but no other abnormalities.
Visual field testing was normal. At transsphenoidal surgery, a firm fibrous vascular tumor was found in the sellar and infrasellar compartments, filling the sphenoid sinus cavity. The excised tissue stained strongly positive for corticotrophin on immunohistochemistry.

DIAGNOSIS
The diagnosis of hypokalemia from Cushing disease secondary to a pituitary macroadenoma was made in view of the findings of hypokalemia from

renal loss, 
metabolic alkalosis, 
suppressed renin and aldosterone level, 
an elevated 24-hour urinary free cortisol with unsuppressed overnight dexamethasone suppression test, 
magnetic resonance imaging of the pituitary showing a macroadenoma, and 
histology of the excised specimen staining strongly positive for corticotrophin. ... 

DISCUSSION
Cortisol has mineralocorticoid activity and circulates in blood at a concentration 1000-fold greater than aldosterone.
The mineralocorticoid receptor in the renal tubule usually is protected from activation by cortisol by the action of 11ß hydroxysteroid dehydrogenase type 2, which converts cortisol to inactive cortisone. At high levels of cortisol, the 11ß hydroxysteroid dehydrogenase type 2 is overwhelmed and excess cortisol can activate the mineralocorticoid receptor. The inhibitory effect of elevated levels of corticotrophin on 11ß hydroxysteroid dehydrogenase type 2 and elevated corticosterone and deoxycorticosteroid, which possess mineralocorticoid activity, also could account for hypokalemia in corticotrophin-dependent Cushing syndrome.

Hypokalemia secondary to Cushing disease is not common; 57% of patients with ectopic Cushing syndrome in one series had hypokalemia compared with only 10% in Cushing disease in another series. The discrepancy likely is related to the severity of hypercortisolism in ectopic Cushing syndrome. In our patient with Cushing disease, hypokalemia likely occurred because of the high levels of corticotrophin from the macroadenoma. The most common cause of Cushing syndrome is the administration of supraphysiologic doses of glucocorticoids. Endogenous Cushing syndrome is rare, with an incidence of 0.7 to 2.4 per million population per year and can be divided into corticotrophin-dependent (80%-85%) or corticotrophinindependent (10%-15%) causes. It is estimated that 75% to 80% of cases are due to corticotrophin production from a pituitary adenoma, 15% to 20% of cases are due to ectopic sources, and <1% of cases are due to corticotrophin-releasing hormone-producing tumors. >

Surgical resection of the pituitary adenoma is the recommended first-line treatment of Cushing disease, but is unfortunately associated with a remission rate of less than 15% in macroadenomas as in this patient. Nonetheless, surgery is still recommended for debulking intent and to increase the success with radiotherapy and medical therapy. Stereotactic radiosurgery is preferred over conventional fractionated radiotherapy because it can be given over 1 session with a faster therapeutic response. Our patient received gamma knife radiosurgery and was started on medical therapy while waiting for effects of radiosurgery to occur.

Medical therapies for Cushing disease can be divided into agents that decrease corticotrophin release at the pituitary (eg, somatostatin analogs such as pasireotide and dopamine agonists such as cabergoline), inhibit steroidogenesis at the adrenal glands (e.g., etomidate, metyrapone, ketoconazole, mitotane), and block glucocorticoid action (mifepristone) at the cortisol receptor level. Patients receiving medical therapy should be educated on the symptoms of hypocortisolism and need for glucocorticoid treatment during sick days. Combination therapy, as in this patient, can reduce drug-related adverse events by using lower doses of either drug.

Bilateral adrenalectomy is an option in cases of refractory Cushing disease.
Cushing disease is associated with a 2- to 5-fold increase in mortality, and hypokalemia occurs if there is severe hypercortisolism, usually secondary to a macroadenoma. Thus, there needs to be a heightened index of suspicion for this possible diagnosis in the evaluation of hypokalemia. Curative treatment results in a reduction in mortality.

Perspective: Personal realities and findings. INDEX
... 2016-06 to 2018-12 --- An interpretation which may become meaningful for you.

During the Fall of 1996 and the Spring of 1998, severe Mercury poisoning was experienced from dental amalgams.

Symptoms included
• impotency;
• frigidity;
• muscle energy dropped by 50%;
• vertigo with periods of light to heavy dizziness;
• all of my torso muscles began to ache;
• my vision blurred and the skin around my eyes tightened;
• pain on my left side from the waist downward for 4 inches;
• glands in my neck became sore and my neck stiffened;
• pain on my right side 4 to 5 inches below my nipple (liver);
• testicular cancer;
• intestinal gas.

In addition, I had been experiencing

Symptoms of Thyroid toxicity, December, 1996:
• greater alertness in the first hours, with great tiredness after the following;
• intense and constant peristaltic action of my intestines such that my abdomen vibrated and it woke me from my sleep;
• abdominal tension and soreness as if I had experienced diarrhea for a long time;
• development of headache and nausea.

From February, 1997, I had discovered that the drug Manerix was immediately beneficial in restoring intestinal peristaltic activity which had been stopped, as I later found, from the influence of the Mercury. Once I had detoxed with high doses of supplements and had a specific dental amalgam removed, ALL of the symptoms abated. The Manerix was no longer required.
Several months later, a new set of symptoms imposed on my health.

SYMPTOMS, June, 1997:
• waking up after 2-3 hours with headache & heart palpitations;
• physically tired to point of exhaustion but mentally alert;
• waking up with febrile paralysis (unable to move) for 10 minutes+;
• unusually anxious, aggressive, and hyper in the afternoon;
• fluctuating body temperature during the evening.

Heavy metal toxicities will depress organ functions according to where one's body deposits them.
Depressed organ functions are poorly revealed by laboratory tests that seek to reveal if an organ is (usually) underfunctioning overall, or, overstimulated, in general. Depressed function translates, frequently, into functioning SLOWER, rather than out-of-balance. Heavy metal toxicities are known to both depress organ functions while they are present, and, to Permanently alter organ functions in the longer-term. In addition, they encourage the development of cancers. With all of these biochemical stresses and anarchy, one's potassium levels will also be thrown into anarchy. The resulting symptoms and tests will be so confused by the multiplicity of changes ongoing that segregating influences on potassium levels and discerning any response to potassium levels alone will be impossible. Still, weaknesses to one's ability to maintain a balanced potassium level longer-term are likely to become a residual reality. Typically, it is recognized that heart, intestinal, and immune systems are challenged.

In the Spring of 1998, I was not myself.
Fatigue, irritability, heart problems came to dominate and frustrate my activities and work.
Taking lose dose thyroid medicine, beginning the Manerix again, and significantly modifying my diet deterred and minimized the symptoms long enough for me to qualify for a new and attractive job. I did not find out until months later that mercury toxicity negates your ZINC intake ... artificially raising your zinc requirement. Low zinc levels lead to skin and tissue degradation, loss of sex drive, lowered immunity ... and these encourage emotional depression. My sex drive had drifted into oblivion sometime in October, 1998. I was somewhat distracted with survival at the time and largely surrounded by men the presence or absence of a sex drive was of no concern to a heterosexual. I also did not find out until I was recovering that mercury diminishes your ability to utilize potassium which is fundamental for a healthy heart function and many cellular functions. Some researchers have been questioning the potential for mercury toxicity to be indicated in the high rate of North American deaths related to heart failure.

The symptoms of acting out, aggressiveness, and, intolerance became added to my detractors.
Electromagnetic radiation from computer monitors and other sources increased symptom presence and intensity.
Acupuncture proved to be very beneficial. Eventually, it all came back to Mercury toxicity from newly leaking dental amalgams.
Many coping mechanisms to strengthen my kidneys, restrain parasite expansion, and counter Mercury toxicity enabled me to survive. Removing the rest of my dental mercury amalgams led to recovery, again.

During 1999 to early 2004, I encountered recurrent exposures to SEVERE chronic illnesses.
Following a transpacific flight in mid-summer, 2003, back to the province of Ontario from Australia, I found myself to be more tired on a daily basis than was normal for me. In the latter part of the flight, significant pain was felt in a tooth area that felt like the tooth was going to explode. An immediate dental appointment was not possible. A few hours after landing, the pain dissipated.

SYMPTOMS: November 2003 to March, 2004
• stepped muscle energy drop by 65%;
• my Guided supplement level continued to increase;
• unsubstantiated increase to near constant state of fatigue;
• periodic vertigo with periods of light to heavy dizziness;
• my vision blurred periodically with forehead tightness;
• my torso muscles began to ache when I was tired;
• my libido dropped to near nothing.

From Spiritual Guidance and personal research, the possibility of there being mercury amalgam beneath each of two gold crowns I had, became a question. Specialists and "experts" in the dental field denied that such could be possible. Perhaps they ignored the fact that these had been added around my age 15 or less with my birth year being 1945. Eventually, I commanded my then dentist to remove the crowns. On doing so, he concluded that there was evidence that mercury amalgam HAD been there, in quantity, and that it had electro-evaporated into my system. A crack had developed in the adhesive bonding the gold crown to the tooth from the pressure changes between a high altitude flight and ground pressure. Mouth fluids had penetrated and the NATURAL electrochemical interaction between the gold and the mercury had vaporized the heavy metal ... to be breathed in and circulated through my body. The inner surface of the gold crowns bore evidence of extensive electric arcing. The gold crowns had felt "warm" uncharacteristically at times. Removing the crowns and the molars they were on resolved the confusion, solved the question of source, and directed me, yet again, to detoxing a body burden of Mercury. As the detoxing proceeded, the symptoms lessened. Remember, mercury diminishes your ability to utilize potassium.

In 2011-09, at the Penticton Hospital in the province of B.C., Dr. Jeffery Gerhard Marschall performed anal surgery to remove a troublesome skin tag. Following the surgery I experienced significant anal pain for a number of days. Thereafter for a period of many months, I experienced a low level of daily fecal incontinence. NO medical assistance or acknowledgement were given by Dr. Marschall, or by other doctors at the Penticton Hospital, or by my General Practitioner, Dr. Rob Calder, of the Osoyoos Medical Centre ... ALL of whom assistance was requested from. It would seem obvious from the timing of the beginning of the DAILY incontinence difficulties, that the surgery was poorly performed and that anal region nerves may have been severed due to incompetency ... only to be denied and hidden from responsibility and correction by the British Columbia Health System procedures.

In 2014-04, at the Henning Emergency Clinic of Kindness - Youth Accessing Health in Penticton, I had the remainder of my teeth removed and obtained a basic set of dentures. Over time, I found that speaking was easier for me and better understood by others if I did so with NO dentures in place. In addition, I found that eating was both easier and more satisfying if I did so without dentures and by crushing foods between my tongue and my gums. For appearances, I made an effort to always put in my lower dentures, at least, when I went out into the public. For these and reasons of finances, I rarely went to restaurants following this surgery, and then, only when by myself. Eating without "chewing" became a source contributor of LOW Potassium levels, according to research I found in late 2018.

During 2015 - 2016, I elected to take on a volunteer position involving conflict resolution within aggressive political dissident who were seeking to act out vengeance against powerful rivals who had committed torture, murder, and abuse against their ethnic, religious, and/or family members. It resulted in 80-hour work week averages doing very focused research followed by communication that was necessarily empathic, tactful, gently challenging, careful listening, and, often during my night hours. As this came as my best option to use my skills and awareness to advance what God wanted, it came with dietary changes which enabled me to remain active for long periods with little nutrition, rest, or interruptions. This was a high risk environment as my success often resulted in the cancellation or failure of very large armaments transactions. No time was available for socializing or intimacy or a personal life. In respect for my wife, we decided to divorce and live separately for her safety and greater contentment.

To effect the above, my diet became most focused on dried dates, frozen wild blueberries, coconut oil, and, other LOW potassium sources. After a year and a half it became time for me to discontinue this work. At the same time, my health changed radically. Physical weakness and disorientation grew and were added to the lack of intestinal peristaltic action which had seemed to activate suddenly about 9 months into this work cycle. Daily colon flushes became quickly necessary in order to avoid auto-toxification and the quickly loss of mental and physical abilities. Over an additional period of 9 months my abdomen distended from relatively flat to my looking as if I were 7 months pregnant. The medical profession were of absolutely no benefit in attempting to diagnose these critical-to-me health problems.

With greatly diminished health and no benefit from the healthcare industry, my prayers Guided me to relocate to the nearby province of Alberta. Every province has their own healthcare bureaucracy and priorities. Perhaps better answers would be found there. Yet, each province in Canada has a healthcare service which is politically controlled by allotted budget. Politicians set what they believe the taxpaying electorate will accept. Then, it is for the medical profession to determine how, when, and where they will spend it. Tests and quality of service and availability of options are often reduced to the minimum. The doctor I had in Lethbridge did the best he could with what was available to him. Essentially, the result was just more frustration from poorly assessed tests and a resistance to undertake more direct and likely more diagnostically productive tests. I elected to privately have a Body Composition test. It revealed that my bone mass had been both growing more dense and stronger over the previous decade ... while I was getting older. A little research indicated that this had only been found to happen when individuals either had a cancer, or, had heavy metal poisoning.

Heavy metal poisoning seemed impossible as I had endeavoured to follow a largely unprocessed foods diet with minimal red meat and had fully detoxed a number of times earlier. Mercury had been my past recurrent challenge and ALL sources of it had been removed. Running a 24-hour Elements Urine test was a simple enough procedure I had effected at earlier times. Avoided by and not available from the medical services, I ordered and paid for it myself. The results were shocking. I had VERY HIGH levels of 10 toxins including uranium, lead, mercury, aluminum, copper, and others! I made arrangements to begin an intensive detoxing routine. Many supplements and ingredients had to be acquired ... as I could afford them, as they were available, and as I learned that they would be best. I began a lengthy research program to thoroughly understand each toxin and many of the health enhancement supplements which I was Spiritually Guided to. All this had to be effected during a period when major symptoms were physical and mental fatigue.

Remember, heavy metals diminish your ability to utilize potassium.
During much of 2018 my efforts to intensively detox toxic amounts of heavy metals and other minerals was interrupted by many challenges: the required supplements were sometimes unavailable, took long delivery times, had not been made available yet. In addition, the necessity to recover from two consecutive month long serious viruses, Bartonella, Hansen's Disease (leprosy), and, a severe lower back injury altogether made the process long. Detoxing is also a strain on physical and immune resources itself. ALL of these changes and challenges typically influence potassium availability, usage, and cellular and blood levels.

It was not until late 2018 that I acquired a 2013 edition of "Laboratory Tests and Diagnostic Procedures with Nursing Diagnoses" which has a partial line mention of "abdominal distention due to decreased peristalsis" in the section on Hypokalemia (Low Serum Potassium Levels). From that mention, I found a report on the Internet from a 1950 McGill University Experimental Surgery study of Low Potassium influence. It dramatically illustrates that a low potassium diet WILL lead to abdominal distention, loss of peristalsis activity, and death. Experimenting with HIGH and LOW potassium diets produced dramatic results for me, sometimes in as little as 15 minutes or as long as an hour.

Symptoms from diet selection, late 2018.

HIGH Potassium Diet result

Increased peristalsis 
Pain, soreness, stiffness 
A reduced reaction of tiredness to drug Flexeril 
Increased difficulties with Aspergillosis blockages
Increased heart symptoms of numbness & cardiac arrhythmias 
Decreased susceptibility to respiratory diseases 

LOW Potassium Diet result

Decreased peristalsis 
Loss of pain, soreness, stiffness
An increased reaction of tiredness (12 hours) to drug Flexeril 
Decreased difficulties with Aspergillosis blockages 
Increased heart symptoms of numbness & cardiac arrhythmias 
Increased susceptibility to respiratory diseases 

The option, for me, was a choice between feeling Pain and Stiffness, and, gaining Inflammation with a HIGH Potassium diet, OR, NO feelings of pain and stiffness, and, no inflammation with a LOW Potassium diet. The RISKS involved included increased immune function and heart stability with a higher potassium diet, and, a lowered immune function and heart instability with a lower potassium diet.

If you are experiencing problems with pain, peristaltic action, and heart activity ... you may choose to experiment with dietary potassium while seriously considering the risks. My decision and my choices are personal and may not be relevant or preferred by yourself.

Article : The Effect of Potassium Deficiency
on Intestinal Motility and Gastric Secretion. INDEX
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1616818/
PDF LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1616818/pdf/annsurg01397-0207.pdf
by D. R. Webster, H. Winter Henrikson, and D. J. Currie
Montreal, Canada -- from the Experimental Surgical Laboratories, McGill University,
Ann Surg. 1950 Oct; 132(4): 779–783.

The effects produced by a loss of body potassium have been studied in a variety of clinical conditions such as diarrhea, intestinal obstruction, Cushing's syndrome and diabetic acidosis. Potassium deficiency has been produced experimentally by feeding a low potassium diet or by injecting desoxycorticosterone. It was shown that potassium deficiency may lead to muscle weakness and, in dogs, to eventual paralysis. In addition to this skeletal muscle change, pathologic lesions in cardiac muscle occur which are associated with characteristic electrocardiographic changes. In man and animals given desoxycorticosterone, the water exchange is increased. ...

To produce potassium deficiency experimentally, animals were fed a low potassium diet (o.oi percent potassium).
In rats the tone and movements of the whole digestive tract decreased progressively as the deficiency continued.
In an average of two months, this resulted in severe distension which eventually was the cause of death.
The hypotonic intestine was usually filled with large amounts of digestive-secretions, even before symptoms became severe. In many animals in the severe stage of deficiency, large amounts of gas accumulated, so that the condition resembled that of paralytic ileus. These signs rapidly disappeared upon the administration of potassium. The bladder of deficient animals was also atonic and was usually found filled with urine. In potassium deficient adult dogs, little change in motility of the digestive tract occurred, although there was a reduction in the strength and rate of rhythmic contractions. In these dogs, water exchange was increased early in the deficiency.

Other studies have been carried out in dogs with gastric-pouches without loss of gastric juice.
In potassium deficiency produced by a low potassium diet, the dogs showed an increase in volume of gastric secretion which paralleled the increase in water exchange. Muscle weakness and eventual paralysis developed in these animals and was relieved by the administration of potassium. In other dogs with gastric pouches which were fed a normal diet of meat, the secretion by the gastric pouch was discarded. Potassium deficiency resulted and the water exchange and volume of gastric secretions increased markedly.

Loss of body potassium due to loss of gastric juice has also been observed by other investigators clinically and in rats.
These studies have shown that simple potassium deficiency in rats greatly reduces motility in the smooth muscle organs of the gastro-intestinal tract and bladder. Because of the accumulation of fluid and gas, there is either an increased secretion of digestive juices and/or a decreased absorption. In potassium deficient dogs, the water exchange and volume of gastric secretions is increased. A clinical illustration is provided by a patient who had a perforation of a diverticulum of the cecum. A cecostomy was performed by the surgeon, Dr. Harry Ballon, and continuous gastric suction was used postoperatively. The cecostomy did not function for three weeks. The patient lost up to eight litres of gastric secretion each day. Parenteral glucose, physiologic saline, and plasma were given intravenously. At the end of this time, although the patient was not paralyzed, the peripheral reflexes were absent. The serum potassium was 9 mg. per ioo cc., the serum chlorides were 290 mg. per ioo cc. and -the carbon dioxide combining power was iOO volumes per ioo cc. of serum.

Ammonium chloride was administered with little or no improvement.
When potassium chloride was administered, the cecostomy began to function and the patient made an uneventful recovery. So it would seem that when gastric and intestinal secretions are lost from the body, a relatively large amount of potassium is likewise lost, as these fluids contain two to three times as much potassium as an equivalent amount of serum. Two effects may ensue:

1. There may be inhibition of the intestinal musculature aggravating an ileus already established from some other cause.

2. There appears to be a stimulus to increase the volume of gastric secretion.
The stomach continues to secrete potassium, and because of the increased volume of secretion, the potassium deficiency develops. Hydration and electrolyte balance can only be restored if potassium is administered.

cecostomy:
the surgical construction of an opening into the cecum, performed as a temporary measure to relieve intestinal obstruction in a patient who cannot tolerate major surgery. Twenty-four hours before surgery, if time permits, only clear liquids allowed. Cleansing enemas and antibiotics are sometimes prescribed to reduce the number of bacteria in the bowel. IV fluids and electrolytes are given, and a nasointestinal tube is inserted.

With the patient under local anesthesia, a tube is inserted into the cecum to allow drainage of feces.
The procedure may also be done to decompress the large bowel and prevent distention until peristalsis is restored after intestinal surgery. After surgery, the tube is connected to a drainage bag. The nurse irrigates the cecostomy tube with saline solution as necessary, allowing the solution to flow in and out by gravity, if possible. Frequent dressing changes are needed to keep the skin clean and dry. An ileostomy bag may be used.

When edema and inflammation have subsided, the obstruction (usually cancer) is resected, the healthy sections of the bowel reconnected, and the cecostomy closed.

Article: Intestinal Peristalsis & Magnesium. INDEX
https://healthfully.com/470686-intestinal-peristalsis-magnesium.html
By Chris Daniels
2011-07-08

Peristalsis is a series of orderly contractions of the intestines that push food through your intestines.
High levels of magnesium can interrupt peristalsis, causing diarrhea and cramping.
High enough levels of magnesium may be obtained when taking magnesium supplements or a large number of supplements using magnesium stearate, or another magnesium compound, as a filler.

Peristalsis
Your digestive system works by pushing a ball, or bolus, of food through the muscular tubes of your esophagus, stomach and intestines. Peristalsis moves food, mixes it with stomach acid, mucus and digestive juices containing enzymes that break down nutrients before they are absorbed. In the esophagus, stomach and small intestines peristalsis is relatively continuous. Peristalsis moving waste through the large intestines occurs only a few times per day.

Magnesium in Your Body
Magnesium is an essential mineral in your body.
Adequate magnesium is important for bone strength, learning and memory, heart function and biochemical reactions.
According to the National Institutes of Health Office of Dietary Supplements, most Americans consume adequate levels of magnesium, neither in deficit nor excess. High doses of magnesium are normally due to dietary supplements and laxatives containing magnesium. The Office of Dietary Supplements states that the upper level of magnesium from supplements is 350 mg per day for adults.

Sources of Excess Magnesium
Most food contains some level of magnesium. Additionally, magnesium is added to many processed foods.
According to the Office of Dietary Supplements, there is no tolerable upper limit for dietary magnesium:
Excess dietary magnesium is excreted with waste. Magnesium stearate, as well as related chemicals, is used in the processing and as a filler in many dietary supplements and medicines in both pill and powder form. Taking large amounts of dietary supplements at once, especially without food, can disrupt peristalsis leading to nausea, cramping, diarrhea and other intestinal discomfort.

Consequences
(Excess) Magnesium causes the muscles in your intestines to contract sporadically rather than in a controlled manner.
This prevents proper digestion as stomach acid and digestive juices are not properly mixed with food.
If a large amount of dietary supplement or medicine are taken at once, they will be pushed through your intestines before they can be absorbed. Space any dietary supplements throughout the day and try to take them with a meal to prevent gastrointestinal discomfort.

Article: Magnesium and Potassium Interaction. INDEX
http://barttersite.org/magnesium-and-potassium-interaction/
by Dr Herbert C. Mansmann M.D., June 10, 2008
The Bartter’s (Syndrome) site.

(This article and other research findings) strongly support
the need to correct Mg deficiency in order to correct potassium serum levels.

Potassium Facts and signs of K deficiency
The daily intake of K in normal patients is 60 to 100 mEq and the amount eliminated is the same, 90% is execrated in the urine and 10% is in the stool.

The normal serum K is 3.5-5.5 mEq/L, and in children (Nelson Ped. on the Bartter’s web page)
a value of < 2.5 mEq/L usually means Bartter’s.

Extracellular fluid is only 2-3 % of total body K.

Each 1 mEq/L decrease of serum K (Potassium) reflects a total body deficit of <200-400 mEq.
A serum K of <2 mEq/L may reflect a total deficit >1000 mEq, (Wallach, J., 7th edition, 2000, p76).

24 hour urine K content is 40-120 mEq/day (Uptodate, 2002).
In France the reference standard is said to be 35-80 mmol per day.

Symptoms of potassium deficiency
Any of the following symptoms (could) be discussed with your doctor, especially when you are asked how do you feel.
This is very important when you have a disease where magnesium deficiency is likely or a disease where potassium deficiency is present.

It would be best if you kept a grading (1, best–10) of the extent of these in a daily diary.
Future K dosing by your doctor, in part, is very likely to be decided on this type of information.

• Chronic fatigue
• Irregular or rapid heart (palpitations)
• Constipation
• Muscle weakness
• Depression
• Nervousness
• Headaches
• Respiratory distress
• Insomnia
• Swollen feet and/or ankles (edema)

TREATMENT of a Low serum Potassium
Most of this section depends on your doctor knowing how you are doing (and caring to do something when relevant).
You (are not advised to) self-managing this part of your treatment, unlike oral magnesium dose adjusting
(a Mg over dose only causes diarrhea), except for an increase in your use of high potassium containing foods.

High content of K is found in the following foods:

K is highest in the following foods,
> 25 mEq per 100 grams (about 3 ounces) are the following:
• dried figs,
• molasses,
• seaweed.

12.5 mEq per 100 grams.
• Dried dates,
• prunes,
• nuts,
• avocados,
• bran cereals,
• wheat germ (both may bind Mg in bowels),
• lima beans

6.2 mEq per 100 grams
• Many vegetables,
• fruits (including bananas),
• most animal meats ..

Several of these can be added to cooking foods if one also consumes the fluid component.

Physicians methods

The IV KCl dose is up to 10 mEq/ hour, need a cardiac monitor if go higher, and some use 20-40 mEq/hr.
Each 1 gram of KCl contains 9.8 mEq of K..

The tablet of the product of K-DUR® 10 is an immediately dispersing extended release oral dosage form of potassium chloride containing 750 mg of microencapsulated potassium chloride (slowly released), a USP equivalent to 10 mEq of potassium in a tablet (PDR 2002). So some will need many pills, always in multiple dosing like every 4-8 hours.

If need 1,000 mEq, because sK is less than 2 mEq/L,
this is an important reason for IV KCl, besides the cardiac danger of being to low.

Study : Potassium and Magnesium drug interactions - from FDA reports. INDEX
https://www.ehealthme.com/drug-interaction/potassium/magnesium/
eHealthMe are a data analysis company who specializes in health care industry.
The below is a summary of Drug interactions collected from 3,164 reporting patients
who take Potassium and Magnesium together to November, 2018.

Most common drug interactions over time *:

< 1 month:
• Back pain
• Lung infection
• Atrial fibrillation (fibrillation of the muscles of the atria of the heart)
• Febrile neutropenia (fever with reduced white blood cells)
• Hypotension (abnormally low blood pressure)

1 - 6 months:
• Anastomotic leak
• Atrial fibrillation (fibrillation of the muscles of the atria of the heart)
• Decreased appetite
• Dehydration (dryness resulting from the removal of water)
• Female genital tract fistula (passage in genital tract of female)

6 - 12 months:
• Drug ineffective
• Rash
• Chest pain
• Coronary artery occlusion (complete obstruction of blood flow in a coronary artery)
• Dry mouth

1 - 2 years:
• Haemorrhage (bleeding)
• Tooth disorder (tooth disease)
• Pituitary tumour benign

2 - 5 years:
• Chronic obstructive pulmonary disease (a progressive disease that makes it hard to breathe)
• Catheter site haemorrhage (bleeding at catheter site)
• Cellulitis (infection under the skin)
• Diabetes mellitus (diabetes, caused by a deficiency of the pancreatic hormone insulin)
• Gastrointestinal haemorrhage (bleeding gastrointestinal tract)

5 - 10 years:
• Alopecia (absence of hair from areas of the body)
• Hair colour changes
• Hair disorder
• Hair texture abnormal
• Madarosis (absence or loss of the eyelashes)

10+ years:
• Catheter site haemorrhage (bleeding at catheter site)
• Cellulitis (infection under the skin)
• Drug withdrawal syndrome

  (interfere with normal social, occupational, or other functioning. are not due to another medical condition, drug use, or discontinuation)

• Eye disorder
• Gait disturbance

Article : Hypokalemia and How It Works ! INDEX
https://prezi.com/-rultxznf7gb/hypokalemia-and-how-it-works/
by Amy Stephens --- 19 October 2012

What is it?
Potassium is a chemical that is critical to proper functioning of nerve and muscle cells, particularly heart muscle.
Minor changes in extracellular potassium levels cause major changes in cell membrane excitability and in other cellular processes.

Approximately 98% of total body potassium is inside of the cells.
Normal blood potassium levels are 3.5-5.0 mEq/L.
Hypokalemia is a serum potassium level below 3.5 mEq/L in the bloodstream.
Hypokalemia can be life threatening because every body system is affected.

Who gets it?
Who gets hypokalemia and why hypokalemia occurs is due to several reasons.
Use of diuretics also known as water pills, diarrhea, and chronic laxative abuse are the most common causes of hypokalemia.
Illnesses and other medications may also cause hypokalemia as well. Additionally women and African-Americans are at a higher risk for developing hypokalemia. Other individuals who may get hypokalemia are patients who have kidney disorders such as renal tubular acidosis, chronic kidney failure, acute kidney failure, magnesium deficiency, leukemia, or Cushing’s disease. Hypokalemia may occur in patients who are vomiting, use enemas or excessive laxative use, have diarrhea, or after an ileostomy operation. Lastly patients which consume decreased amounts of potassium in his/her diet may also get hypokalemia.

Patients who have poor dietary intake of potassium such as cases involving bulimia, anorexia, starvation, pica, and alcoholism.
Dental problems such as the inability to chew or swallow.
Financial burdens such as poverty also contribute to hypokalemia.

What are the risk factors?
Risk factors of hypokalemia include muscle weakness, ileus, constipation, arrhythmias, hypotension, cardiac arrest, polyuria, hyperglycemia, anorexia, nausea, vomiting, poor diet, abdominal distention, paralysis of bowel wall, mental depression, thirst, abdominal tympanism, reduced tendon reflexes, myocardial degeneration, and low blood potassium. Risk factors also include actual potassium deficits such as excessive use of diuretics, diarrhea, or vomiting. Risk factors can also include relative potassium deficits such as alkalosis, water intoxication, or total parenteral nutrition.

What is the pathophysiology?
Hypokalemia increases the difference in the amount of potassium between the fluid inside of the cells and the fluid outside of the cells. The increased difference reduces the excitability of cells. As a result, the cell membranes of all excitable tissues, such as nerve and muscle, are less responsive to normal stimuli. When the loss of extracellular potassium is gradual, cells adjust and cellular potassium decreases in proportion to the extracellular fluid potassium level. The potassium difference between the two fluid spaces remain unchanged, and symptoms of hypokalemia may not appear until the potassium loss is extreme. Rapid reduction in serum potassium levels causes dramatic changes in function. Hypokalemia may result from either an actual total body potassium loss or from the movement of potassium from the extracellular fluid to the intracellular fluid causing a relative decrease in extracellular potassium level.

What is the system involved?
What are the manifestations? Respiratory changes are likely because of weakness of the muscles needed for breathing.
Skeletal muscle weakness results in shallow respirations. Therefore respiratory status should be assessed first in any patient who might have hypokalemia. Musculoskeletal changes include skeletal muscle weakness in response to hypokalemia. A stronger stimulus is needed to begin muscle contraction. A patient may be so weak that he or she cannot stand. Hand grasps are weak and a decreased response to deep tendon reflex stimulation (hyporeflexia) may be seen. Severe hypokalemia causes flaccid paralysis. Cardiovascular changes include a thready and weak pulse. Palpation is difficult and the pulse is easily blocked with light pressure. The pulse rate can range from very slow to very rapid and an irregular heartbeat (dysrhythmia) may be present. Measure the patients blood pressure in the lying, sitting, and standing position because orthostatic hypotension occurs with hypokalemia.

Neurologic changes from hypokalemia include an altered mental status.
The patient may have short term irritability and anxiety followed by lethargy that progresses to acute confusion and coma as hypokalemia worsens. Behavioral changes caused by hypokalemia can occur quickly. Intestinal changes occur with hypokalemia because smooth muscle contractions in the intestinal tract are decreased, which leads to decreased peristalsis. The patient has hypoactive bowel sounds and may have nausea, vomiting, constipation, and abdominal distention. Severe hypokalemia can cause the absence of peristalsis also known as a paralytic ileus.

How is it diagnosed?
Laboratory data confirm hypokalemia.
Laboratory data includes a complete blood count (CBC) that is completed per the physician’s orders.
A direct relationship exists between low magnesium levels and low potassium levels therefore magnesium levels are very important. Hypokalemia causes EKG changes in the heart therefore an EKG is utilized. EKG changes show a flattened T wave with an eventual emergence of a prominent U wave. The ST segment is depressed with a slightly peaked P wave. Lastly frequent premature ventricular contractions are present. If dysrhythmias are present they can lead to death, particularly in older adults who are taking digoxin. In addition to the lab values and EKG results hypokalemia is also diagnosed with supporting signs and symptoms as mentioned earlier in risk factors.

How is it treated?
Drug therapy for the treatment and prevention of hypokalemia includes additional potassium and drugs to prevent potassium loss. Most potassium supplements are potassium chloride, potassium gluconate, or potassium citrate. The amount and route of potassium replacement depend on the degree of loss. Potassium is given IV for severe hypokalemia. The drug is available in different concentrations and carries a high alert warning as a concentrated electrolyte solution. Before infusing any IV solution containing potassium chloride, check and re-check the dilution of the drug in the IV solution container. Potassium is a severe tissue irritant and is never given by IM or subcutaneous injection.

Tissues damaged by potassium can become necrotic and slough, causing loss of function and requiring reconstructive surgery. IV potassium solutions irritate veins and can cause phlebitis. Oral potassium preparations may be taken as liquids or solids. Potassium has a strong unpleasant taste that is difficult to mask although it can be mixed with many liquids. Potassium chloride can cause nausea and vomiting give the drug during or after a meal and advise the patients using the drug at home not to take it on an empty stomach. A potassium sparing diuretic may be prescribed for patients with hypokalemia that need diuretic therapy.

What are the interventions?
Interventions for hypokalemia aim to prevent potassium loss, increase serum potassium levels, and ensure patient safety.
The priorities for nursing care of the patient with hypokalemia are ensuring adequate oxygenation, patient safety for fall prevention, and prevention of injury from potassium administration. The next priority is monitoring the patients response to therapy.

What are the complications?
Patients with hypokalemia have increased changes in several body systems.
Implement safety measures with a patient who has muscle weakness from hypokalemia including falls precautions such as eliminating hazards and assisting with ambulation. If safety measures are not assessed and evaluated the patient could cause harm to his or herself. Respiratory monitoring is performed at least hourly for severe hypokalemia and includes rate and depth. Also be sure to check oxygen saturation to determine breathing effectiveness. If respiratory monitoring is not assessed and evaluated the patient could go into cardiac arrest and code. Assess respiratory muscle effectiveness by checking the patients ability to cough. Examine the face, oral mucosa, and nail beds for pallor or cyanosis. Lastly evaluate arterial blood gas values for decreased blood oxygen levels and increased arterial carbon dioxide levels which indicate adequate breathing effectiveness. If respiratory muscles are not assessed and evaluated there may potentially be no supportive evidence of respiratory effectiveness.

Potassium is vital to the normal functioning of the muscles, heart, and nerves.
Potassium plays an important role in controlling activity of smooth muscle, skeletal muscle, and muscles of the heart.
Potassium is important for normal transmission of electrical signals throughout the nervous system within the body. Hypokalemia essentially affects all systems involved. The respiratory system, musculoskeletal system, cardiovascular system, neurological system, and intestinal system are all affected by hypokalemia.

Article : Does Cooking a Banana Eliminate Potassium? INDEX
https://healthyeating.sfgate.com/cooking-banana-eliminate-potassium-12477.html
Written by Meg Campbell --- Updated November 27, 2018

Although getting enough potassium has been shown to help protect against high blood pressure, kidney stones and bone loss, the average American consumes just 2,640 milligrams of this essential mineral a day, or less than 60 percent of the 4,700 milligrams recommended for healthy adults. As the most widely consumed fruit in the United States, bananas are an important source of potassium in the American diet. Because most traditional preparation methods don't affect the mineral, cooked bananas are generally as potassium-rich as the raw fruit.

Heat and Potassium
Minerals are highly stable nutrients that generally remain unchanged when they’re exposed to heat.
For this reason, dry-heat cooking methods don’t affect a banana’s potassium content, even when it’s subjected to higher temperatures or longer cooking times. Dried bananas -- which are made when fresh bananas are exposed to low heat for several hours -- supply about four times more potassium per ounce than the fresh fruit. This doesn’t mean that potassium levels increase during cooking, however; it simply means that the mineral becomes more concentrated as moisture levels decrease. Calorie for calorie, fresh bananas and dried bananas supply roughly the same amount of potassium.

Effects of Boiling
Although dried, baked, grilled, sauteed and fried bananas have as much potassium as raw bananas, the mineral isn’t impervious to every cooking method. Water -- particularly boiling water -- can leach a significant amount of minerals from food, including potassium. A 2014 study published in the International Journal of Food Sciences and Nutrition found that soaking a banana in water caused it to lose just over 40 percent of its potassium, while a 2013 study published in in the journal African Health Sciences concluded that boiling water reduces a banana’s potassium content even further. Because bananas are rarely soaked or boiled, however, this isn’t a major concern.

Other Consequences
Even if you can be confident that baking bananas into bread won’t destroy their potassium content, cooking can affect other nutrients. Raw bananas are a good source of vitamin C, a water-soluble nutrient that’s degraded by light and heat. A medium-sized banana -- or one that has about 100 calories, according to the U.S. Department of Agriculture -- is five times richer in vitamin C than a 100-calorie serving of dried bananas. Although B vitamins are generally more stable than vitamin C, they’re still susceptible to heat and may degrade under higher cooking temperatures.

Cooking also impacts a banana’s firmness and fiber quality, mainly through the breakdown of cell walls and starch. This is why cooked bananas often have a thick, gel-like texture.

Further Considerations
Potassium loss is a far bigger concern when it comes to vegetable preparation.
Roasted carrots retain more potassium than boiled carrots, just as sauteed spinach is a better source of potassium than boiled spinach. Potatoes, which are a leading source of potassium in the American diet, are frequently boiled. Cut potatoes -- especially those cut into small pieces -- lose more potassium in boiling water because a greater surface area is exposed. According to a 2008 study published in the Journal of Food Science, boiling decreases the amount of potassium in cubed potatoes and shredded potatoes by 50 percent and 75 percent, respectively.

Article : Cooking Methods For High Potassium Foods. INDEX
http://highpotassiumfoods.org/
high-potassium-foods/cooking-methods-for-high-potassium-foods/
by James Smith --- 2012-02-25

How high potassium foods are prepared is important in determining how much potassium in the food will get into your body. It is no good to have 4700 mg of potassium in the food you would consume and then lose a large amount of it during the preparation.

Most methods of cooking make it easy to keep the potassium in the food.
But one method in particular frequently pulls potassium out of the food.

The easiest method to keep all the potassium in the food is to eat the food raw.
That is a good method for most vegetables, fruits and spices. It is not recommended for animal products though.
Animal products are more easily contaminated and can more easily grow harmful organisms, although plants can also be contaminated.

If the plant foods are picked fresh, consumed fresh and washed prior to eating, they have a low likelihood of having harmful organisms. If you know the producer of the plant food, you can determine the possibility of chemical contamination. If you know what to look for you can determine if the fruit or vegetable is spoiled.

For most animal products though, it is difficult to spot contamination.
Even the most careful farmer can have meat, dairy or eggs with harmful organisms.
Almost all eggs have salmonella on the shell surface. All poultry should be assumed to have salmonella on the surface.
Meats can have organisms hidden and will not show the problem like spotted or softened produce does.
Dairy can have microorganisms that don't show if not pasteurized.

When handling animal products, the utensils used with the raw product should not be used with the cooked product unless thoroughly washed before using with the cooked product. Hands, dishes and utensils should be washed before touching the cooked product if they had contacted the raw previously.

Although there are knowledgeable producers and consumers that have used raw animal products safely, I feel it is too difficult. Some of my friends and I have had contaminated raw animal products from sources we trusted. So I feel all meat and egg products should be cooked, and dairy pasteurized.

For high potassium foods, you have a multitude of choices for preparation.
You can eat it raw after washing. You can steam it, bake it (without baking soda or powder), fry it, grill it, roast it or broil it.
These methods will lose none or minimal amounts of potassium, and can be used with most dishes.
Many barbecue enthusiasts already have tried various vegetables grilled.
To mention just a few, peppers, potatoes, onions, and zucchini are great sliced and grilled.

Boiling in water is the main preparation method that will lose potassium from many foods.
It pulls the potassium into the water. If the water is consumed though, you will consume all of the potassium.
This is commonly done with soups, chilies and stews. If the water is discarded, it will reduce the amount of potassium you get from the food. Combine that with the common method of adding salt to the water the food is boiled in, and you will have also increased the sodium, thus ruining the potassium to sodium ratio, and reversing the healthful effects you are looking for.

A good method for preparing intact grains, such as rolled oats or quinoa, is to add just enough water to soak into the grain and then microwave the dish. This will heat the grain and destroy any organisms and make the grain soft enough to eat. All the water is driven into the grain and is consumed so no potassium is lost. This can also be done with dry lentils and beans, although the soak time is longer.

Of course, spices ... will increase the potassium content of the dish while adding flavor.

Article : Low-Potassium Meat & Fish. INDEX
https://www.livestrong.com/article/533230-low-potassium-meat-fish/
by Jessica Bruso --- Oct. 03, 2017

People who suffer from kidney disease need to watch their potassium intake.
They need to minimize the stress their diet places on their kidneys, which help regulate potassium levels.
Consuming too much potassium can interfere with the rhythm of your heart. Early symptoms of high potassium levels include numbness, tingling and weakness. If potassium levels aren't lowered, a heart attack could occur.

Fish and Seafood
While normally considered relatively high in potassium, some fish and seafood options are still low enough in potassium to fit into a low-potassium diet on occasion. Imitation shrimp and imitation scallops both have less than 100 milligrams of potassium per 3-ounce serving. Oysters, clams, orange roughy and light tuna canned in oil have less than 200 milligrams per serving.

Chicken and Turkey
Although chicken and turkey tend to have relatively high levels of potassium when compared to other types of meat, some options can be low in potassium. Roasted turkey meat without the skin can have under 100 milligrams of potassium per 3-ounce serving. Chicken backs, chicken liver and ground turkey have under 200 milligrams of potassium per serving.

Red Meat
Red meat tends to have moderate levels of potassium, with between 100 and 300 milligrams per serving.
Pork chitterlings, lamb and beef liver, however, have less than 100 milligrams of potassium per serving.
Pork liver and many cuts of cooked beef, including tip round roast and bottom round roast, are a bit higher in potassium, but still have less than 200 milligrams per 3-ounce serving.

Sodium Considerations
If you are following a low-potassium diet because of kidney problems, you'll probably need to avoid foods high in sodium as well. A number of meat and seafood options that are low in potassium are also high in sodium, such as pickled pork hocks, which have less than 100 milligrams of potassium per serving. Corned beef, shrimp, Italian sausage, ham, bratwurst and crab each had less than 200 milligrams of potassium per serving.

Article : Kitchen Losses of Potassium. INDEX
http://charles_w.tripod.com/arthritis10b.html
by Charles Weber, MS
Author email; isoptera at att.net --- Author telephone: 1 828 692 5816

... Whichever vegetables are boiled suffer losses equivalent to processing losses if fresh, or often can suffer further losses if they have already been processed. Unless salt is present in the boil water or canning liquids, there is a limit to how much potassium can be lost. This is probably because large negatively charged molecules can not diffuse out of the heat damaged cell wall, and the charges inside the cell must remain balanced. This limit appears to be over 50% for most vegetables. The losses tend to be greater with larger amounts of water and longer boiling times....

Baked or broiled vegetables retain everything except a fairly large loss of vitamin C and lesser losses of some of the B vitamins [Pearson][Krehl]. Usually only potatoes and stuffed peppers are baked, but in theory all foods could be baked or microwaved. One way to cook food in a microwave which would lose so much moisture if baked so that they would not taste good, would be to place them in a casserole or closed pot along with a small amount of water. Meat which is broiled sometimes actually increases in potassium content if fats are rendered out of them. Pumpkins and squash can be baked right in the shell if they are punctured to avoid exploding. It is easy to make pudding after baking them. If a young pumpkin or squash is used it is possible to eat it seeds and all. ...

In order to gain the greater speed that using the top of the stove implies you could fry the vegetables.
This is already often done with onions, potatoes, mushrooms, eggplant, peppers, squash, and tomatoes.
Many vegetables which are difficult to fry can be fried by placing them in the pan with vegetables which are easy to fry.
Oil is often used to prevent sticking to the pan. A small amount of oil for frying is much preferable to boiling and discarding the boil water. ...

Actually it is not the boiling itself which is bad, but the subsequent discard of the water.
If the cook were to retain the water as when making soup or for use when boiling future vegetables the situation is solved, for if they are not allowed to boil dry, there are no losses at all. The boil water can also be used as a beverage. It is especially tasty when derived from mixed vegetables (to my taste buds). This would be a way of augmenting your potassium intake if your family would be willing to grant you more than your fair share of the liquid when pulling out of a deficiency.

If small amounts of water are used in closed pots, known as steaming, the losses should be minimized. .... If the liquid at the bottom of the pot is used, there are no losses at all. Pressure cooking is a form of steam cooking. It is much faster and less likely to run dry. ...

Gravies and drippings consisting of watery material are usually rich in potassium.
You should always make an effort to sop up, spoon up, or drink up the watery liquids on the bottom of your plate or in the pan while attempting to leave the fats behind. If it is impossible to separate them, it is often possible to skim the solid off the top after a sojourn in the refrigerator. Decanting fat off of a tall glass is another possibility. ...

AVERAGE POTASSIUM EATEN
If every one had an average intake of potassium equal to his fair share of the as grown potassium, they would receive about 3,500 milligrams per day [Economic Research Service]. After processing losses and uneaten food is subtracted from the total [Adelson], my best guess is that the average daily intake is about 2,000 milligrams per day. Keep in mind that half the people are eating less than the average. Old people have an intake less than the average [Dall & Gardner] [Dall, et al]. Black people in Georgia average 1,500 milligrams per day, while their white neighbors average 2,000 milligrams [Grim]. I say the above is an unacceptably high loss. Anyone taking a pay cut like that would be very, very unhappy.

You hardly have to wait for the best estimate of an ideal intake.
The human race has been living with virtually these same foods for millions of years.
We must be adapted to the concentrations in food as grown by this time. So the as grown amount should be a minimum to aim for, and I therefore propose it as a recommended daily requirement or RDR or RDA, that is required for optimum health as opposed to minimum daily requirement or MDR, a requirement for bare survival by young healthy adults under no stress. South American Indians receive about seven thousand milligrams per day.

POISONS
You should bear in mind that almost all plant products have mildly toxic materials in them.
Each plant family is usually different from the others. Therefore, it is important to vary your menu.
If you concentrate on one particular plant, you may find yourself in the embarrassing position of the man who turned orange from eating too many tomatoes and carrots, or have a vital food element tied up in the digestive tract as the oxalic acid in spinach and rhubarb is alleged to do to calcium, or much worse to be badly sickened by alkaloids as the poor people in India are sometimes when they eat only a local wild pea during a famine. These toxic substances are only mildly toxic and present in small amounts in cultivated plants so variety should solve the problem satisfactorily for edible plants. You can see which foods belong to which families in order to rotate and maximize the advantage at;
LINK: http://www.mall-net.com/mcs/rotate.html

There are no toxic meats in commerce, so that variety in meat is probably not essential to take care of the above circumstance. Liver is an exception. Eating only liver can produce vitamin A and vitamin D toxicity. It is important that seafood or seaweed be eaten from time to time if you discontinue eating iodized salt or receive no iodide in some kind of supplement. Some seafood has fairly high concentrations of cadmium, mercury, arsenic and poisonous ciguatera, so supplements of iodide are safer. Do not take iodate or elemental iodine though. Iodide may be obtained from
Anbex,inc., 530 Morris Ave., Springfield, NJ, USA., LINK: www.anbex.com

Most fruits and grains are probably largely devoid of poisons or disadvantageous substances.
The custom of many cultures to concentrate on one grain, such as wheat, for instance, is probably not harmful from the circumstance of poison although wheat has a substance which interferes with copper. This lack of poisons is probably the usual case for unstored grain in developed countries. In undeveloped countries, aflatoxins on moldy seeds have been shown to cause liver cancer in animals (“undeveloped countries” is a euphemism for “countries afflicted by tropical disease).

One exception to variety being sufficiently protective may be the solenaceous food of the nightshade family, tomatoes, potatoes, peppers, and eggplants. If they are eaten, be sure to eat only red, ripe, vine ripened tomatoes and baked unsprouted potatoes. It has been demonstrated that baking destroys at least some of the poisons. If green potatoes are eaten raw it is possible to be poisoned badly enough to die.

In summary, I suggest that you take Hunter's advice and select your food only from the outside edges of the supermarkets where the unprocessed vegetables, meats and dairy products are displayed [Hunter BT in an address] until such time as the processed food industry gets its act together and stops destroying nutritional value and putting poisons in the food and lose nothing yourself by boiling it.

You can purchase a book called POTASSIUM NUTRITION, In Heart Disease, Rheumatoid Arthritis, Gout, Diabetes.

It has an extensive discussion about every aspect of potassium nutrition, physiology, and diseases caused by a deficiency or inability to excrete potassium. It is available from
iUniverse, 1663 Liberty Drive, Bloomington, IN 47403.

LINK: http://charles_w.tripod.com/book.html

INTRODUCTION of the BOOK
It is my belief that a pervasive potassium deficiency caused by improper processing of food is causing a large part of the poor health in western civilization, being especially involved in heart disease, rheumatoid arthritis, gout, diabetes, and high blood pressure.

Virtually any textbook in the past would devote no more than a paragraph to potassium which would state that potassium is never deficient in the diet, or give one exception from the dozen or more known ways of loss, or in some only under clinical conditions.

The reason for this careless treatment of potassium is probably because potassium is present in almost all foods as grown in large quantities. Professionals think about it as if it were air or water. However, even air and water can be deficient and if voluminous texts are not written about those deficiencies, it is because both of those deficiencies can be detected by our senses. Extremely powerful emotions and instincts impel people to correct those deficiencies immediately and at any cost. Potassium is odorless, colorless, and, in the usual concentrations, tasteless. There is no way to detect a deficiency and cell content can not even easily be assessed in the body by modern analytical procedures other than whole body scintillation counters. Whole body cell content is virtually "invisible" other than by whole body scintillation counters.

When potassium supplements are prescribed, they get around the discordance between their convictions and practice semantically by calling the supplements "salt substitutes”, "polarizing solutions”, “GIK” (glucose, insulin, potassium) salts. "pharmaceutical affecters”, "ORT salts (oral rehydration therapy for diarrhea)", or similar terms. A deficiency is further defined out of existence by defining the blood serum content is normal at a 4.2 Meq/liter when the actual figure is 4.8 [Scribner].

Psychic stress stimulation of aldosterone, diarrhea (Potassium supplements to babies brought mortality from a virulent strain of diarrhea from 35% to 5% [Darrow] ), profuse perspiration, excessive vomiting, eating sodium carbonate or bicarbonate (because hydrogen ion is excreted at the same site as potassium), laxatives, diuretics, licorice, hyperventilating, enemas, shock from burns or injury, hostile or fearful emotions, and very high or low sodium intakes all increase potassium losses, some massively. All together would probably be lethal in a fairly short time. Reliance on grain (especially white flour) or fatty foods, boiling vegetables, use of chemicals (soft drinks, for instance) instead of food, and use of most processed foods including frozen and canned ... permit considerable reduction of intakes. So does the reduced appetite associated with a sedentary life.

To speak of potassium deficiency as an aberration when enormous numbers of people are affected by these circumstances and our food is so badly damaged is not logical. Even if a serious degenerative disease does not materialize, an adequate intake is desirable to forestall future disasters and to permit one to operate at optimum. Some of the manifestations of the placebo effect become understandable in light of the affect of emotions on electrolyte hormones. However, we cannot always be assured of a placebo being available, certainly not on the firing line, but not even for that matter in the quiet of a hospital where even nurses can be testy at times.

It is especially important that nutrition be established by experiment.
Currently, every one in the medical establishment is convinced that potassium deficiency cannot be involved in rheumatoid arthritis, but this with only one experiment ever having been performed. It simply is not possible to predict the outcome of an experiment with certainty without actually performing it. It would be desirable to determine the affect of every food common in commerce not only on arthritis, but on all the degenerative diseases. Some foods, known to be poisonous to animals or have poisonous related species in the wild, have been used for thousands of years without ever having been tested. This is undoubtedly due to a universal quasi religious conviction or instinct that foods our parents taught us to eat or taste good could not possibly be harmful. This is not necessarily the case. Such experiments could have another advantage in that they might uncover foods that have a beneficial effect. Even small effects would be worth knowing about. The above conviction (or instinct) is so strong that most people will not eat nutritious food if tastier, but less nutritious food is available. Their instincts override their intellect not only in their eating habits, but in their scientific efforts. These scientific efforts are further thwarted from pursuing nutritional investigations because medical science stresses pharmaceuticals and glamour theories [Forman].

Please keep in mind, though, that potassium ramifies through every cell and process in the body, has almost no storage, and has a dangerous dependence on its precise control for nerve impulse transmission. This makes it a mineral to be cautious about. In particular I recommend getting as much as possible from food. Even food requires a little care because it has a wide range of concentrations. You must take responsibility for your own intake ....

CHAPTER 9: Regulation of Potassium by Hormones.
--- Potassium and sodium are regulated by at least four steroid hormones.
ACTH from the pituitary gland in the brain controls these steroids..
Aldosterone is used when potassium intake is high and sodium intake is low.
Deoxycorticosterone is used when potassium intake is high and sodium intake is high.
18hydroxy-doxycorticosterone is used when potassium intake is low and sodium intake is low. ... also regulates acidity.
16alpha-18dihydroxy-deosycorticosterone is used when potassium intake is low and sodium intake is high.

CHAPTER 10: Potassium Physiology
--- Potassium is essential for nerve transmission and to provide cations for the cell.
Symptoms of a potassium deficiency ... include abnormal thirst, inability of kidneys to concentrate fluid, reduction of muscular strength, and reduction of cell alkalinity, Symptoms of a potassium deficiency that are difficult or impossible to reverse are also shown. These include atrophy of the glomerulosa of the adrenals, scarring of the kidneys, destruction of mitochondria, death of heart cells, and increased mortality from stroke. It is proposed that potassium is important for resisting bacterial disease. Rheumatoid arthritis is proposed to be greatly accentuated by potassium deficiency.

The author, Charles Weber, has a degree in chemistry and a masters degree in soil science.
He has researched potassium for 50 years, primarily a library research. He has cured his own early onset arthritis (33 years old). He has published articles on allied subjects in; The Journal of Theoretical Biology (1970, 1983), The Journal of Applied Nutrition (1974), Clinical and Experimental Rheumatology (1983), and Medical Hypotheses (1984, 1999).

It has been found that borax will cure rheumatoid arthritis.
It will also get rid of fluoride in the body. ...

It has been found that supplements of the amino acid, taurine, will restore the abnormal electrocardiogram present during a potassium deficiency by an unknown mechanism. This information has been used in several case histories by George Eby to control a long standing type of cardiac arrhythmia called pre atrial contractions (PACs), a benign but irritating and nerve racking heart problem, with 2.5 grams of taurine with each meal. . Taurine is said to be low in the diets of vegetarians. The 2.5 grams recommended by the American Heart Association causes diarrhea in some people and should probably be reduced in those people. Taurine has been used for high blood pressure, migraine headache, high cholesterol, epilepsy, macular degeneration, Alzheimer’s disease, liver disorders, alcoholism, and cystic fibrosis, and depression. Keep in mind that some people may have a genetic defect that limits the amount of taurine tolerated and that adequate molybdenum may desirable. Also taurine may make a copper deficiency worse based on a single case history, so adequate copper may be necessary [Brien Quirk, private communication].

Article : How can potassium disappear after cooking? INDEX
https://chemistry.stackexchange.com/questions/
5119/how-can-potassium-disappear-after-cooking
by Eric Brown --- May 25, 2013 --- and others.

I read this at this webpage:
LINK: http://www.whfoods.com/genpage.php?dbid=90&tname=nutrient#impactcookingstorageprocessing

How do cooking, storage, or processing affect potassium?

Potassium losses from cooking of high-potassium foods can be significant.
In the case of spinach for example, potassium levels have been shown to drop from 6.9 to 3.0 grams in 3 and 1/2 ounces of spinach after blanching for several minutes (a loss of about 56%).

REPLIES:

... the potassium present in foods will leach out into water when you cook them.
Potassium is present in food in the form of potassium ions (K+).
These K+ ions happen to be extremely soluble in water.

When food is boiled, the cells break down and release their contents more easily which makes the K+ions free to move into the water. The K+ ions remain in the water since they are so highly soluble in it.

This happens to all water-soluble nutrients like the B vitamins, vitamin C, sodium, etc.
Some ways to avoid the loss of all these nutrients would be to steam such foods instead of boiling them since the food wouldn’t come into contact with water.

Side note: The same problem occurs when you deep fry foods containing fat-soluble nutrients like vitamins A and E.
These leach out easily into oil and so all those nutrients would also be lost in the process.

Water does contact food when steamed, otherwise it wouldn't get heated.
Also, the food drips water. You do loose less nutrients since less water comes in contact with the food.

Product: Taking Supplements, Yes, No, Variables. INDEX
https://www.medicinenet.com/potassium_supplements-oral/article.htm
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

LINK 2: https://top10supplements.com/best-potassium-supplements/
Last Updated on November 28th, 2018
Written by Austin Meadows

Potassium preparations are used for supplementing potassium in order to treat or prevent LOW potassium levels in the blood (hypokalemia). There are few or none available for treating HIGH potassium levels. Most literature, especially medical reports, does not address the influence of potassium rich and potassium depleted foods.

Potassium Chloride brand names include:
K-Dur, KLor Con, K-Tab, Klorvess, K-Lyte CL

Side Effects of potassium supplements are those of potassium toxicity:
• weakness,
• fatigue,
• muscle cramps,
• mood changes,
• constipation,
• nausea,
• vomiting,
• diarrhea,
• bloating,
• abdominal pain,
• flatulence and abdominal discomfort,
• abnormal heart beats (arrhythmias), heart attack,
• inflammation of the liver (hepatitis),
• bleeding or perforation of the stomach or small intestine from ulcers, and
• narrowing (stricture) of the small intestine from healed ulcers.

Potassium loss / deficiency can occur through:

• Low potassium diet
• Chronic kidney disease
• Diarrhea
• Diabetic ketoacidosis
• Excessive use of alcohol
• Excessive use of laxatives
• Excessive sweating
• Use of diuretics
• Vomiting
• Antibiotic use
• Pituitary macroadenoma
• Elevated cortisol level
• Heavy metal poisoning
• Depressed hormone levels

Oral potassium is usually taken with meals and fluids to (reduce) intestinal problems.

Pharmaceuticals/Popular

1. NOW Foods Potassium Citrate (99 mg) Capsules
2. Emergen-C Super Orange, 200 mg potassium bicarbonate
3. Nature Made Potassium Gluconate (90 mg)
4. Twinlab Potassium Caps (99 mg potassium citrate & potassium aspartate)
5. Solaray Potassium (99 mg potassium amino acid complex)
6. Solgar Potassium Tablets (99 mg potassium gluconate)
7. Nature’s Bounty Potassium Gluconate (99 mg)
8. NOW Foods Full Spectrum Mineral Caps (50 mg potassium chloride)
9. Jarrow Formulas Bone-Up (99 mg potassium citrate)
10. Country Life Potassium, 99 mg as potassium citrate, potassium amino acid chelate.
    

    
    

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    Product: Table Salt, Windsor. INDEX
    https://www.realcanadiansuperstore.ca/
    Food/Pantry/Herbs%2C-Spices-%26-Sauces/
    Salt-%26-Peppers/Iodized-Table-Salt/p/20126203_EA
    
    

    Ingredients:

    • salt
    • calcium silicate
    • sugar
    • potassium iodide
    
    

    Windsor® Household Salt’s tiny crystals dissolve quickly in liquid, which makes it a good choice in soups, stews, or any meal on a slow simmer.

    It will perk up the flavour of your fresh-brewed coffee, freshen the air in a room, remove wine stains from fabrics, cut rust, and even patch up nail holes.

    Ingredients of various table salts and substitutes are rarely advertised. Check the package, always.

    Cost can vary widely depending upon store, sales, delivery.

    Some varieties of table salt are to be AVOIDED because they contain Aluminum rather than potassium.
    

    
    

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    Product: Iodized Salt, Diamond Crystal Brand. INDEX
    https://www.diamondcrystalsalt.com/product/iodized-salt
    
    

    Ingredients:

    • salt
    • sodium silicoaluminate
    • dextrose
    • potassium iodide
    
    

    Available in small packets for restaurant and fast food use, primarily.

    This is an example of a brand to AVOID as it supplies aluminum which is a toxic metal indicated in chronic illnesses.
    

    
    

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    Product: Foods HIGH in Potassium. INDEX
    https://www.prevention.com/food-nutrition/a20466110/
    13-foods-that-have-more-potassium-than-a-banana/
    By Caroline Praderio --- May 10, 2018

    LINK 2: https://www.myfooddata.com/articles/food-sources-of-potassium.php
    Written by Daisy Whitbread, MScN
    Powered by USDA Nutrition Data
    Last Updated: December 11th, 2018

    
    

    NOTE: YOUR optimum level of potassium for your health and symptoms may change according to your degree of health, your storage of heavy metals and other toxins, your age, and your assimilation and metabolic abilities. Assume that it may change.

    Foods to RAISE your Potassium level, OR,
    to Avoid in order to REDUCE your Potassium level.

    • frozen spinach
    • butternut squash
    • Swiss chard
    • yoghurt
    • lima beans
    • mushrooms
    • kale
    • avocado
    • salmon
    • banana
    • guavas
    • pomegranate
    • edamame
    • cantaloupe
    • cooked tomatoes
    • sweet potatoes
    • apricots
    • carrots
    • russet potatoes
    • halibut
    • dates
    • beets
    • beet greens
    • black or white beans
    • clams
    • cherries
    • mangoes
    • mulberries
    • papayas
    • blackberries
    • zucchini

    
    

    Potassium-rich foods can LOWER your risk of high blood pressure, fatigue, irritability, and hypertension, stroke, and heart disease,
    yet equally can RAISE your health risks if you have LOW blood pressure, no natural teeth, experience chronic pain.

    Signs of toxic potassium blood levels include weakness, paralysis, chronic pain, nausea, vomiting, and heart palpitations.

    Those with chronic kidney disease (CKD) are usually best to lower their potassium.
    

    
    

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    Product: Foods LOW in Potassium. INDEX
    https://www.webmd.com/food-recipes/low-potassium-diet-foods#1

    LINK 2: https://healthyeating.sfgate.com/menu-low-potassium-foods-1688.html
    Written by Paula Martinac --- Updated December 02, 2018

    LINK 3: https://dailynaturalremedies.com/11-foods-low-in-potassium/

    
    

    NOTE: YOUR optimum level of potaasium for your health and symptoms may change according to your degree of health, your storage of heavy metals and other toxins, your age, and your assimilation and metabolic abilities. Assume that it may change.

    Foods to LOWER your Potassium level, OR,
    to Avoid in order to RAISE your Potassium level.

    • apples
    • blueberries
    • raspberries
    • lemon
    • celery
    • lettuce
    • cucumber
    • cabbage
    • raw mushrooms
    • cooked carrots
    • coffee
    • cornmeal
    • bread
    • cake
    • plums
    • pears
    • noodles
    • pasta
    • pies
    • tea
    • rice
    • potatoes (soaked for 2 hours before cooking)

    
    

    Signs of toxic potassium blood levels include weakness, paralysis, chronic pain, nausea, vomiting, and heart palpitations.

    Those with chronic kidney disease (CKD) are usually best to lower their potassium.
    

    
    

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    Product: INDEX
    

    
    

    
    

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    Product: INDEX
    

    
    

    
    

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    LINKS from Lenntech, and others. INDEX
    http://www.lenntech.com/

    LINK 2: http://rmalab.com/sites/default/files/tests/instructions/20140107_CI_UrineElement.pdf
    Rocky Mountain Labs Clinical Info report for Professionals, 2014-01-07
    An assessment of the benefits and limitations of various test protocols.

    
    

    INDEX
    

    LINK to INDEX page (offline)

    LINK to Empower, Maintain, & Repair YOUR Health

    
    

    Articles on the Internet are transitory. The publishers may remove them, change sites, change URLs, or change titles. For the purpose of maintaining an availability of these articles for myself and you, I have reprinted parts in the relevant monographs with authorship maintained, coding simplified for error-free loading and minimal file size, and a LINK to the original document. Identity trackers and advertising bots have been removed from the original bloated and manipulative coding. NOTHING in writing is absolute; don't treat human opinion, projection, and observation as an Idol. Doing so can kill you, or worse, have you impose abuse on others. I gathered and researched this data, mediated with the Grace of God through prayer as a benefit in my integrating discovered available digital information which would acquaint me with the overall content related to the health issues. I have found that God is ALWAYS available when we are Reverent in our Asking, open-minded in our Listening, and, Assertive in our Choice of Action. Doctors did not expect me to survive birth. In the past 25 years, medical and health "experts" have cautioned or directed me, more than 14 times, that I had little time left to live, or would die ... because THEY did not understand my challenges, were not motivated to professionally diagnose, or, chose to superstitiously recall as absolute previously flawed training. I am still alive beyond age 70. With the assistance of God, my Personality, the research and a lack of dismissiveness of a number of persons ... I have found resolution to numerous health challenges. This has enabled me to assist many others who had been abandoned, brainwashed, or traumatized. May my experience and successes also empower you. This is one document which you may find helpful as a BASIC introduction to maintaining and improving YOUR health.