Potassium and arrhythmias

I had 3 ablations, pacemaker, watchman, weekly hospital stays etc for my arrhythmias and yet potassium supplement at exactly 4.5 levels is what is keeping my heart calm.

8-17-22 on vacation, I got covid and according to my pacemaker the past 52 days from the last download, I had 486 or so episodes. Every day. Two were high (atrium hr) 303 and 306 hr for up to 6.5 or 8 minutes before my pacemaker converted it. That’s when I felt really under duress.

I had a EP colleague referral from dr Natale here where I’m “vacationing” and he figured it out. Genius. He said I need to keep my potassium at 4.5 and get frequent labs. My cardiologist at home suggested 4.0 but there was never any labs to follow up. 4.0 wasn’t my magic number. Now I know 4.5 is.

While still in the hospital on potassium dosages to maintain K levels to 4.5, my heart is finally calm. Finally. Not even one PAC. Heaven. (My “heaven” standards are low, heaven is getting a shower after 4 days here in the ward and my multiple ward mates not screaming all night) But my heart is calm and I’m above ground. Heaven.

I can’t turn back the clock, nor be a Monday morning quarterback, but it is something I do think of - if I could had any dr suggest K since 2004, maybe my heart wouldn’t be so crispy BBQ fragile and I could had avoided my pacemaker and the weekly hospital stays.

I am very pleased that you are doing so much better, and I hope you continue to find relief this way.

I’m discharged after 6 days! Actually excellent medical staff patching me up and changing my cardizem doses. Calm heart today.

Hi Susan - Great news! So pleased to see you have relief.

When you get settled, here's a link to a post from a while back ... "Let's Not Forget About Potassium" that I offered after learning that I was low in potassium... and it did make a huge difference in my
events once I consistently kept the levels in range....

Hope you can now relax and enjoy your visit with your relatives.

Best to you,
Jackie

Scroll down thru the posts until the second from the last.

[www.afibbers.org]

That's great Susan.

This is an excellent time release K. Easy on my GI. With Lasix my K dropped to 3.0 so they gave me this and I was discharged two days stable at 4.5. Fast absorbing liquid. They gave me a 200ml bottle to take home. It’s a shame I can’t find a GI friendly K at home.

[iasispharma.com]

So glad to hear, Susan! / Thanks for the link to your article, Jackie.

Thank you Susan and Jackie and everyone for underlining potassium. I think it was an important missing piece for me.

Good luck Susan and let us know how things are are 4.5 going forward!

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susan.d
He said I need to keep my potassium at 4.5 and get frequent labs. My cardiologist at home suggested 4.0 but there was never any labs to follow up. 4.0 wasn’t my magic number. Now I know 4.5 is.

At the ER during my first (known) afib, my serum K was 3.1. 18 years hence, I don't recall all the details, but I recall that what I wanted was serum K >= 4.5 on a fasting test and around 4.8 or 4.9 five or six hours after consuming supplements (this seemed to be the consensus of those here at the time). This is before I understood that potassium should be consumed over the day (or timed release). I asked my then GP to give me a script for hourly blood draws for serum potassium. He gave it but I never followed through as I would have had to camp out overnight at the hospital lab, as they were the only ones open in the wee hours. At some point, Jackie (same one who posted above) suggested that it is best to get magnesium levels in order first, then potassium. I did an EXA test (intracellular mineral analysis from a cheek swab that has been tested against heart cell data gathered from those undergoing a heart procedure). It showed low levels of magnesium. I posted the data here for potassium & calcium also, but those data got lost in a redo of the system long ago by Hans (the founder). Hence I did focus on magnesium & added potassium to go with it. I used to travel with a container of potassium chloride and found that it would set off a TSA scanner. I then put the container out, so they wouldn't have to search my bag. Potassium chloride is hard on the gut for many people. I later determined that potassium citrate did not bother my gut and had a bonus in that I'd previously had kidney stones and the citrate was prescribed to prevent them (other people liked potassium gluconate or bicarbonate). I've had serum potassium tests around 3.9 without issue, but I still go for a value of 4.5. Today, I also tend to fast much longer before tests (16 or more hours) as that is now my eating pattern, this may be why the levels are lower on my tests. I usually put 2 tsp of potassium citrate (about 4 g of potassium) powder in a liter of water and drink over the day.

Though I never got one, a number of people here got an agricultural potassium meter ("Cardymeter") to measure saliva potassium. The folks with periodic paralysis (from changes in serum potassium levels) had correlated salvia readings to serum. I haven't looked at their website in years. There was a conference room session on using the meters. [www.afibbers.org] I know both Shannon and Carey were two of the people here with one of these meters. I think the real time feedback was helpful for some of them. I'm not sure if the new meters work as well for this purpose.

{edit anyone supplementing with electrolytes should have good kidney function, otherwise they can build up in the serum and be harmful}



Edited 3 time(s). Last edit at 10/22/2022 10:36PM by GeorgeN.

Excellent reminder post, George... and thanks for the important notation to focus first on optimizing the IC magnesium levels. That made a huge difference for me back then and I continue to follow those protocols today. My heart remains calm. (Last Natale touch-up ablation for a-flutter in 2015. )
So many things influence both electrolytes, we can't afford not to remain 'vigilant.'

Be well,
Jackie

Quote
GeorgeN
I know both Shannon and Carey were two of the people here with one of these meters. I think the real time feedback was helpful for some of them. I'm not sure if the new meters work as well for this purpose.

If by "new meters" you mean the meters currently available from Horiba, yes, they work better than the (now ancient) Cardymeters. They were selected by NASA for use on the space station for creating IV fluids in space (something we'll have to do if we're going to Mars), and I personally validated the meter against Quest Diagnostics lab results 5 times and got matching results all 5 times. I used it successfully for two years on a daily basis taking what is considered dangerously high doses of potassium.

I saw a post somewhere a few years ago by some Cardymeter advocate declaring the Horiba meter to be completely unreliable, and the only thing I found unreliable was his baseless opinion. They work just fine IF you follow directions precisely, IF you treat it like the lab instrument it is, and IF you do the translation from saliva levels to serum levels correctly. It's not hard at all, but it does require discipline. I see reviewers on Amazon whining that you have to calibrate it every time. Duh? It's a lab instrument. Of course you have to calibrate it! Calibrating it takes about 30 seconds. Testing a sample takes another 30 seconds, and the results will match any lab results if done correctly. So yes, you can obtain real-time potassium levels within a minute or two as many times as you like.

That said, I don't recommend it for the vast majority of people. It's not going to help most people, and potassium supplementation is potentially dangerous.

Quote
GeorgeN
Jackie (same one who posted above) suggested that it is best to get magnesium levels in order first, then potassium.

What should the magnesium to potassium ratio be?

Potassium is one of the body’s essential nutrients for healthy function; and, fortunately, it’s also one that is easily obtained through food sources…. Typically raw fruits and veggies. If tempted to supplement instead of food sources, then it’s critically important to have regular lab tests to evaluate potassium levels..and even that may not be enough to help prevent the consequences of too much supplemental potassium. It’s best to be aware of all you need to know about getting potassium from food.

When I began my AF ‘career,’ one of the articles I read referenced a book on potassium… titled,
Everything You Always Wanted to Know About POTASSIUM but Were Too TIRED to Ask….
By Betty Kamen, PhD (Copyright 1992).

One point was relevant to my situation in that Hypoglycemia was reviewed. In part… (p. 150 …”Potassium is depleted by low blood sugar because of over-activity of insulin. This sugar–regulating hormone drives sugar into cells but uses up potassium in the process. Thus, a latent potassium deficiency can become symptomatic under the influence of insulin-stimulating foods, such as sweets.”

In short, the impact of hypoglycemia is to deplete potassium and, thus, permit increased cellular sodium and calcium – which can cause muscle spasm in muscles of the blood vessels that contract during migraines. Potassium supplementation (by food) is an important part of the dietary treatment of low blood sugar, with or without headache. (My issue was hypoglycemia…not headaches.)

While this book is almost an antique… it contains an abundance of tips on how to ensure proper levels of potassium while avoiding the many adverse effects of too much potassium. Example - Since cooking destroys potassium (especially vegetables), eating fresh, raw foods like a banana which is high potassium should be eaten along with something high fiber. Fiber helps to normalize the blood sugar response.

There is a handy section with a food table for Na/K content.

In the chapter on Understanding Potassium, there is a list of 48 Potassium-Deficiency Associated Disorders. Including: EKG alterations, enlarged heart, arrhythmia, increased heart rate, low blood sugar, intolerance to cardiac drugs, headaches, hypertension, rapid pulse, suppressed immune system…and more. (page 22).

Jackie

Quote
Daisy
Jackie (same one who posted above) suggested that it is best to get magnesium levels in order first, then potassium.

What should the magnesium to potassium ratio be?

I'm guessing very individual. I have an absurdly high magnesium tolerance, if others (at least most) took the quantity of magnesium I take, they'd be on the toilet all day. I've asked a number of docs, including doc friends if they have a clue why mine is so high, none do. What I suggest is to gradually increase magnesium intake till your stools get a little loose, then back off just a bit. This is then a good level that is specific to you. At least in my case, the form of the magnesium does not seem to make a difference. As long as I consume enough, it is fine. I've taken every form I'm aware of, including some where I react magnesium hydroxide (which is in milk of magnesia) with chilled carbonated water to make magnesium bicarbonate water and with organic apple cider vinegar to make magnesium acetate.

I also have a very high magnesium tolerance and need to take about 1200 mg of mag citrate daily to avoid constipation. I have a good diet and also take one 99mg capsule of potassium citrate daily. My potassium is usually 4.4 - 4.5 but I just wondered if there are other factors to consider since I take so much magnesium?

Daisy - Those ratios may be highly dependent upon the individual's need for replenishing the Mg, the K or both. There are general range/guidelines that are considered 'typical' for the average person... but even that can be so highly variable it's undoubtedly very difficult, if not impossible, to give a 'one size fits all' recommendation especially when heavy exercise is involved.

George is a perfect example of extremely high repletion demands on muscle cells due to his intense exercise. Suffice to say, he's successfully managing his own unique demands for nutrients that support intense utilization and then replenishment of all that the muscle, nerve tissue, etc requires to function at that high exertional level.
(Remember, the heart is a muscle.)

And, when measuring the intracellular electrolyte levels, (via ExaTest), there also should be test results showing kidney function to determine if the amount of the electrolyte consumed actually gets absorbed and metabolized into the target tissue... so it's complicated.

Jackie

Quote
Daisy
I also have a very high magnesium tolerance and need to take about 1200 mg of mag citrate daily to avoid constipation. I have a good diet and also take one 99mg capsule of potassium citrate daily. My potassium is usually 4.4 - 4.5 but I just wondered if there are other factors to consider since I take so much magnesium?

Your potassium levels are good, so no need to adjust in my opinion. The recommended intake of potassium is 4500 mg /day, 99 mg is a small amount.

Yeah, I kind of doubt that 99 mg/day of potassium is actually even doing anything. That's less potassium than a small glass of orange juice. Might want to consider substituting cheaper, tastier OJ, or a dozen other cheaper, tastier things. Do you like kiwi fruit? Kiwi has 215 mg of potassium per fruit.

That crazy intensive K I’m taking rose my K to 5. So I’m holding it. I didn’t even take my K for 24 hours before the labs to get an accurate result and with Lasix it was 5. . I’m still on Lasix and only taking 6mg a day of K. When I fly home I’m hoping Natale will advise and redo the labs. But K is helping. Instead of 2-10 episodes a day, my heart is quiet. Just long enough I hope for tomorrow’s night flight.

Would anyone like to comment on this supplement? Keto K1000 is a powder with Calcium from calcium lactate (75 mg 6%dv). Magnesium from magnesium citrate (120mg 30% dv), chloride from sea salt 15 mg less than 1 %dv), sodium from sea salt 10 mg (less than 1% dv), potassium from potatssium citrate 1,000 mg (21% dv), trace mineral complex 100 mg.

Does this seem like a reasonable way to supplement potassium? One serving is a scoop that contains the above, in 16 ounces of water. No more than 3 scoops per day.

Thanks so much for any thoughts---

I used this product and thought it was a good choice for supplementing. I limited myself to 2 scoops/ day sipped throughout the day. I latter switched to Dr Berg’s electrolyte powder; same basic ingredients but tasted and mixed better. Sold in larger container and also in individual travel packs; I like it. I limit my self to 2k of potassium/ day from supplements to be conservative.

Thanks so much, that is very helpful

Potassium is probably the easiest way to f around and find out.

[jamanetwork.com]

A 32-year-old medical secretary became hypokalemic after she had begun taking a liquid protein diet. She was given slow-release potassium chloride for this, and subsequently used the medication indiscriminately whenever she felt weak or tired. One evening diarrhea developed; she said she had taken "a lot of potassium pills." She was told that the diarrhea probably resulted from potassium chloride, to take no more pills, and that the diarrhea would probably remove the excess potassium. She was found dead the next morning.

Quote
PavanPharter
Potassium is probably the easiest way to f around and find out.

[jamanetwork.com]

A 32-year-old medical secretary became hypokalemic after she had begun taking a liquid protein diet. She was given slow-release potassium chloride for this, and subsequently used the medication indiscriminately whenever she felt weak or tired. One evening diarrhea developed; she said she had taken "a lot of potassium pills." She was told that the diarrhea probably resulted from potassium chloride, to take no more pills, and that the diarrhea would probably remove the excess potassium. She was found dead the next morning.

Omg! I had a k lab on Sunday (actually Saturday in the USA) and my k was 5.0. It was supposed to be 4.5. The urgent care didn’t exam me (charged me) nor give me any advice. I only went for the lab. So I held (7 doses) my twice a day K until today in the USA and took one 1/3 dose just once to calm my heart’s tachycardia blips I’ve been getting. I figured Lasix would drop my k and I needed something. I feel dreadful. I hope I don’t end up like that lady. No diarrhea.

I’m not taking this “intense treatment k” anymore. It ramps up two quickly one’s k… but today I feel really off. It could had been the 16+ hour flight but I don’t know. Thank goodness I see Natale tomorrow and will ask his advice and get a K lab. Or I could go to the ER. My pacemaker is vibrating today. The CT said The EP while on vacation tweaked the settings and raised it to 480 voltage to decrease the long QTc I had from sotalol.

[pubmed.ncbi.nlm.nih.gov]

[pubmed.ncbi.nlm.nih.gov]

Another study:

QT Interval Prolongation
The QTc interval is the best prognostic ECG parameter in LQTS families. A QTc interval of at least 470 milliseconds is a predictor for increased risk for symptoms, whereas a QTc of at least 500 milliseconds predicts an increased risk of life-threatening cardiac events. The risk for cardiac events demonstrates a nearly exponential increase for the QTc interval decile. The maximal QTc duration measured at any time before age 10 was shown to be the most powerful predictor of cardiac events during adolescence, regardless of baseline, mean, or most recent QTc values.23,26

Quote
susan.d

Omg! I had a k lab on Sunday (actually Saturday in the USA) and my k was 5.0. It was supposed to be 4.5.

Above 6.0 is where it gets dangerous. [www.mayoclinic.org].



Edited 1 time(s). Last edit at 10/27/2022 07:56AM by GeorgeN.

There was a time I would have killed to have a K+ level of 5.0. That would have guaranteed NSR for me, but my body just doesn't want to be that high. My natural level if I do nothing is about 3.6, right at the minimum of the normal range. Everybody has their natural "normal" and changing that with any sort of dependability is quite difficult. Also potentially dangerous if you don't know with certainty that you have normal kidney function and aren't taking any potassium-retaining drugs (the list includes several common BP meds).

K around 4.5 does keep my heart calm with zero pacs, or any blips of any stray beats. It’s just hard to maintain that level. I suppose I could get weekly blood drawn. But k levels for my body is so variable jumping as low as 3.0 with Lasix to my last lab of 5.0 with Lasix within 9 days of daily hospital testing after starting intensive K therapy. So how often should I get tested? After my 2.75 labeled syringe dose of liquid K yesterday (instead of the rx for 6 on the syringe) I felt the worst I ever felt. But I had a calm heart. Last night I held the evening K dose and I returned to very short seconds to 2-3 minutes of tachycardia but felt less chest hard vibrating beats. My pacemaker has captured 303 and a 306 heart rate episodes which are so unpleasant when instantly my pacemaker drops it low with pacing accompanying a rush of symptomatic dropping of HR. It’s the chest vibration that’s the worst. My assigned pulmonologist stated I have “ dyspnea”. I think it’s the constant 90.4% pacing from the higher voltage settings that the dyspnea is diagnosed. I can feel the constant uncomfortable vibrations.