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17
17 Introduction to Potassium
467
The Fluid, Electrolyte and Acid-Base Companion
K
+
K
K+
+
K+ K
+
+
K
K +
BUN
Na+ Cl– glucose
+
K
K+ HCO3– Cr
K+
+
K+
K
+
K
Potassium is the final electrolyte which will be covered in this book. Some
of the major differences between sodium and potassium are outlined below:
Sodium Potassium
• Primary extracellular cation. • Primary intracellular cation.
• Alterations in sodium concentra- • Alterations in potassium concen-
tion affect the osmotic movement tration result in electrical signals
of water in and out of cells. Most that interrupt normal cardiac
clinical symptoms are related to rhythm, muscle activity and nerve
cerebral edema or dehydration. conduction.
Medical Latin:
• Hypokalemia: low plasma potassium,+ K < 3.5 mEq/L.
• Eukalemia: normal plasma potassium, 3.5 <+ <K 5.0 mEq/L.
• Hyperkalemia: increased plasma potassium,+ >K5.0 mEq/L.
• Kaluresis: loss of potassium in the urine.
468
S. Faubel and J. Topf 17 Introduction to Potassium
+
K
K +
K
+
+
K
2 K+
intracellular 3 Na+
Total intracellular
potassium is
(28 L × 140 mEq/L).
3,920 mEq
intracellular compartment
K+ =140 mEq/L
The two central aspects of potassium physiology which must al- aaa
ways be considered are:
• The vast majority of potassium is ___________. intracellular
• Small changes in the extracellular _________ concentra- potassium
tion can have dramatic clinical consequences.
469
The Fluid, Electrolyte and Acid-Base Companion
K+
+
K
K +
K+
The body has both an immediate and a long-term strategy to regulate the
plasma potassium concentration. Cellular buffering is the immediate de-
fense against a change in plasma potassium, while the kidneys control long-
term potassium balance.
Cells secrete potassium when plasma potassium falls; cells absorb potas-
sium when plasma potassium rises. The secretion and absorption of potas-
sium by cells is referred to as buffering. The kidneys affect long-term potas-
sium balance through the excretion and resorption of potassium.
Cellular control of potassium movement is influenced by:
• catecholamines • cellular synthesis
• insulin • cellular destruction
• plasma pH • plasma potassium
Renal potassium regulation is governed by:
• plasma potassium • flow in the distal nephron
• aldosterone
An understanding of these systems is necessary to comprehend the disor-
ders which cause hypokalemia and hyperkalemia. The remainder of this
chapter reviews the important concepts in intracellular and renal regula-
tion of plasma potassium.
470
S. Faubel and J. Topf 17 Introduction to Potassium
K+ K +
2 K+ 3 Na+
ATP
AMP
The ________ pump moves potassium into the cell and sodium Na-K-ATPase
out of the cell. It is responsible for maintaining low _______ and sodium
high ________concentrations within the cell. potassium
471
The Fluid, Electrolyte and Acid-Base Companion
catecholamines
K+ K +
ß-2 receptor
2 K+
ATP
AMP
3 Na+
472
S. Faubel and J. Topf 17 Introduction to Potassium
insulin
K+ K +
insulin
receptor
2 K+
ATP
Insulin causes the _______ of glucose and potassium into cells. movement
473
The Fluid, Electrolyte and Acid-Base Companion
K+
K+
Acidosis Alkalosis
High plasma hydrogen concentration causes Low plasma hydrogen concentration causes
the cellular uptake of hydrogen and the excre- the cellular release of hydrogen and the resorp-
tion of potassium. tion of potassium.
Think: potassium and pH always Think: aLKalosis Think: potassium and hydrogen
move in opposite directions. concentration walk together.
Low K+
pH causes potassium hydrogen causes potassium
474
S. Faubel and J. Topf 17 Introduction to Potassium
+
K K +
140 mEq/L
140 mEq/L
+
K
+
K
Acute increases in cell number are uncommon but can occur dur-
ing the treatment of megaloblastic anemia with _______ or B-12. folate
475
The Fluid, Electrolyte and Acid-Base Companion
K +
K
+
K+
K+
+
K
476
S. Faubel and J. Topf 17 Introduction to Potassium
K+
gradients into the tubule.
low potassium high potassium
477
The Fluid, Electrolyte and Acid-Base Companion
ALDOSTERONE
+
K
+
K
K+ +
K
+
K
Plasma potassium K+
Nonresorbable anions
PO4 3 A-
K
+
+
K
+
K
HCO3
K
+
K+
478
S. Faubel and J. Topf 17 Introduction to Potassium
479
The Fluid, Electrolyte and Acid-Base Companion
+
K
The positively charged potas-
4 sium flows down chemical K+
and electrical gradients into
the tubule.
480
S. Faubel and J. Topf 17 Introduction to Potassium
K +
+
K
K+
+
K
+
K
+
K
Increased flow of fluid quickly washes away se- Increased delivery of sodium increases sodium
creted potassium to maintain the concentration resorption to enhance the electrical gradient.
gradient.
When the flow rate in the distal nephron is increased, it enhances both
the chemical and electrical gradients for potassium secretion. Increased distal
flow refers to the increased delivery of water and sodium to the distal neph-
ron.
Increased distal flow enhances the chemical gradient by quickly washing
away any secreted potassium. This prevents the accumulation of potassium
in the tubule which would decrease the chemical gradient.
Increased delivery of sodium to the distal nephron increases sodium re-
sorption and enhances the electrical gradient, favoring potassium excre-
tion.
481
The Fluid, Electrolyte and Acid-Base Companion
Na+ Na+
A-
HCO3
Cl–
Cl– HCO3
Cl– Cl–
K+
+
K
The electrical gradient normally draws _________ into the tubule. potassium
482
S. Faubel and J. Topf 17 Introduction to Potassium
SummaryIntroduction to potassium.
Potassium is the primary intracel- The important factors which influ-
lular ion. 99% of total body potassium ence the Na-K-ATPase pump are
is located in cells. Movement of 1% of beta-2 receptor activity, insulin and
the cellular potassium to the extra- pH.
cellular compartment can cause car- Epinephrine and beta-2 selective
diac arrhythmias. drugs (e.g., albuterol) stimulate the
Na-K-ATPase pumps and can lower
+
K
plasma potassium. Beta-blockers
potassium = (e.g., metoprolol, propranolol) have
4 mEq/L
K
+
the opposite effect.
+
K
2 K+
potassium =
140 mEq/L ATP AMP ß-2
3 Na+
ATP
K+
K+
+
K insulin
receptor
K+
K +
ATP
Cellular redistribution is con- K+
ATP H+
K+
AMP
483
The Fluid, Electrolyte and Acid-Base Companion
SummaryIntroduction to potassium.
Cell lysis releases potassium into Plasma potassium concentration is
the plasma and can cause hyperkale- an important factor in the kidney’s
mia. handling of potassium. Increased lev-
els stimulate potassium excretion
while low levels trigger potassium
retention.
140 mEq/L
+
K
+
K
ALDOSTERONE
484