Hyperkalemic changes during spironolactone therapy for cirrhosis and ascites, with special reference to hyperkalemic intermittent paralysis.

Abstract

AbstractThe frequency and clinical significance of the hyperkalemia associated with spironolactone therapy was studied by analyzing 755 serum potassium values obtained on 29 patients with cirrhosis and ascites. The patients were classified as follows: 1) control group treated intermittently with combinations of conventional diuretics; and 2) spironolactone groups—(A) patients treated with spironolactone alone, and (B and C) nonazotemic and slightly azotemic patients, respectively, treated with spironolactone plus diuretics.Hyperkalemia was indicated in 3.3 per cent of 302 control serum potassium determinations, and in 48 per cent of 325 determinations made during spironolactone treatment. The increase in serum potassium concentration was more marked in the slightly azotemic group, although the initial levels were no higher than in the other groups of patients. Hyperkalemic intermittent paralysis associated with spironolactone therapy occurred in 5 patients. Studies of the urinary excretory patterns suggested a distal as well as a proximal tubular site of action of spironolactone. The significance of the tubular levels of spironolactone action in the development of hyperkalemia is discussed.