Potassium-rich Foods Research Articles

Potassium-rich diet and risk of stroke: Updated meta-analysis

Recently a few prospective population studies provided additional and heterogeneous information concerning the reported statistical associations between potassium (K) intake and stroke risk. Therefore, we updated our previous meta-analysis of K intake and risk of cerebrovascular events.Three studies were added to the previous analysis, and the results of the comparison between the event rate in the two extreme categories of K intake were used. Pooled analysis of 14 cohorts (overall 333,250 participants and 10,659 events) showed an inverse and significant association between K intake and risk of stroke (Relative Risk: 0.80; 95% CI: 0.72–0.90).Our results indicated a favorable effect of higher K intake on risk of stroke. These results confirm the appropriateness of worldwide recommendations for a population increased consumption of potassium-rich foods to prevent cardiovascular disease.

Muscle Disease

On the basis of strong research evidence, Duchenne muscular dystrophy (DMD), the most common severe childhood form of muscular dystrophy, is an X-linked recessive disorder caused by out-of-frame mutations of the dystrophin gene. Thus, it is classified asa dystrophinopathy. The disease onset is before age 5 years. Patients with DMD present with progressive symmetrical limb-girdle muscle weakness and become wheelchair dependent after age 12 years. (2)(3). On the basis of some research evidence,cardiomyopathy and congestive heart failure are usually seen in the late teens in patients with DMD. Progressive scoliosis and respiratory in sufficiency often develop once wheelchair dependency occurs. Respiratory failure and cardiomyopathy are common causes of death, and few survive beyond the third decade of life. (2)(3)(4)(5)(6)(7). On the basis of some research evidence, prednisone at 0.75 mg/kg daily (maximum dose, 40 mg/d) or deflazacort at 0.9 mg/kg daily (maximum dose, 39 mg/d), a derivative of prednisolone (not available in the United States), as a single morning dose is recommended for DMD patients older than 5 years, which may prolong independent walking from a few months to 2 years. (2)(3)(16)(17). Based on some research evidence, treatment with angiotensin-converting enzyme inhibitors, b-blockers, and diuretics has been reported to be beneficial in DMD patients with cardiac abnormalities. (2)(3)(5)(18). Based on expert opinion, children with muscle weakness and increased serum creatine kinase levels may be associated with either genetic or acquired muscle disorders (Tables 1 and 3). (14)(15)

Potassium Intake, Stroke, and Cardiovascular Disease: A Meta-Analysis of Prospective Studies

The objective of this study was to assess the relation between the level of habitual potassium intake and the incidence of cardiovascular disease (CVD).Prospective cohort studies have evaluated the relationship between habitual potassium intake and incidence of vascular disease, but their results have not been not entirely consistent.We performed a systematic search for prospective studies published, without language restrictions (1966 to December 2009). Criteria for inclusion were prospective adult population study, assessment of baseline potassium intake, assessment of vascular events as outcome, and follow-up of at least 4 years. For each study, relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using a random-effect model, weighted for the inverse of the variance. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.Eleven studies were identified, providing 15 cohort samples that included 247,510 male and female participants (follow-up 5 to 19 years), 7,066 strokes, 3,058 coronary heart disease (CHD) events, and 2,497 total CVD events. Potassium intake was assessed by 24-h dietary recall (n = 2), food frequency questionnaire (n = 6), or 24-h urinary excretion (n = 3). In the pooled analysis, a 1.64-g (42 mmol) per day higher potassium intake was associated with a 21% lower risk of stroke (RR: 0.79; 95% CI: 0.68 to 0.90; p = 0.0007), with a trend toward lower risk of CHD and total CVD that attained statistical significance after the exclusion of a single cohort, based on sensitivity analysis (RR: 0.93; 95% CI: 0.87 to 0.99; p = 0.03 and RR: 0.74; 95% CI: 0.60 to 0.91; p = 0.0037).Higher dietary potassium intake is associated with lower rates of stroke and might also reduce the risk of CHD and total CVD. These results support recommendations for higher consumption of potassium-rich foods to prevent vascular diseases.

Oral potassium supplementation in surgical patients

Hospital inpatients are frequently hypokalaemic. Low plasma potassium levels may cause life threatening complications, such as cardiac arrhythmias. Potassium supplementation may be administered parenterally or enterally. Oral potassium supplements have been associated with oesophageal ulceration, strictures and gastritis. An alternative to potassium salt tablets or solution is dietary modification with potassium rich food stuffs, which has been proven to be a safe and effective method for potassium supplementation. The potassium content of one medium banana is equivalent to a 12 mmol potassium salt tablet. Potassium supplementation by dietary modification has been shown to be equally efficacious to oral potassium salt supplementation and is preferred by the majority of patients. Subsequently, it is our practice to replace potassium using dietary modification, particularly in surgical patients having undergone oesophagogastrectomy or in those with peptic ulcer disease.

Contribution of Dairy Products to Dietary Potassium Intake in the United States Population

Objective: Adequate dietary potassium intake is associated with a reduced risk of cardiovascular and other chronic diseases. The Dietary Guidelines for Americans 2005 identifies milk and milk products as a major contributor of dietary potassium and lists dairy products, along with fruits and vegetables, as food groups to encourage. This paper further examines the impact of dairy consumption on the potassium intake of the United States (US) population.Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2002 we determined potassium intakes for various age groups of individuals who met the recommended number of dairy servings compared to those who did not. We also examined the impact of dairy servings consumed on mean and median potassium intakes and compared intakes to the age-appropriate Adequate Intakes (AI).Results: For all age groups, mean and median potassium intakes did not meet the respective AI. Mean potassium intakes were significantly greater in those subjects who met dairy intake recommendations compared to those who did not for all age groups. Mean and median potassium intakes increased with increasing dairy intake but were below current intake recommendations for all age groups analyzed. For adults age 19 to 50, 16.1% consumed the recommended number of dairy servings per day. For those 51 and older, 10.7% met current dairy intake recommendations.Conclusions: Consumption of dairy products is below current recommendations which contributes in part to suboptimal dietary potassium intakes among a large proportion of the US population. Since adequate potassium intake is associated with decreased risk of chronic disease, consumption of a variety of potassium-rich foods, including fruits, vegetables and low-fat and fat free dairy products, should continue to be encouraged.

Primary periodic paralyses

To review the current knowledge about primary periodic paralyses (PPs). Periodic paralyses are a heterogeneous group of disorders, clinically characterized by episodes of flaccid muscle weakness, occurring at irregular intervals. PPs are divided into primary (hereditary) and secondary (acquired) forms of which the secondary PPs are much more common than the primary PPs. Primary PPs are due to mutations in genes encoding for subunits of channel proteins of the skeletal muscle membrane, such as the muscular sodium, potassium or calcium channels, or the SCL4A1 protein. Primary PPs include entities such as hyperkalemic PP, hypokalemic PP, paramyotonia congenita von Eulenburg, Andersen's syndrome, thyrotoxic PP, distal renal tubular acidosis, X-linked episodic muscle weakness syndrome and congenital myasthenic syndromes. Attacks of weakness or myotonia may be triggered or enhanced by vigorous exercise, cold, potassium-rich food, emotional stress, drugs such as glucocorticosteroids, insulin or diuretics, or pregnancy. Depending on the pathomechanism, episodes of weakness may respond to mild exercise, ingestion of potassium, carbohydrates, salbutamol, calcium gluconate, thiazide diuretics, carboanhydrase inhibitors, such as acetazolamide or dichlorphenamine, and episodes may be prevented by avoidance of potassium-rich food, or drugs, which increase serum potassium. This review presents and discusses current knowledge and recent advances in the etiology, molecular genetics, genotype-phenotype correlations, pathogenesis, diagnosis and treatment of primary PPs.

Warm-up phenomenon in myotonia associated with the V445M sodium channel mutation

Sirs: Myotonia is a clinical phenomenon consisting of uncontrolled temporary muscle stiffness after voluntary or evoked muscle contractions [1]. It is a cardinal symptom in non-dystrophic myotonias, including chloride and sodium channelopathies. Myotonia typically occurs after a period of rest and decreases with continuing exercise, commonly referred to as the warm-up phenomenon. This is in contrast with what occurs in paradoxical myotonia, where muscle stiffness increases as a result of continuing exercise. The warm-up phenomenon is an established clinical feature in chloride channelopathies, both in recessive myotonia congenita (Becker’s disease) as well as in dominant myotonia congenita (Thomsen’s disease). It has also been shown to occur in limb muscles of patients with a sodium channelopathy [1, 4]. By contrast, paradoxical myotonia has been established by others as the characteristic feature of sodium channel myotonias [3]. Thus, unlike the phenotypic homogeneity of chloride channelopathies, sodium channel mutations are associated with a broad spectrum of clinical phenotypes [5]. Here we report three patients with a predominant and generalised warm-up phenomenon associated with the V445M missense mutation of the SCN4A gene encoding the alpha-subunit of the voltage gated sodium channel. Three patients, from two families, with an autosomal dominant non-dystrophic myotonia and a predominant warm-up phenomenon were referred to our clinic. All patients had complaints of generalised muscle stiffness since birth and had earlier been diagnosed as Thomsen’s disease, but recent chloride channel gene (CLCN1) mutation screening was negative. Clinical myotonia was generalised, severe and painful. All patients noticed aggravation of myotonia at cold temperatures and only one patient reported aggravation after eating potassium rich food. They all used sodium channel blockers (mexiletine 200 mg three times a day, procainamide 1000 mg three times a day and quinine 200 mg three times a day respectively) with a good subjective effect. Needle EMG of all patients revealed myotonic discharges in all muscles investigated (left biceps muscle, right first interosseus muscle, right rectus femoris muscle, left tibialis anterior muscle and left orbicularis oculi muscle). We measured the warm-up phenomenon in three different muscle groups during a drug free period. The warm-up phenomenon of eyelid muscles and right hand flexor muscles was quantified by measuring the difference between two relaxation times - timed with a stopwatch - , i.e. after maximum voluntary contraction of three seconds following ten minutes of rest and after ten successive contractions. For leg muscles we compared the first and tenth trial on a ‘chair test’ in which the time required to rise from a standardised chair, to move around it and to sit down again was measured. DNA extracted from 20 ml of blood was screened for mutations in SCN4A by direct nucleotide sequence analysis. All patients showed a marked generalised warm-up phenomenon (Table 1). Direct nucleotide sequence analysis of all three patients showed the same missense mutation (c.1333G>A; p.V445M) in SCN4A. Table 1 Clinical relaxation times (in seconds) of three patients after the first (1st) and tenth (10th) maximum voluntary contraction of eyelid muscles (eyes), right hand flexor muscles (hand) and leg muscles (legs) The V445M sodium channel mutation was first reported by Rosenfeld et al. causing a painful myotonia congenita [4]. The warm-up phenomenon was mentioned in one patient. Here we report three patients with a predominant and generalised (eyelid muscles, right hand flexor muscles and leg muscles) warm-up phenomenon in association with the same V445M sodium channel mutation. Although quantitative computer analysis for the warm-up phenomenon of a single muscle group has already been developed, we used clinical tests in order to be able to measure this phenomenon in three various muscle groups [2]. For a definite molecular diagnosis clinicians should be aware that a predominant and generalised warm-up phenomenon may be found in chloride channelopathies but also in sodium channelopathies. A definite diagnosis is important for informing patients about their disease, orienting therapy and genetic counselling [5]. Thus, in patients with severe, painful myotonia in combination with a clear warm-up phenomenon, we recommend screening of SCN4A with particular attention for the V445M mutation.

Hyperkalemia and hyperdopaminemia induced by an obsessive eating of banana in an anorexia nervosa adolescent

Banana is known as a dopamine-rich and potassium-rich food, however no previous data regarding biochemical or psychological alteration induced by excess intake of banana has been reported. We have experienced an adolescent female case of Anorexia nervosa (AN) who denied eating anything but maximum 20 bananas and less than 500 ml mineral water per day for more than two years. During the period of massive banana eating habit, she showed increase of serum potassium (from 4.7 mEq/l to 6.1 mEq/l) and whole blood dopamine (from 11 ng/ml to 210 ng/ml; normal range 0.5–6.2 ng/ml), and obvious dysthymia that is inexplicable only by the pathology of AN. When the patient resumed other food ingestion after 26 months of obsessive and restricted eating of banana, the abnormalities in her blood data and her psychological state were all corrected toward normal. We conclude that in this case, the obsessive and restricted habit of banana ingestion resulted in hyperkalemia, hyperdopaminemia, and psychological change.

The Evolution-Informed Optimal Dietary Potassium Intake of Human Beings Greatly Exceeds Current and Recommended Intakes

An organism best fits the environment described by its genes, an environment that prevailed during the time period (millions of years) when evolution naturally selected the genes of its ancestors-those who survived to pass on their genes. When an organism's current environment differs from its ancestral one, the environment's mismatch with the organism's genome may result in functional disadvantages for the organism. The genetically conditioned nutritional requirements of human beings established themselves over millions of years in which ancestral hominins, living as hunter-gatherers, ate a diet markedly different from that of agriculturally dependent contemporary human beings. In that context, we sought to quantify the ancestral-contemporary dietary difference with respect to the supply of one of the body's major mineral nutrients: potassium. In 159 retrojected Stone Age diets, human potassium intake averaged 400 +/- 125 mEq/d, which exceeds current and recommended intakes by more than a factor of 4. We accounted for the transition to the relatively potassium-poor modern diet by the fact that the modern diet has substantially replaced Stone Age amounts of potassium-rich plant foods (especially fruits, leafy greens, vegetable fruits, roots, and tubers), with energy-dense nutrient-poor foods (separated fats, oils, refined sugars, and refined grains), and with potassium-poor energy-rich plant foods (especially cereal grains) introduced by agriculture (circa 10,000 years ago). Given the fundamental physiologic importance of potassium, such a large magnitude of change in potassium intake invites the consideration in human beings of whether the quantitative values of potassium-influenced physiologic phenomena (eg, blood pressure, insulin and aldosterone secretion rates, and intracellular pH) currently viewed as normal, in fact disaccord with genetically conditioned norms. We discuss the potential implications of our findings in respect to human health and disease.

Low-carbohydrate, high-protein diets that restrict potassium-rich fruits and vegetables promote calciuria

In a recent issue of Osteoporosis International, Carter et al. reported that subjects adhering to a ketogenic, lowcarbohydrate/high-protein (LCHP) diet for weight loss did not display increased bone turnover markers after 3 months compared to control subjects consuming a typical, unrestricted diet [1]. In this trial, weight loss averaged 6.4 kg versus 1.1 kg in the dieters and controls respectively (p=0.0008), whereas the mean urinary N-telopeptide increased by 1.6 versus 1.9 nmol BCE/mmol creatinine in the dieters and controls, respectively (p=0.86). Although this trial supports the view that high-protein diets do not adversely affect bone [2, 3], the dietary level of alkalizing minerals was not considered. High-protein diets generate excessive amounts of acid due to the obligatory catabolism of sulfur amino acids, and bone may respond by releasing basic salts into the circulation [4]. Hence, if high-protein intakes are not accompanied by an adequate intake of alkalizing minerals, which have a neutralizing effect in vivo, bone health may be adversely affected [4–6]. Here we discuss unpublished data regarding acid/base metabolism from our recent trial comparing ketogenic and nonketogenic LCHP diets [7]. In this trial, 19 adults (body mass index: 34.4T1.0 kg/m) were randomly assigned to a ketogenic LCHP diet (k-LCHP; 60% of energy as fat; 5% energy as carbohydrate) or to a nonketogenic LCHP diet (n-LCHP; 30% of energy as fat; 40% of energy as carbohydrate). The n-LCHP diet was composed mainly of low-fat dairy products, fruits and vegetables, and low-fat meats, whereas the k-LCHP diet consisted primarily of high-fat meats and some vegetables. The diets were similar in protein content (~20 g/mJ), but daily intakes of potassium (1,935 versus 3,535 mg) and calcium (715 versus 1,110 mg) were markedly different for the k-LCHP versus n-LCHP diets. Blood and urine samples were collected at baseline and at week 2. Weight loss, blood ketone concentrations and anion gap values, and urinary calcium concentrations at baseline and week 2 are shown in Table 1. The blood anion gap, the interval between the sum of blood cations and blood anions, is a direct indication of the acidity of blood. For comparison, Table 1 also displays values for urine calcium calculated from predictive equations based on the dietary protein:potassium ratio [8, 9]. These data indicate that n-LCHP diets are associated with lower acid loads and lower rates of calcium excretion as compared to k-LCHP diets. Moreover, anion gap values and urinary calcium were highly correlated (r=0.542, p=0.016). Since the predicted calciuria was similar to actual values, it would appear that potassium-rich foods favorably influence acid/base metabolism and reduce calciuria. Alexy et al. [10] have presented longitudinal evidence that inadequate intakes of alkalizing minerals from fruits and vegetables may adversely impact bone health. Also, based on data from Lewis et al. [11], the calcium-rich Osteoporos Int (2006) 17:1820–1821 DOI 10.1007/s00198-006-0214-y

Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients

Cardiac surgery patients are commonly treated with diuretics, which can result in hypokalemia requiring potassium supplementation. Our objective was to determine whether cardiac surgery patients receiving therapy with potassium-wasting diuretics can safely and beneficially maintain serum potassium levels by eating potassium-rich foods. A prospectively randomized trial of diet vs medication supplementation of potassium was undertaken. Patients who were to undergo cardiac surgery and who would be receiving therapy with oral furosemide postoperatively were eligible for the study. Forty-eight patients were enrolled in the trial, and 38 patients completed the study. Patients received either potassium-rich foods (diet) or potassium chloride pills (medication). There was no significant difference in mean (+/- SD) serum potassium concentrations between groups preoperatively (4.25 +/- 0.30 vs 4.29 +/- 0.33 mEq/L, respectively), on postoperative day 3 (4.23 +/- 0.40 vs 4.27 +/- 0.40 mEq/L, respectively), or postoperative day 4 (4.23 +/- 0.48 vs 4.24 +/- 0.33 mEq/L, respectively) for the diet and medication groups. Length of stay was significantly lower in the diet group (5.0 +/- 0.9 vs 6.3 +/- 2.2 days, respectively). When asked their preferences for method of supplementation, 79% of patients preferred the diet method. Cardiac surgery patients receiving therapy with diuretics can maintain serum potassium levels at clinically adequate concentrations by eating potassium-rich foods. Length of stay was significantly reduced. This method of potassium supplementation demonstrates the potential for reduced costs and increased patient satisfaction.

Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men.

Animal experiments and epidemiological studies have suggested that high potassium intake may reduce the risk of stroke, but the evidence is inconclusive, and the role of other nutrients in potassium-rich foods remains unknown. We examined the association of potassium and related nutrients with risk of stroke among 43 738 US men, 40 to 75 years old, without diagnosed cardiovascular diseases or diabetes, who completed a semiquantitative food frequency questionnaire in 1986. During 8 years of follow-up, 328 strokes (210 ischemic, 70 hemorrhagic, 48 unspecified) were documented. The multivariate relative risk of stroke of any type for men in the top fifth of potassium intake (median intake, 4.3 g/d) versus those in the bottom (median, 2.4 g/d) was 0.62 (95% CI, 0.43, 0.88; P for trend=0.007). Results for ischemic stroke alone were similar. Intakes of cereal fiber and magnesium, but not of calcium, were also inversely associated with risk of total stroke. These inverse associations were all stronger in hypertensive than normotensive men and were not materially altered by adjustment for blood pressure levels. Use of potassium supplements was also inversely related to risk of stroke, particularly among men taking diuretics (relative risk, 0.36; 95% CI, 0.18, 0.72). Although these data do not prove a causal relationship, they are consistent with the hypothesis that diets rich in potassium, magnesium, and cereal fiber reduce the risk of stroke, particularly among hypertensive men. Potassium supplements may also be beneficial, but because of potential risks, use should be carefully monitored and restricted to men taking potassium-losing diuretics.

Potassium supplements and potassium-sparing diuretics. A review and guide to appropriate use.

Epidemiological and clinical studies suggest that low dietary potassium intake may have an important role in determining the development of diseases such as hypertension, and perhaps even stomach cancer, and that increased potassium intake may have beneficial effects in several other conditions. Dietary adjustment or active potassium supplementation has been suggested as a natural, less costly and safe method of increasing potassium levels, although active supplementation with tablets or solutions is not recommended in healthy people with normal serum potassium levels. However, increasing dietary potassium intake in the elderly and in patients with renal impairment must be considered with caution. Diuretics have a long established role in the management of hypertension and heart failure. There is no convincing evidence to suggest that the small reduction in plasma potassium levels associated with low dose thiazide and loop diuretic therapy needs to be routinely prevented by the use of potassium-sparing drugs. In non-digitalised patients little association has been found between mild diuretic-induced hypokalaemia and arrhythmias. Thus, the routine prophylactic use of potassium-sparing diuretics in combination with non-potassium-retaining diuretics for the treatment of hypertension and oedematous states is not justified. Based on current evidence, treating all patients whose serum potassium level decreases below 3 mmol/L is recommended, although for certain patients at particular risk of hypokalaemia, levels may need to be maintained above 3.5 mmol/L. In overt hypokalaemia, several therapeutic options are available to the clinician. These include increased consumption of potassium-rich foods, the use of salt substitutes, medicinal potassium supplementation or distal tubular (potassium-sparing) diuretics.

Chloride and potassium-rich foods

Chloride and potassium-rich foods

The efficacy of a potassium-rich diet compared to diuretic treatment on the renal elimination of thallium in the rat

The influence of potassium retaining diuretic agents (K-canrenoate and triamterene) on the renal elimination of orally ingested thallium (48.9 μmol = 10 mg/kg) in rats proved negligible, whereas in earlier studies we had demonstrated that furosemide significantly enhances the elimination of thallium from the body via the renal route. We could not establish a relationship between the elimination of potassium and thallium on the one hand and between the thalliuresis and the urine production under the influence of diuretic drugs on the other hand. In connection with our interest in the interaction between thallium and alkali-ions like potassium and sodium we also studied the influence of a sodiumrich and a potassium-rich diet on the rate of thallium elimination from the rat's body. When the animals were fed a potassium-rich diet, the amount of thallium excreted in 1 week was increased from 21% of the ingested dose (controls) to 57%. This considerable increase in thallium elimination was not further enhanced by simultaneous treatment with the most potent diuretic furosemide. In the present animal model the treatment with potassium-rich food (approximately 40 mmol KCl · kg−1 · day−1) is superior to the administration of furosemide, with respect to the acceleration of thallium elimination from the body. A sodium-rich diet, however, did not increase the rate of renal elimination of thallium and even inhibited the effect of furosemide in this respect. The mechanism underlying the influence of potassium and sodium on the renal elimination of thallium remains obscure. The relative and absolute amounts of sodium and potassium present in the diet might be of importance with respect to the explanation of species differences observed in the sensitivity towards the effects of thallium and also in the therapy of thallotoxicosis.

Overview: Salt and the development of essential hypertension

There is ample evidence suggesting that excess salt ingestion is involved in the pathogenesis of essential hypertension. In man the evidence is indirect; in the laboratory animal the evidence is direct and unequivocal. Of particular significance are the experimental findings indicating that the youngest animals are those most susceptible to salt-induced hypertension and that even relatively brief periods of exposure to a high salt diet in early life can result in permanent hypertension. The public health implications of such data warrant attention in light of current practices of early introduction of salted baby foods, which expose the infant to many times its need for sodium and serve no nutritional purpose. Salt intake by adults in this country averages 10 g per day. The daily requirement is less than 0.5 g, an amount that is adequately supplied by a diet of naturally unsalted foods. Higher intakes among groups of people correlate with higher prevalence rates of hypertension in what could be interpreted as a dose-response relationship. Hereditary predisposition combined with excessive salt consumption may be the common means by which essential hypertension develops. In Westernized societies, higher sodium intake tends to accompany lesser use of the potassium-rich foods. The resultant dietary disproportion of high-sodium: low-potassium may have even greater clinical importance for the development of hypertension than that of the sodium ion alone.

Potassium, acetazolamide, and intraocular pressure.

The effect of long-term administration of acetazolamide on the potassium balance of 15 glaucoma patients was studied. Average duration of treatment was two years. No total body potassium depletion was noted; serum potassium was below normal in one case (3.1 mEq/liter). Administration of potassium chloride (average dose, 58 mEq daily) did not cause a lowering of intraocular pressure; nor did it appear to alter potassium balance. Patients receiving long-term treatment with acetazolamide were unable to excrete concentrated urine (serum osmolarity per urine osmolarity ratio of 1:2.3 after an 18-hour fast). Three of 15 patients developed urinary tract disease. Patients on long-term acetazolamide therapy rarely need supplemental potassium. Where advisable, it is best provided by a diet high in potassium-rich foods, as enteric-coated preparations may cause small-bowel ulceration.

Jiu-Jitsu Methods of Resuscitation

<h3>Abstract</h3> <h3>Background</h3> Sodium intakes of different populations around the world became of interest after a positive correlation was drawn between dietary sodium intake and prevalence of hypertension. Sri Lanka has adopted a salt reduction strategy to combat high blood pressure in the population with escalation of non-communicable diseases. <h3>Objective</h3> To measure intake of salt, potassium and sodium/potassium ratio of adults in urban and rural settings. <h3>Design</h3> A community based study of 328 adults between 30-59 years, including equal numbers from urban and rural sectors. Weight, height and waist circumference were measured. Blood pressure was measured by a standardized automated measurement system and the mean of two readings was used for analysis. 24-hour urine was collected and measured for creatinine, sodium, potassium levels. <h3>Results</h3> Mean daily salt consumption was 8.3g (95%CI:7.9,8.8), which is 1.6 times higher than WHO recommendation. Mean daily potassium intake was 1,265g (95%CI:1191.0,1339.3), which is 2.8 times lower and sodium/potassium ratio was 4.3 (95%CI:4.2,4.5), which is 7 times higher than WHO recommendation. Daily salt consumption was significantly higher in males (9.0g;95%CI:8.3,9.8) than females (7.7g;95%CI:7.2,8.2); rural (8.9g;95%CI:8.2-9.6,) than urban (7.7g;95%CI:7.2,8.3) with increasing body mass index (8.2g;95%CI:6.1,10.2 to 10.0g;95%CI:8.5,11.6). Systolic blood pressure was significantly positively correlated with high BMI and waist circumference. <h3>Conclusions</h3> High salt consumption, low potassium intake and high sodium/potassium ratio was found in this population. This information can be used to set targets to reduce salt intake in the population. Need to create awareness to enhance the consumption of potassium rich food while reducing salt intake to minimize future NCD burden.