Low Potassium Levels Caused by Fluid Pills are Dangerous and Easily Avoided
Low potassium levels are present in twenty percent of hospitalized patients. (Potassium under 3.6) This is an extremely important fact. Patients with low potassium levels are ten times more likely to die in the hospital. More people die because low potassium makes cardiac arrest much more likely. It also increases the number of patients who develop atrial fibrillation which is becoming more common. Low potassium levels are most commonly caused by treatment with fluid pills. Half the patients on diuretics with low potassium also have a magnesium deficiency.
These facts have very practical implications for treatment. The most common cause of low potassium levels is medical treatment with fluid pills. I recently spoke with a patient who developed atrial fibrillation because she had a low potassium level related to a fluid pill which she was taking for high blood pressure. Fluid pill treatment has very broad effects. It does lower the pressure, but it does it by reducing the amount of sodium in the body. It does nothing to address the root cause of high blood pressure. We have medications available now that do interfere with the root causes of high blood pressure. It is not best practice to give fluid pills alone. Losartan/hydrochlorothiazide is a combination pill that costs $4 at Walmart. By using that drug in small doses, catastrophes due to low potassium levels can be avoided. Hydrochlorothiazide leads to lower potassium. Losartan leads to higher potassium. When combined, potassium levels are much more likely to be just right. If the blood pressure is not very high to begin with, half a tablet may be enough. Unlike the fluid pills, losartan blocks a hormone that is a root cause of high blood pressure. Losartan makes the artery more normal. It reduces artery thickness and helps the artery expand more normally. These are the kind of considerations that make optimal medical treatment optimal. Please sign up for a free subscription for more information like this.