Arrhythmias (Heart Rhythm Disturbances) and Potassium

Diuretic drugs in the thiazide family tend to deplete the body of the minerals potassium and magnesium. People using such drugs are usually advised to take potassium supplements because potassium deficiency can cause arrhythmias.

In addition to the deficiency issue, it is probably healthy to take in at least five times as much potassium as sodium (and perhaps 50 to 100 times as much). However, the standard American diet contains twice as much sodium as potassium. Therefore, taking extra potassium may be a good idea in order to balance the sodium we consume to such excess.

The most common use of potassium supplements is to make up for potassium depletion caused by diuretic drugs. By depleting the body of potassium, some diuretics can cause or worsen arrythmias.

Potassium is one of the major electrolytes in your body, along with sodium and chloride. Potassium and sodium work together like a molecular seesaw: when the level of one goes up, the other goes down. All together, these three dissolved minerals play an intimate chemical role in every function of your body.

Read more details about Potassium.

Evidence suggests that potassium supplements may be most effective for people who eat too much salt.¹³

When used by physicians, potassium is usually measured according to meqs (milliequivalents) rather than the more common mg (milligrams). A typical therapeutic dosage of potassium is between 10 and 20 meq, taken 3 to 4 times daily.

Potassium is an essential mineral that we get from many common foods. Bananas, orange juice, potatoes, avocados, lima beans, cantaloupes, peaches, tomatoes, flounder, salmon, and cod all contain more than 300 mg of potassium per serving. Other good sources include chicken, meat, and various other fruits, vegetables, and fish.

Over-the-counter potassium supplements typically contain 99 mg of potassium per tablet. There is some evidence that, of the different forms of potassium supplements, potassium citrate may be most helpful for those with high blood pressure.¹

Research indicates that it is important to get enough magnesium, too, when you are taking potassium.^2,3,4 It might be wise to take extra vitamin B12 as well.⁵

• Integrative MD
• Naturopathic doctor
• Clinical nutritionist or registered dietitian

Safety Issues

As an essential nutrient, potassium is safe when taken at appropriate dosages. If you take a bit too much, your body will simply excrete it in the urine. However, people who have severe kidney disease cannot excrete potassium normally and should consult a physician before taking a potassium supplement. Similarly, individuals taking potassium-sparing diuretics (such as spironolactone), ACE inhibitors (such as captopril), ^{1 2 3 4} or trimethoprim/sulfamethoxazole ⁵ should also not take potassium supplements except under doctor supervision.

Potassium pills can cause injury to the esophagus if they get stuck on the way down, so make sure to take them with plenty of water.

Interactions You Should Know About

If you are taking:

• Loop diuretics or thiazide diuretics : You may need more potassium.

• ACE inhibitors (eg, captopril , lisinopril , enalapril ), potassium-sparing diuretics (eg, triamterene or spironolactone ), or trimethoprim/sulfamethoxazole : You should not take potassium except on the advice of a physician.

• Potassium: You may need extra magnesium and vitamin B 12 .

1. Stoltz ML, Andrews CE Jr. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA. 264(21):2737-8.
2. Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA. 274(7):538.
3. Warren SE, O'Conner DT. Hyperkalemia resulting from captopril administration. JAMA. 1980;244:2551-2552.
4. Grossman A, Eckland D, Price P, Edwards CR. Captopril: reversible renal failure with severe hyperkalaemia. Lancet. 1(8170):712.
5. Alappan R, Perazella MA, Buller GK. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med. 124(3):316-20.

1. Overlack A, Maus B, Ruppert M, et al. Potassium citrate versus potassium chloride in essential hypertension. Effects on hemodynamic, hormonal and metabolic parameters [in German; English abstract]. Dtsch Med Wochenschr. 1995;120:631-635.
2. Saito N, Kuchiba A. The changes of magnesium under high salt diets and by administration of antihypertensive diuretics. Magnes Bull. 1987;9:53.
3. Dorup I, Skajaa K, Thybo NK. Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium-potassium pumps in skeletal muscle of patients receiving diuretic treatment. J Intern Med. 1993;233:117-123.
4. Whang R, Whang DD, Ryan MP. Refractory potassium repletion: a consequence of magnesium deficiency (Review Article). Arch Intern Med. 1992;152:40-45.
5. Drug Evaluation Annual. Vol 3. Milwaukee, WI: American Medical Association; 1993.
13. Whelton PK, Buring J, Borhani NO, et al. The effect of potassium supplementation in persons with a high-normal blood pressure. Results from phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOPH) Collaborative Research Group. Ann Epidemiol. 1995;5:85-95.