UPPER GASTROINTESTINAL LESIONS AFTER POTASSIUM CHLORIDE SUPPLEMENTS: A CONTROLLED CLINICAL TRIAL

doi:10.1016/S0140-6736(82)90002-2

The Lancet

Volume 320, Issue 8307, 13 November 1982, Pages 1059-1061

https://doi.org/10.1016/S0140-6736(82)90002-2 Get rights and content

Abstract

The effects of a new microencapsulated potassium chloride formulation on upper gastrointestinal tract mucosa was compared with that of a popular wax-matrix formulation in 48 healthy volunteers. After a week of KCl, subjects were gastroscoped, the endoscopist being blind to the type of preparation taken. Wax-matrix formulations were associated with a higher incidence of upper gastrointestinal lesions. The lesions were not accompanied by epigastric symptoms. Glycopyrrolate, given to some volunteers to decrease gastric emptying, aggravated the effects of potassium chloride.

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There are more references available in the full text version of this article.

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Citation Excerpt :
Acute toxicity from extremely high potassium intake as supplements in healthy adults was evaluated (WHO, 2012b). McMahon et al. (1982) examined 48 healthy young men ingesting 3.7 g potassium/day for seven days in the form of wax-matrix formulations or microencapsulated formulations. The wax-matrix formulations resulted in considerable mucosal pathology, with erosions, gastric ulcers, inflammatory lesions and bleeding as evaluated by endoscopy, whereas the microencapsulated formulations resulted in significantly fewer effects.
High sodium chloride (NaCl) intake is associated with health risks. NaCl may be replaced by potassium chloride (KCl) to decrease sodium intake. However, increased potassium may also have negative health effects. We conducted a benefit and risk assessment of increasing potassium by ratios of 30:70, 50:50, 70:30 (weight % K⁺: weight % Na⁺) in children, adolescents and adults in Norway, using intake data from national food consumption surveys and available literature on potassium health effects. An intake of at least 3.5 g/day of potassium decreases risk of stroke and hypertension, and this level was used in the benefit assessment of the healthy population. Three g/day of potassium added to mean food intake is assumed safe, and these levels were used in the risk assessment. Not all persons reached the protective level of potassium, and increasing numbers exceeded the safe levels, in these scenarios. In addition, elderly above 85 years and infants below one year of age, as well as several patient groups and medication users, are particularly vulnerable to hyperkalemia. In conclusion, the number of Norwegians facing increased risk is far greater than the number likely to benefit from this replacement of sodium with potassium in industrially produced food.
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Pill-induced esophageal injury is a well described clinical entity. In contrast, pill-induced gastric injury has not been well characterized. In this report, we describe two patients with acute gastric ulcers due to pill ingestion and review the available literature on pill-induced gastric injury. The first patient presented with upper gastrointestinal hemorrhage and was found to have a large gastric ulcer with multiple potassium chloride pills in the ulcer crater. The second patient presented with odynophagia and endoscopy revealed doxycycline-induced esophageal and gastric injury. To our knowledge, this is the first case report of doxycycline-induced gastric ulcer.
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1993, Gastroenterology
Background: It is not widely appreciated that nonsteroidal anti-inflammatory drugs (NSAIDs) may cause damage distal to the duodenum. We reviewed the adverse effects of NSAIDs on the large and small intestine, the clinical implications and pathogenesis. Methods: A systematic search was made through Medline and Embase to identify possible adverse effects of NSAIDs on the large and small intestine. Results: Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation). NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems. The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials. Conclusions: The adverse effects of NSAIDs distal to the duodenum represent a range of pathologies that may be asymptomatic, but some are life threatening.
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1991, Journal of Urology
The effect of meals on the physiological and physicochemical actions of potassium citrate was examined in 8 patients with nephrolithiasis maintained on a constant metabolic dietary regimen. Potassium citrate (20 mEq. 3 times per day), whether given with food or on an empty stomach, significantly increased urinary pH, citrate and potassium, and decreased urinary calcium and ammonium. Moreover, potassium citrate decreased urinary saturation of calcium oxalate and uric acid, although it slightly increased that of brushite. However, there was no significant difference in these measures when the drug was given with meals from the time when it was given on an empty stomach. Thus, the effect of potassium citrate on urinary risk factors is unaffected by food.

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UPPER GASTROINTESTINAL LESIONS AFTER POTASSIUM CHLORIDE SUPPLEMENTS: A CONTROLLED CLINICAL TRIAL

Abstract

Gastric ulcerations after Slow-K

N Engl J Med

Gut lesions due to slow-release KCl tablets

N Engl J Med

Chlorure de potassium et ulceres non specifiques de l'intestin grele

Schweiz Med Wochenschr

Mouth ulceration and slow-release potassium tablets

Br Med J