Salt is essential to life. In some instances, however, salt retention becomes a problem. The swelling of the ankles during menstruation is a common example of salt retention. Very serious problems with salt retention occur in heart failure, high blood pressure, liver and kidney diseases. In these conditions, the body actively strives to retain the salt. As a result of this effort, another mineral, potassium, is often lost by the body.Usually, salt retention and potassium loss takes place in the kidneys. In individuals with an ileostomy, however, additional sodium retention and potassium loss occurs from the bowel.
Recently, Drs. Clark, Hill, and Macbeths, writing in the medical journal Gastroenterology, documented the phenomenon of sodium retention and potassium loss in an individual with an ileostomy. This information is important when medication is given to reduce swelling of the ankles or to treat high blood pressure. The most common medication used for these purposes is the thiazide-type diuretic (water pills). These medications work by causing the kidneys to lose sodium.
Water is lost in conjunction with the sodium. In addition, these diuretics also produce potassium loss. Thus the ileostomate, who is already losing potassium in the ileostomy effluent, will lose more potassium from the kidney and perhaps an additional amount from the bowel leading to depletion of the body's potassium stores.
Potassium is needed in all cells of the body so its deficiency results in loss of muscle strength. Individuals develop weakness, muscle cramps, and other problems with muscle coordination. Continuous potassium depletion may result in palpitations of the heart and serious kidney difficulties. Potassium levels may be measured in the blood. In addition, an electrocardiogram might give useful information about the potassium content in heart cells.
Although this admonition does not hold true in all instances, ileostomates should alert their physicians that the common diurectics used may produce excessive potassium loss with the difficulties described above. Two are available which do not have this potassium-losing effect and tend to help the body retain potassium. They are spironaolactone (aldactone-A) and triamterence (cyrenium). These diurectics are less powerful than the more commonly used "water pills" but, if necessary, may be used in conjunction with them to diminish the potassium loss.
Methods to replace the body's store of potassium are the use of diet and medications. Bananas, cantaloupe, and tea are among the foods rich in potassium. Thus, as is usually the case, prevention of potassium depletion is most important. Prompt administration of potassium during diarrhea and avoidance of strong diuretic medications are excellent ways to prevent potassium loss. Often1 more rapid repletion is required than can be achieved with oral therapy. Intravenous administration of potassium is required with hospitalization and close watching. Food is usually not enough to replace potassium lost by diarrhea or from diuretic therapy and potassium-containing medication is needed. Enteric coated tablets should not used. Liquid is preferred for ileostomates which may, in itself, produce diarrhea. Caution is advised. (People with ileoanal pouches suffer the same potassium loss as ileostomates.)
via Ottawa Ostomy News
and Regina Ostomy News, Mar/Apr 2002 |
