Potassium-magnesium citrate versus potassium chloride in thiazide-induced hypokalemia

• Published in: Kidney international Vol. 57; no. 2; pp. 607 - 612
• Main Authors: Wuermser, Lisa-Ann, Reilly, Christopher, Poindexter, John R., Sakhaee, Khashayar, Pak, Charles Y.C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2000; Nature Publishing; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Citrates - administration & dosage; Citrates - adverse effects; Citrates - urine; diuretic therapy; Diuretics; Double-Blind Method; Drug Combinations; Female; Humans; Hydrochlorothiazide - adverse effects; Hydrogen-Ion Concentration; hypercalciuric nephrolithiasis; hypokalemia; Hypokalemia - chemically induced; Hypokalemia - drug therapy; Hypokalemia - urine; hypomagnesemia; Kidney Calculi - chemically induced; Magnesium - blood; Magnesium Compounds - administration & dosage; Magnesium Compounds - adverse effects; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Potassium Chloride - administration & dosage; Potassium Chloride - adverse effects; Potassium Compounds - administration & dosage; Potassium Compounds - adverse effects; Sodium Chloride Symporter Inhibitors - adverse effects; Urinary system; hypomagnesemia; hypokalemia; hypercalciuric nephrolithiasis; diuretic therapy; Diuretic; Human; Metabolic disorder; Hydroelectrolytic balance disorder; Chemotherapy; Potassium compound; Chlorine ion; Complication; Thiazine derivatives; Hypokaliemia; Magnesium; Inorganic element
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.2000.00881.x

Potassium-magnesium citrate versus potassium chloride in thiazide-induced hypokalemia. The purpose of this study was to compare the value of potassium-magnesium citrate (KMgCit) with potassium chloride in overcoming thiazide-induced hypokalemia. Sixty normal subjects first took hydrochlorothiazide (HCTZ; 50 mg/day). After three weeks of treatment (or earlier if hypokalemia developed), they were randomized to take KMgCit (42 mEq K, 21 mEq Mg, and 63 mEq citrate/day) or potassium chloride (42 mEq/day) for three weeks while continuing on HCTZ. KMgCit significantly increased the serum potassium concentration from 3.42 ± 0.30 mEq/L on HCTZ alone to about 3.8 mEq/L (P < 0.001). Potassium chloride produced a similar increase in serum potassium concentration from 3.45 ± 0.44 mEq/L to about 3.8 mEq/L (P < 0.001). KMgCit significantly increased the serum magnesium concentration by 0.11 to 0.12 mEq/L (P < 0.01), whereas potassium chloride produced a marginal decline or no significant change. KMgCit was less effective than potassium chloride in correcting HCTZ-induced hypochloridemia and hyperbicarbonatemia. KMgCit, but not potassium chloride, significantly increased urinarypH (by about 0.6 unit), citrate (by about 260 mg/day), and urinary magnesium. KMgCit is equally effective as potassium chloride in correcting thiazide-induced hypokalemia. In addition, KMgCit, but not potassium chloride, produces a small but significant increase in serum magnesium concentration by delivering a magnesium load, and it confers alkalinizing and citraturic actions.