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For dialysis patients, managing potassium intake is crucial for heart health. Excess potassium, often from high-potassium foods like bananas, can lead to life-threatening conditions such as hyperkalemia. This document discusses the physiological mechanisms of potassium secretion and reabsorption in the kidneys, specifically involving the cortical collecting duct principal cells and intercalated cells. Key factors influencing potassium levels include dietary potassium, plasma potassium, aldosterone, and flow rates of tubular fluid. It’s vital for patients to understand how their diet impacts their overall health and potassium balance.
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Doc: So you understand about your potassium intake? Dialysis Patient: Yeah, if I eat too many bananas my heart stops!
N a Cortical Collecting Duct Principal Cell Regulated Potassium Secretion Tubular Fluid Na+ K+ K+ Interstitial Fluid
N a Cortical Collecting Duct Intercalated Cell Regulated Potassium Reabsorption K+ ATP H+ ? K+ Interstitial Fluid
Factors which Influence K Secretion • Dietary Potassium and Plasma Potassium • Aldosterone • Flow Rate of the Tubular Fluid • ADH • Acid-Base Balance
Na+ K+ CCD Principal Cell K+ K+ N a 1 2 Potassium Secretion: Effects of Plasma K+ and Dietary K+ High K+ diet Potassium Secretion (mEq/day) Normal diet 3 4 5 6 7 8 PK(mEq/L)
K+ Adenal Cortex Aldosterone + FEK
-Vte Na+ Na+ Late Phase AR N N a a Early Aldosterone Increases Potassium Secretion Tubular Fluid K+ R A K+ Interstitial Fluid
K+ Na+ Physiological Range K+ CCD Principal Cell K+ K+ N a Potassium Secretion: Effects of Tubular Fluid Flow Rate High K+ diet Normal diet Potassium Secretion (mEq/day) Low K+ diet 0 10 20 30 40 50 Distal Flow Rate(nl/min)
Na+ ADH N a ADH Increases Apical Potassium Channels Tubular Fluid K+ Principal Cell K+ V2 Interstitial Fluid
Na+ K+ CCD Principal Cell K+ K+ N a 1 2 Potassium Secretion: Acute pH Effects Alkalosis, pH 7.5 Normal, pH 7.4 Potassium Secretion (mEq/day) Acidosis, pH 7.2 3 4 5 6 7 8 PK(mEq/L)
Loop Diuretics ECV Distal K delivery Distal Flow Aldo Distal K Secretion K Excretion
N a 25y/o Male with Liddle Syndrome, a Familial “Salt-Sensitive” Hypertension At Dx: BP 170/110 , PNa 140 mEq/l, PK 2.5 mEq/l , Low Renin/Aldosterone Vte- Na+ Tubular Fluid R K+