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Wednesday, May 20, 2009

Another reason to skip the soda: Potassium depletion

Supporters of the recent Senate Finance Committee proposal to tax sugary drinks may want to arm themselves with the findings of a new study on soda drinking. The study, published online May 13 by the International Journal of Clinical Practice, presents some alarming case studies of cola-induced hypokalaemia brought on by chronic consumption of up to 10 liters per day of sugar-sweetened cola.

The study's findings suggest that "potassium deletion should be added to the long list of soft drink-related health problems," (obesity, type 2 diabetes, dental decay and metabolic syndromes, to name a few), said a related editorial. To illustrate, the editorialist relates a case from his own files in which a 51-year-old man with COPD, hypertension and idiopathic gastroparesis developed persistent hypokalaemia, generalized weakness and loose stools. After running through a number of possible causes, the doctor hit upon the problem when the patient arrived in his office with a two-liter bottle of Pepsi in tow; upon further questioning, the patient estimated his total daily consumption at 4 liters. He agreed to keep his intake to two liters, and saw his potassium gradually rise back into the normal range.

The editorial also cites the intriguing case of a 44-year-old ostrich farmer who returned from a kangaroo-hunting trip in the Australian outback with profound muscle weakness and respiratory distress that required intubation and mechanical ventilation. It turned out that his serum potassium level plummeted when he upped his Coca-Cola intake to 10 liters (from his usual 4 liters daily) to combat his thirst on the hunt (From the study, "Coca Cola and kangaroos," Lancet, 2004; 364: 1190).

The editorial warns against relegating these cases as "outliers," citing some rather unsettling statistics. Worldwide consumption of soft drinks was almost 83 liters per person in 2007, with the U.S. level even higher at an estimated 212 liters per person. While healthy adults often can tolerate low potassium levels, not so for patients with heart problems, the editorial points out, and even moderate chronic cola consumption has been associated with chronic kidney disease.

The statistics should be a wake-up call for internists, especially considering the steady rise of obesity and type 2 diabetes. Most people know that sugary drinks are unhealthy, but public health initiatives have focused largely on children and teens. However, the editorialist urges, internists need to start asking their adult patients about soft drink consumption, along with questions about alcohol, cigarette and drug use.

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1 Comments:

Anonymous Anonymous said...

Coke Zero depleted my potassium. I am up this time of morning because my severe calf cramp woke me up crying. It is 0148. I am sure that it is because of my drinking Coke Zero and eating half a piece of cake. I have to take potassium every day, and sometimes more often, due to sugar depleting my potassium. Please be careful drinking diet sodas.

October 21, 2011 2:50 AM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

ACP Internist and ACP Hospitalist also contribute to and draw upon content from Get Better Health, a network created by Val Jones, MD, to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the clinician's point of view on health care reform, science, research and patient care.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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