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5 Potassium: Dietary Reference Intakes for Toxicity
Pages 125-140

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From page 125...
... This chapter presents the committee's review of the evidence on the toxicological effects of excessive potassium intake and its conclusion regarding establishing a potassium UL. For context, the committee's findings are preceded by a brief summary of the decision made regarding the potassium UL in the Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005 DRI Report)
From page 126...
... Guided by the first step of the DRI organizing framework, the committee sought to identify potential indicators of toxicological adverse effects from excessive potassium intake. The section that follows describes the evidence the committee reviewed to identify indicators that could potentially inform the derivation of the potassium UL.
From page 127...
... The committee also compiled reported adverse effects of the potassium trials included in the Agency for Healthcare Research and Quality systematic review, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks (AHRQ Systematic Review) (Newberry et al., 2018)
From page 128...
... Adverse Events Reported in Potassium Supplementation Trials The AHRQ Systematic Review did not have a key question regarding adverse events in potassium trials, but it provided a brief summary of commonly reported adverse events, including gastrointestinal discomfort. Build
From page 129...
... Under these conditions, only one study provided evidence on hyperkalemia and reported higher prevalence among those in the placebo group than in the potassium supplement group. The committee's findings on changes in blood potassium concentrations are augmented by a meta-analysis of potassium supplementation trials; it found that among relatively healthy indi­ iduals there were v small increases in plasma or serum potassium concentrations (weighted mean difference: 0.14 mmol/L [95% confidence interval: 0.09, 0.19]
From page 130...
... 130 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 5-1 Potassium Supplementation Trials Included in the AHRQ Systematic Review and the Committee's Supplemental Literature Search That Provided a Description of Adverse Events or Blood Potassium Concentrations Duration, Reference Weeksa Participants Intervention Crossover Studies Patki et al., 1990 8 37 Indian adults, mean age Placebo 49.9 ± 7.6 years, with mild 60 mmol/d liquid K hypertension who did not take supplement antihypertensive medications throughout trial Graham et al., 6 43 British adults, 40–70 years Placebo 2014 of age, at moderate 64 mmol/d KCl cardiovascular disease risk Richards et al., 4–6 12 New Zealand adults, Control period 1984 19–52 years of age, with mild 140 mmol/d K hypertension supplement He et al., 2010 4 42 British adults, 18–75 years Placebo of age, with untreated mild 64 mmol/d KCl hypertension 64 mmol/d KHCO3 Vongpatanasin et al., 4 30 U.S. adults, mean age 54 ± Placebo 2016 12 years, with prehypertension 40 mmol/d KCl or stage I hypertension 40 mmol/d K3Cit Parallel Randomized Controlled Trials Barcelo et al., 1993 144 57 Spanish adults,g 27–64 Placebo years of age, with moderately 30–60 mmol/d K3Cit severe active lithiasis and low/ low-normal urinary citrate
From page 131...
... K3Cit: 4.3 ± 0.3 (p < .01 compared to placebo) ~61h 105i 1 placebo and 2 K3Cit No significant changes in serum K participants dropped out due to gastrointestinal intolerance 3 K3Cit participants reported mild nausea, epigastric pain, or abdominal distention continued
From page 132...
... 132 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 5-1 Continued Duration, Reference Weeksa Participants Intervention Jehle et al., 2013 104 201 healthy, Swiss adults, Placebo 65–80 years of age 60 mmol/d K3Cit Macdonald et al., 104 276 postmenopausal, British Placebo 2008 women, 55–65 years of age 55.5 mmol/d K3Cit 18.5 mmol/d K3Cit 300 grams additional fruit and vegetables/d Gregory et al., 52 83 U.S. women, mean Placebo 2015 of 66 years of age,l with 40 mmol/d K3Cit postmenopausal osteopenia Obel, 1989 16 48 black, Kenyan adults, Placebo 23–56 years of age, with 64 mmol/d K mildly increased blood supplement pressure Siani et al., 1987 15 37 Italian adults, 21–61 years Placebo of age, with SBP ≥ 160 mm Hg 48 mmol/d K and/or DBP ≥ 90 mm Hg supplement Chatterjee et al., 12 29 African American adults, Placebo 2017 at least 30 years of age, with 40 mmol/d KCl prediabetes Bulpitt et al., 1985 12 33 British adults, mean of 55 Control years of age,o with 64 mmol/d K hypertension, receiving a supplementp K-losing diuretic
From page 133...
... group (19.0 versus 9.8 percent, respectively) 56 102m No major adverse events No significant change in serum K concentrations in K supplement group Placebo group had similar results NR 87 No major adverse events Plasma K, end of trial (mmol/L)
From page 134...
... 134 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 5-1 Continued Duration, Reference Weeksa Participants Intervention Svetkey et al., 1987 8 116 U.S. adults, mean age of Placebo approximately 51 years, with 120 mmol/d K DBP between 90 and 105 mm supplement Hg, untreated during trial Braschi and 6 85 British adults, 22–65 years Placebo Naismith, 2008 of age, with BP ≤ 160/105 mm 30 mmol/d KCl Hg 30 mmol/d K3Cit Naismith and 6 59 British adults, 25–65 years Placebo Braschi, 2003 of age 24 mmol/d KCl Franzoni et al., 2005 4 104 Italian adults, 35–65 years Control of age, with mild to moderate 30 mmol/d K-aspartate hypertension, untreated during trial Miller et al., 1987 4 38 pairs of identical twin, U.S.
From page 135...
... ; symptoms resolved during study 58 82 No reported adverse effects from Serum K, end of trial (mmol/L) t: the K supplement Control: 4.18 ± 0.46 K group: 4.38 ± 0.26 (p < .001 compared to control)
From page 136...
... This level of potassium intake would likely be below the UL for individuals without kidney disease, diabetes, heart failure, adrenal insufficiency, or individuals using ACE-Is, ARBs, or other medications that may raise blood potassium concentrations to levels that could lead to adverse effects. There is evidence that very high doses of supplemental potassium ingestion can lead to adverse events, and in extreme cases has led to death, even in the absence of kidney disease or other factors that alter potassium excretion.
From page 137...
... kValues are the mean baseline urinary potassium excretions plus mean change at 104 weeks for the high K3Cit, the low K3Cit, and the vegetable/fruit intervention groups, respectively. lMean age 65.1 ± 5.9 years in supplementation group (n = 42)
From page 138...
... 2008. The effect of a dietary supplement of potassium chloride or potassium citrate on blood pressure in predominantly normotensive volunteers.
From page 139...
... 2017. Guiding prin ciples for developing Dietary Reference Intakes based on chronic disease.


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