Time for my first #medtwitter #Tweetorial on Insulin and Potassium regulation!
This is part 1 of a tweetorial series on K homeostasis/Hyperkalemia. This is a big topic, so I’ll stick to concepts.
Poll: What percent of total body Potassium is within extracellular fluid?
This is part 1 of a tweetorial series on K homeostasis/Hyperkalemia. This is a big topic, so I’ll stick to concepts.
Poll: What percent of total body Potassium is within extracellular fluid?
The answer is only 2%!
That means shifts of even small amounts of K either in or out of the ECF leads to huge changes in plasma K concentration.
A great way to think of K regulation is external and internal K balance.
This interplay was described in a 1978 NEJM review
That means shifts of even small amounts of K either in or out of the ECF leads to huge changes in plasma K concentration.
A great way to think of K regulation is external and internal K balance.
This interplay was described in a 1978 NEJM review
External Balance revolves around Total Body Potassium (TBK) and is determined by K intake - K excretion.
Internal Balance revolves around the distribution of K w/in our intra- and extracellular fluid compartments
K excretion is primarily through kaliuresis, unless ⬆️diarrhea
Internal Balance revolves around the distribution of K w/in our intra- and extracellular fluid compartments
K excretion is primarily through kaliuresis, unless ⬆️diarrhea
In normal physiology, External Balance alone can handle even potentially lethal amounts of K ingestion, acute or chronic.
If renal excretory capability is overwhelmed, cellular shift adaptations help out by imparting Internal Balance.
Poll - Does [K] impact Insulin levels?
If renal excretory capability is overwhelmed, cellular shift adaptations help out by imparting Internal Balance.
Poll - Does [K] impact Insulin levels?
The answer seems to be yes! Let’s look at Insulin and K
In one study, increase in [K] causes increases in rat pancreas insulin excretion
K infusions in dogs raise serum insulin levels, which then drop after infusion
However this hasn’t been as well established in humans
In one study, increase in [K] causes increases in rat pancreas insulin excretion
K infusions in dogs raise serum insulin levels, which then drop after infusion
However this hasn’t been as well established in humans
Insulin helps shift K into cells and therefore postprandial Insulin rise lowers glucose and K prior to kaliuresis, which can take hours after a meal.
I’ve wondered why IV insulin is used rather than other routes to tx HyperK, seems to be dose-response related.
I’ve wondered why IV insulin is used rather than other routes to tx HyperK, seems to be dose-response related.
Next time, we’ll take a deep dive into the role of #Aldosterone in K Homeostasis.
Ref: PMID 355876, 27756725, 1146998
Happy to take in any feedback since this is my first venture into tweetorials!
Ref: PMID 355876, 27756725, 1146998
Happy to take in any feedback since this is my first venture into tweetorials!
