I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Diet and Recipes => Topic started by: Panda_9 on July 14, 2006, 03:27:10 AM
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As promised I have obtained a detailed list of how much potassium is in foods. Ill post it over the next few days as its quite long. Will be posting some recipes over time as well. Just a warning, I may forget, so feel free to remind me if I haven't posted the list in the next few days :)
Edit: I have marked in pink those foods that are also high in phosphate, as they didn't show up on the scan.
Edit:
The points system explained
1 point = 1mmol of potassium
1mmol = 39mg of potassium
For example, if you are allowed to have 100 points per day, this means you can have 100mmol or 3900mg. To calculate points/mmol into mg, its simply mmol x 39.
The points system makes it a little easier as most foods are listed in mg (they are here anyway). You generally should stick to foods that are 200mg or less per serve. One serve is equal to 5 points.
This tip has come up in another thread, I had forgotten all about it until now. To reduce potassium content in vegetables, remove any skin, and soak in water for an hour prior to cooking. Discard water and cook in fresh water. Discard cooking water. I don't have the info on how much this will reduce potassium, I don't think its a hell of a lot, but it will help.
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As promised I have obtained a detailed list of how much potassium is in foods. Il post it over the next few days as its quite long. Will be posting some recipes over time as well. Just a warning, I may forget, so feel free to remind me if I havent posted the list in the next few days :)
Can't wait :)
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Appologies for the bad scanning skills ;D If theres any problems let me know. These lists were a life saver for me. There are so many things I didnt realise I had to limit.
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Thanks for the list. I had to save it to my computer (right-click, Save Image As) to be able to read all of it, since it didn't fit on my screen.
The list I would like to see is the Phosphate list. I have never had any problems with my potassium.
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Thanks! I saved for referral later -- noticed vegemite :) heard it's like poi and grits -- you have to grow up eating it or it is very difficult to learn to like.
Lorelle
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Thanks Bajanne, i was just going to ask her to reduce the size (if she could) cuz i cant see the whole thing at once. But since you gave that helpful hint, I AM GOOD TO GO, Thanks again....
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Appologies for the bad scanning skills ;D If theres any problems let me know. These lists were a life saver for me. There are so many things I didnt realise I had to limit.
Thank you, can you go back and crop the others like you did the first one. If not that is ok, but the first one looks nice and cropped and aligned. If you can't I will do it when I have some time. :)
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Ohh now you want me to see the dietition again to get another list!! LOL Geez! :P I'll see what I can do. She wants me to see her for weight loss so I would say I'll be seeing her again soon.
Epoman, I didnt crop the first one, not sure why it turned out better. Ill see what I can do.
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Done! Please let me know if they are too big or if you still cant veiw them. Its no trouble to change them.
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very nice lists :) Just hope the links always stay active :)
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They will always be active as Im not changing my ISP any time soon. Let me know if they stop working. I am happy to email the list to anyone who wants it.
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They will always be active as Im not changing my ISP any time soon. Let me know if they stop working. I am happy to email the list to anyone who wants it.
I hadn't realized that they were not attached, can you please re-add them as attachments. I like all pictures to be attached, not linked. That way I can assure 100% that the pics will always be up. I hate going to a site and seeing a "red X" because links are either down or dead.
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Oh I didnt know I could attach them, will do.
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Oh I didnt know I could attach them, will do.
Thanks, in the future however try to make the width of a picture not more than 760wide, the reason is that many people do not have 19" or bigger monitors and are still using 800X600 with that resolution, people will have to scroll left and right to see the whole picture. These are fine, but in the future please try to remember size matters. ;D
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Pfft as if size matters! ;)
Ill resize them, its not a problem, I think they could be a bit smaller.
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Oh I didnt know I could attach them, will do.
Thanks, in the future however try to make the width of a picture not more than 760wide, the reason is that many people do not have 19" or bigger monitors and are still using 800X600 with that resolution, people will have to scroll left and right to see the whole picture. These are fine, but in the future please try to remember size matters. ;D
Oh THANK YOU THANK YOU THANK YOU!! Now I can ACTUALLY SEE them!! I only have a small 17" (just got it last year .. as my 15" finally went) and so I had to scroll :P And NOW I don't :)
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lol no worries angie. I always forget I've got a 19" as I'm so used to it.
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Threw lists out about the renal diet years ago along with the dietitian, who as been bugging me the past few months. It is very good to know if you are a new patient, but when you get the same info 100s of times you get a bit p#%$~# off.
Once you have been on dialysis for, say over five years. You should know what you can or can not eat. Even how much of the food you are not suppose to eat. We all have our little treats.(which are usually full of potassium :o)
The renal dietitian gets me so wound up. I make the sign of the cross when she comes near me >:( I most probably know more about the renal diet than her. The first thing you get handed over is a Bloody List. Are should I say a UPDATED LIST :-\ What have they grown a potassium free banana :-X
This was a special RANT by:-
Kevno
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Actually kevno, I was surprised to find how much the renal diet has changed in the last 10 years. When I was on PD 12 years ago, the diet was a lot more restrictive than it is now.
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Great list, thanks!
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I most probably know more about the renal diet than her.
lol ya ... I told my Renal Dietician about how some rootbeers have phosphate while her list said that all rootbeer is safe ;)
WRONG!! Certain brands ADD Phosphate!! READ THE LABELS!!
Safe Rootbeer in MY area (Canada .. ontario):
NOT Safe rootbeer:
oh sorry ... I was just replying but I guess this part was irrelevant since it is Phosphate and not Potassium :( :-[
well there is no way to delete this post ... it was relevant to what the earlier post was about the dietician .. but I will also put part of this in the new Phosphate thread.
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Amber I go back for over 30 years now. The renal diet is unbelievable to the way it used to be. The renal diet used to be worked out in protein grammes. 20,30 up to a 90gramme protein renal diet. When I first started on haemo. I was put on a 20 gramme protein diet. You had to look under a pea to find the meat. Plus a lot of high cal supplements. Now you can eat as much meat as you like. Then no bread. The only bread I could have was a special bread made in a TIN. Every point of the diet as changed, and I know it keeps changing. Now it is more for phosphate and potassium. How much you can drink as changed too. When I went back on CAPD just 18 years ago you were only suppose to have 500mls a day. Now at the unit the nurses are not to bothered as long as you are not over 3kg up. You used to get moaned at being 2kg up over the weekend :-\ In the 70's on haemo all the children on the unit run potassium over 6. Mine as been as high as 8 thats when they gave me some sandy stuff to lower it. Now never have a potassium lab result over 4.5.
All as changed and is still changing. They give with one hand, and take twice as much with the other. But if you were on the renal diet in the 70's you would be wondering what to eat. The answer was Sugar and more Sugar. Until they found out all those calories damages your heart.
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When I was on it as a teen, I had to have only white bread/crackers, not multigrain or wholemeal, minimal milk, no cheese, no salt, no this no that. I was on a 750ml restriction. Being only young and having very supportive parents, I did really well with sticking to it. Sometimes I did get up during the night and have a big swig of milk. Its strange though, it only took me one slice of cheese and my knuckles would swell and the pain was so great I had to wear a glove to stop them even moving slightly.
This time round on PD, I ate pretty much whatever I wanted, within reason, but because it was ineffective I wasnt eating hardly anything. It took me not eating or drinking for 3 days til they put me on hemo. With hemo I mainly had trouble with potassium, phosphate, and Hb, and my diet was extremely limited. Meat wasnt a problem, it was most any fruit or vegetables. Now with nocturnal I eat whatever I like, and have only had high K if Ive gone back in-centre for whatever reason. I just had a whole grilled tomato for breakfast, before hand I could only have 1 or 2 slices.
There is one lady at unit who could eat whatever and it didnt make a difference to phosphate at all.
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In 86 they started giving me medication for renal failure, never started dialysis until 87. They never said anything about diet to me. Only gave me half gallon containers of bp medication and half gallon containers of aluminum binders and told me to keep taking them until told otherwise.
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Diets not too important if you arent on dialysis, unless its reflecting in your blood levels. While I still had some function on PD, my fluid wasnt restricted, and my diet wasnt too bad.
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Ya exactly! Back in the 80's when I was in renal failure but not yet on dialysis I didn't have to worry about diet so much .. except to not have a lot of protein and watch my salt intake. And then when I went on PD I still didn't have to watch my fluids at all since I still had one of my original kidneys and was still peeing a lot. Then when I had my transplant I had to watch my weight because of the Prednisone.
I never had to watch my Potassium honestly til just this past year once I started HD for the first time in my life.
The diet is harder now than I have ever known but upon reading how it was in the 70's on Hemo .. I am glad I chose PD back then and am glad I didn't have to start dialysis til 1990 and had my transplant soon after :)
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Certain brands ADD Phosphate!! READ THE LABELS!!
Safe Rootbeer in MY area (Canada .. ontario):
NOT Safe rootbeer:
Umm, I remember reading the labels on Barq's rootbeer and there is a difference between canned and bottled softdrinks. I can't remember if it was canned or bottled but one had phosphate and the other didn't.
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sorry I feel bad I took this thread off topic.
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Goofynina .. can you move this post by sandman to the phosphate thread because it is more relevant there and he knows I am asking you this. Thx. (After that you can delete this post of mine saying this thx!)
Angieskidney, the ADMIN team does NOT delete posts on this website (only for extreme circumstances, even then only I can make that decision, however a mod is free to delete their OWN post.). Also if you have a request that a post be moved, locked, deleted, etc. All requests should be sent to a mod or admin via email or PM or at the very least in the "Site Requests, Comments, Technical Help." section. Thank you. :)
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All requests should be sent to a mod or admin via email or PM or at the very least in the "Site Requests, Comments, Technical Help." section. Thank you. :)
Oh I didn't realize the correct procedure .. thx for correcting me.
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I don't know why my case is different but I am on PD and my potassium
runs on the low side. I have to eat potassium rich foods and even have to
take a potassium supplement daily. I'm new to all of this, (since mid-April) but it sounds like a
lot of you are on potassium restricted diets. But I do have to take Phoslo and watch
the phosphorus.
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Everyone is different. It also depends if you are still urinating? Do you usually eat high potassium foods? There are various factors. But, too low of potassium is just as dangerous as high potassium. It can stop your heart. "Good News For The Day." So, keep taking the supplements.
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I don't know why my case is different but I am on PD and my potassium
runs on the low side. I have to eat potassium rich foods and even have to
take a potassium supplement daily. I'm new to all of this, (since mid-April) but it sounds like a
lot of you are on potassium restricted diets. But I do have to take Phoslo and watch
the phosphorus.
on PD I didn't have to worry about Potassium like I do now on HD.
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Ohio Buckeye what is your appetite and food intake like? While I was on PD I was barely eating much and my K did get low and went on supplements whilst in hospital. I chose not to take them when I was discharged as they can be dangerous. I just tried to eat some bananas, grapes etc too keep it up. If yours is low and you eat normally and dont urinate, well then thats a good thing I reckon. As long as you are closely monitored in case it creeps up. Its also important to know the signs of a high or low potassium, so you can get help quickly.
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I need to eat more protein as it is a little low and as I said more potassium.
I really try to eat more but I am a diabetic and try to keep sugars under control and
also do not want to gain weight. I get some of the low carb protein bars and
drinks to help. I still urinate. I don't know what the signs are for low or high
potassium. That is scary. I will start on cycler soon. Training 8/9-10.
I desperately want PD to work for me.
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I love this point system. It is so simple. We've never been given anything like that--just told a few foods to cut out! That is a much healthier approach in my opinion.
I need a lot of potassium for PKD and my son needs low potassium so that is a real pain!
Mom 3
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Just like bananas, potatoes are high in Potassium as well. French fries! Most of us can't have hardly any of those :( Just like potato chips! Most of us have to stick to Corn Chips ;)
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Ohio Buckeye, that would make it pretty hard having diabetes as well. It really doesnt take much to eat more potassium. Fruit is probly the best way, even if you just have a couple of peices in the high category a day. Have some sliced tomato and low fat cheese on crackers as a snack. If you need some help dont be afraid to ask for ideas.
Mom3, I love the point system too, it does make it so much easier to be aware of what your eating. When I was on dialysis the first time round (before transplant), I wasnt given any real detail on the diet. So I pretty much just cut out alot of things, not realising it its actually ok to have a little bit of the high K group. I have a very hard time trying to please my partner with food as most of what he likes I couldnt eat, so I didnt want to cook it. It must be awful with two opposites to cook for. I am greatful for nocturnal for that reason. I am now able to eat normally, and my partner and I can have the same meals.
6 hot potato chips is equal to one serve (5mmol)!!!
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I am not familiar with the point system. Are points regarding potassium only or other
things too like phos.? Where do you find out about the point system?
I do try to eat fresh fruit a lot. Love it. I was trying to eat enough to not have
to take a supplement but it did not come up enough so I take a rather large supplement
now. I did not know that they are dangerous. What are the symptoms of high or
low potassium. I know there can be an irregular heartbeat and heart can stop but are
there others?
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Sorry I did start explaining the points system in my initial post but I must of wiped it and forgotten about it. Your dietition should be able to tell you how many "points" you can have per day. Its not the same for everyone. Phosphate is completely different.
1 point = 1mmol of potassium
1mmol = 39mg of potassium
For example, if you are allowed to have 100 points per day, this means you can have 100mmol or 3900mg. To calculate points/mmol into mg, its simply mmol x 39.
The points system makes it a little easier as most foods are listed in mg (they are here anyway). You generally should stick to foods that are 200mg or less per serve. One serve is equal to 5 points.
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Sorry I did start explaining the points system in my initial post but I must of wiped it and forgotten about it. Your dietition should be able to tell you how many "points" you can have per day. Its not the same for everyone. Phosphate is completely different.
1 point = 1mmol of potassium
1mmol = 39mg of potassium
For example, if you are allowed to have 100 points per day, this means you can have 100mmol or 3900mg. To calculate points/mmol into mg, its simply mmol x 39.
The points system makes it a little easier as most foods are listed in mg (they are here anyway). You generally should stick to foods that are 200mg or less per serve. One serve is equal to 5 points.
Wow that is a great post! I was not aware of the point system neither.
I am not familiar with the point system. Are points regarding potassium only or other
things too like phos.? Where do you find out about the point system?
I do try to eat fresh fruit a lot. Love it. I was trying to eat enough to not have
to take a supplement but it did not come up enough so I take a rather large supplement
now. I did not know that they are dangerous. What are the symptoms of high or
low potassium. I know there can be an irregular heartbeat and heart can stop but are
there others?
http://www.webmd.com/hw/lab_tests/hw202677.asp
http://www.womens-health-club.com/minerals/potassium.htm
A deficiency may result in fatigue, cramping legs, muscle weakness, slow reflexes, acne, dry skin, mood changes, irregular heartbeat.
Excessive potassium can be toxic and will affect your heart, but is mainly a problem when you suffer from a problem such as kidney failure.
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Thanks, Im glad someone reminded me as that was the whole point of me posting the lists. When I was on 3x5hrs I was allowed 90 points per day. However, I was still having a high K regardless of the fact that I was sticking to that 90 points too a tee, and alot of the time not even having that much. Im pretty sure I was measuring things wrong, like a medium tomato on the list might be alot smaller than I thought. I did read somewhere that you can have 1mmol per kg of body weight, but dont quote me on that!
The dietition said I was the first person that had asked about specific mmol's in relation to diet. I found that weird, as the only other thing you get is a little pamphlet that doesnt go into great detail.
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Never heard of the point system.
Here we are given our allowances and just say under that amount you are given.
Some may differ but mine are:
2500 mg of potassium
2000 mg of sodium
1200 mg of phosphorus
I can eat anything I want as long as I stay under that amount for the day and maintain my protein intake of 120-130 grams a day.
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I have only been told "watch what you eat and stay away from these high content foods..." ::)
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I guess they say that because if you were to eat say banana, you can only have a small amount. I found I had to steer clear of tomato all together. After a few trips to ER I wouldnt touch tomato, bananas, chocolate, or anything really high.
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Is anyone on a 0 K bath? It's used with patients who always have a high potassium.
Some of the patients at my center are on this bath for either part or all of their treatment.
It's lower than the "normal" 2 K bath.
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Are you sure its a 0 K? I think there would need to be some level of potassium in the dialysate or we'd end up dead or with a big rebound. The lowest we have here is a 1 K.
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Lowest here I beleive is a 1 also. I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on.
I told them I would be willing to have no potassium added and would eat my way to the desired level. ;D However they didnt go for it.
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If there is no potassium in the dialysate then you would think your blood level would have to be daaaaamn high to warrant using a K0, and then if it was so high you probly would be dead before you even get to dialysis. I have had levels from 6.2-6.8 and after having all the IV and oral treatment, I was then dialysed on a K1. I just cant imagine anyone dialysing on a K0.
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Lowest here I believe is a 1 also. I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on.
I told them I would be willing to have no potassium added and would eat my way to the desired level. ;D However they didn't go for it.
Would that be interesting .. a banana a day to keep the nephrologist away. :o
But really, there is such bath as 0 K. It may be used only during the last hour or so of treatment.
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Lowest here I believe is a 1 also. I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on.
I told them I would be willing to have no potassium added and would eat my way to the desired level. ;D However they didn't go for it.
Would that be interesting .. a banana a day to keep the nephrologist away. :o
But really, there is such bath as 0 K. It may be used only during the last hour or so of treatment.
Yeah 0 K does exist, but many nephs don't like to use ZERO K, it can be dangerous. I was on ZERO K for a while, the whole 3 hours treatment. But when I went to Davita they would NOT allow it.
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I wouldnt want to use a 0 K either. Hell noooooooo. I dont even like using a 1K, but its only usually when I go to high dependancy so I dont mind as much. Im on a 1.25K for nocturnal which seems to be ok so far.
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Well, I would imagine, some patients do need it.
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I just thought it was a bit extreme. Perhaps those patients dont follow the diet at all?
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I just thought it was a bit extreme. Perhaps those patients dont follow the diet at all?
Some patients do not. There was a gal here who would drink orange juice and her heart would start racing. She would still do it despite knowing that it was the potassium in it that was causing the problem.
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It may have to do with the individual's diet, based on their culture or ethnicity.
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Good point Zach. Ive seen a few Dx patients from other backgrounds and they have a very hard time trying to understand the diet. Once I heard a dietition trying to talk to this family about how their traditional diet was extremely bad for Mrs X, and they just did not get it. The whole time she was in hospital (across from me), they bought her in foods like a massive jug of soup, shellfish, all bad things. The poor dietition was ready to give up on them I think. Theres another lady, I think shes indian, who doesnt understand that rice is considered fluid as well, but she continues to eat alot of it. She often ends up with pulmonary oedema requiring admission.
Whereas me, I just cant get my head around the fluid restriction at all!
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If there is no potassium in the dialysate then you would think your blood level would have to be daaaaamn high to warrant using a K0, and then if it was so high you probly would be dead before you even get to dialysis. I have had levels from 6.2-6.8 and after having all the IV and oral treatment, I was then dialysed on a K1. I just cant imagine anyone dialysing on a K0.
I dialysed on zero K for over a decade. I wanted a more liberal diet. I kept my K at normal levels because I counted my potassium mg. intake.
Don't forget - a zero K bath doesn't necessarily drop your K to zero - it just ALLOWS it to get to zero. My pre-K levels were high normal and
post-K low normal. Now I am fine with 2K.
There was a practise in my unit to do half the treatment with zero - usually the first half and then changing to 2K. I predicted (correctly) that
it wouldn't last since it was an added task for the staff. There's an idea for Fresenius! A machine that automatically changes the dialysate! If it
doesn't exist, it should.
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What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.
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What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.
I don't know if this post is directed to me. What your post K is depends on several factors including what your pre K was and how much dialysis you are receiving. So dialysing on a zero K bath does not necessarily bring your potassium down to zero. I kept my potassium in a normal range but slightly wider than on 2K for over 10 years. I also kept a running log of my potassium intake.
And while it is riskier than 2k, for non-compliant patients, it can be the lesser of two evils.
I do agree though that 1k is a better idea. For some reason, it wasn't an option in my unit back then.
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What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.
LOL, using a ZERO K bath does not mean your potassium goes to ZERO at the end. If you potassium went to ZERO you are correct you would DIE. Using a Zero K bath means you will not receive any NEW potassium while dialyizing.
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Good point Epoman!
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What is the differences with the dialysate bath levels 2K, 1K and zero K?
What do those figures stand for?
What was added to them to give these added values?
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What is the differences with the dialysate bath levels 2K, 1K and zero K?
What do those figures stand for?
What was added to them to give these added values?
K = means Potassium .. but I am still new at Hemo so I don't know how to explain the rest. Hopefully someone can explain it in simple terms. But from what I understand from Epoman is that 0 K bath just gives none back so I assume that means that the 1K and the 2K give back a certain amount (a percentage??). I am not sure. But I DO know that you don't want your potassium to drop too low just like you don't want it to be too high. But that dialysis patients usually have higher potassium levels because they don't have kidneys to eliminate the potassium.
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Difference between the baths are the level concentration of potassium in them.
THe number is mEq/l--Milliequivalents per liter (K) is potassium.
In round about terms. In dialysis the patient's blood starts out with a higher potassium level. So during dialysis the potassium moves from the higher concentration of the patients blood to the lower concentration of the potassium bath.
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What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.
LOL, using a ZERO K bath does not mean your potassium goes to ZERO at the end. If you potassium went to ZERO you are correct you would DIE. Using a Zero K bath means you will not receive any NEW potassium while dialyizing.
I wasnt saying that, Im not that stupid. I was repeating what hemohortensia previously said "it just ALLOWS it to get to zero"
sandmansa, the different levels of potassium in dialysate determine how much potassium needs to be taken out of the blood until there is a safe balance in the level. If you have a high blood potassium, then you want to use a low K dialysate (Eg a K1). If you have a potassium that is in the high range of normal or thereabouts, then you would probably use a K2. Me personally, I use a K1.5 if Im dialysing in centre. In basic terms, the lower the K in the dialysate, the more K it will pull out of your blood.
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Thanks everyone. That was very helpful. Now, just one last question.
What are the amounts of potassium in each level of dialysate. Meaning exactly how much potassium is in K2, K1.5, K1 and K zero solutions?
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Its not really necessary to know how much is in each but for example a K1 has 2.6g/L of potassium chloride. That is whats on mine anyway, Im assuming its the same everywhere.
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Thanks Amber. Please forgive the seemingly silly questions but I'm just being curious.
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Thats ok, I know it must be hard not knowing things, and its only normal that you may ask some silly questions. Nothing wrong with that at all!
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Difference between the baths are the level concentration of potassium in them.
The number is mEq/l--Milliequivalents per liter (K) is potassium.
In round about terms. In dialysis the patient's blood starts out with a higher potassium level. So during dialysis the potassium moves from the higher concentration of the patients blood to the lower concentration of the potassium bath.
Ah that makes so much sense! So basically it works on the methods of osmosis and diffusion? (I am not sure which is which but I learned that is the method Peritoneal Dialysis works and I assume parts of Hemo dialysis too (I am still learning .. it is hard for Sandman to know when even I don't know certain things :P) :-[
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Spot on angie :)
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In relation to the discussion on zero K dialysate, I received this info from my home training nurse, thought I would add it here as I asked him about using zero K dialysate.
Potassium is one of those too much and too little things. Too much and
it can kill you. Too little and it can kill you. So you have to be
like Goldie-locks. But we only have one bear.
Like most things with our bodies, they run best when within a very
small range. In the case of potassium it is between about 3.2 to 4.5
mmol/l (milimoles per litre). With renal failure, the potassium gets
too high because the kidneys are responsible for the regulation. High
potassium is very serious because it causes muscle weakness in the
lower limbs initially, irregular pulse, low blood pressure, abdominal
cramping, nausea, diarrhoea. Things get worse as the levels rise,
eventually leading to severe paralysis and cardiac arrest.
With haemodialysis the aim is to reduce the level of potassium to more
normal levels, without getting it too low. Low potassium can lead to
muscle weakness, paralysis, cramping, weak pulse, low blood pressure.
Looks very similar to high potassium. However, this is the more common
condition, except when you have renal failure.
With haemodialysis, there is an initial very rapid removal of potassium
(and other stuff) with the blood level gradually reaching a balance.
If there was no potassium in the dialysate, then the level would
continue to drop. Leading to severe hypokalaemia (low potassium). With
very long dialysis, as with nocturnal, the level would be too low for
too long. Once dialysis is stopped, the level once again starts to
rise, getting into the normal range quickly and then going beyond
again until the next dialysis.
The commercial dialysate that we use comes in K 1.0, 1.5 and 2.0. Most
people on nocturnal add some potassium to make the 1.0 a 1.5. This
seems to keep people in a more comfortable range. Because you are
getting such good dialysis and all your figures are low anyway, they
tend to stay in the more normal range for longer.
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Thanks Amber, that is very informative.
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Amber can I quote that info for my own person use?
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Here is a bit more info. I must say I am learning something here! I don't see why you couldn't use it Angie :) For personal reasons I have taken names and details out of the quote.
If your level went too low on nocturnal for some reason, can it still rebound and go too high?
Well, we are hoping that it will not go too low while doing the long
dialysis. That is why there is some potassium in the dialysate. To
keep things in the normal range through the night.
The rebound for someone on nocturnal tends to be less dramatic. This
is probably partly due to the body being able to get rid of excess
potassium as the acid levels become more balanced.
In renal failure, you also get an increase in acid in the blood. The
body doesn't know what to do with the excess acid because the kidneys
look after that. It does the equivalent of stuffing it in a draw. It
put as much acid (hydrogen ions) as it can into any spare cell. The
trade off is that something has to come out of the draw. That's
potassium. It leaves the cell and moves out into your blood.
However, dialysis fixes the acidosis by using bicarbonate. The long
dialysis enables all that stuff shoved in the draw to come out.
Potassium then has to go back into the cell to maintain the balance.
this is why some potassium is needed in the dialysate. Once you stop
dialysis, the acid levels begin to rise again and so does the
potassium as the body does the hydrogen/potassium swap. With nocturnal
though, it rises and falls more like a gentle ripple rather than a
storm surge as with shorter dialysis.
Even if you are very strict with potassium in your diet. There will
still be an increase in potassium due to the acid changes occurring in
your body.
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I have found this thread really useful. I have never had a problem with high K. In fact my K is on the low side. I have just had my K increased in dialysis as it was too low. My pre being about 4.5 and my post 2.7. I'm now on the 2K.
I remember when I first had dialysis 10 years ago my K was really high and they couldnot bring it down and my diet was more restricted than it is now.
Half the things I'm not allowed to eat or that are harmful I do not seem to like or enjoy eating. I often wonder if my body knew that it was harmful for me while I was growing up and tried to stop me eating them before my kidneys gave up.
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Half the things I'm not allowed to eat or that are harmful I do not seem to like or enjoy eating. I often wonder if my body knew that it was harmful for me while I was growing up and tried to stop me eating them before my kidneys gave up.
Whatever the reason, it's good that you have come to that point. ;)
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I fought to stay on 2K but my potassium was too high. Finally I realized "Hey, screw it, let them put me on 1K and then my Potassium will be good" and it is. :clap;
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I fought to stay on 2K but my potassium was too high. Finally I realized "Hey, screw it, let them put me on 1K and then my Potassium will be good" and it is. :clap;
If you need it, go for it!
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Be careful on a K1 that you dont get the rebound effect. Im a shocker for it.
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Be careful on a K1 that you dont get the rebound effect. Im a shocker for it.
Explain~
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The rebound effect is basically a result of your potassium level going too low too quickly. It is more likely to happen on conventional dialysis as the treatments are short. Here is some useful info I got of my Dx nurse....
The rebound for someone on nocturnal tends to be less dramatic. This
is probably partly due to the body being able to get rid of excess
potassium as the acid levels become more balanced.
In renal failure, you also get an increase in acid in the blood. The
body doesn't know what to do with the excess acid because the kidneys
look after that. It does the equivalent of stuffing it in a draw. It
puts as much acid (hydrogen ions) as it can into any spare cell. The
trade off is that something has to come out of the draw. That's
potassium. It leaves the cell and moves out into your blood.
However, dialysis fixes the acidosis by using bicarbonate. The long
dialysis enables all that stuff shoved in the draw to come out.
Potassium then has to go back into the cell to maintain the balance.
this is why some potassium is needed in the dialysate. Once you stop
dialysis, the acid levels begin to rise again and so does the
potassium as the body does the hydrogen/potassium swap. With nocturnal
though, it rises and falls more like a gentle ripple rather than a
storm surge as with shorter dialysis.
Even if you are very strict with potassium in your diet. There will
still be an increase in potassium due to the acid changes occuring in
your body.
From that, I understand that on conventional dialysis, you arent getting rid of all the K that is stuffed in the draw, so as a result of it dropping low after using a low K dialysate, the K from the draw is released. On nocturnal, the K is removed from the draw, therefore you wont get excess K coming out of the draw and creating a rebounding K level where it jumps up pretty quickly.
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That is a VERy good post! :thx; :2thumbsup;
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Yes, Amber, Thank you. 8)
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No worries. That is the first time someone has ever explained that to me in such detail that is easy to understand. I know it doesnt apply to everyone, but it certainly does to me. Nocturnal has been a life saver for me in regards to ER trips for high K.
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Here's a link to the USDA National Nutrient Database listing for the Potassium content in foods:
http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18a306.pdf
Hope it's helpful.
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I thought this post by Ken Shelmerdine was important:
http://ihatedialysis.com/forum/index.php?topic=1220.msg22742#msg22742
I think it's true to say we become experts of our own health condition. When I was pre-dialysis my potassium level went to 6.9. This level was considered to be so bad that I got a call to go to A&E immediately. They took it again at the hospital and it had come down to 6.2. which is still high. Now a few weeks previously I'd asked my renal doc if I could reduce the strength of one of my BP meds (Beta Blockers) and maybe compensate with a higher dose of the other tablet I was taking (Candesarten, an ARB blocker) He cut the beta blocker to half strength (2.5ml) and doubled the ARB to 16ml. The day I got the call to go to A&E I had earlier in the day seen an article on the net about a clinical study that indicated ...wait for it.... raised serum potassium blood lab readings in patients using ARBs. I mentioned this to the A&E medic and after disappearing for about 10 minutes I guess to get someone else's opinion or look it up in a book,(God knows) He came back and agreed that yes this could indeed be the cause..Doh, Who's the bloody Doctor?????!!!!!!!! Came off the ARB completely, replaced it with a diuretic and in 2 weeks it was down to 4.8. ::)