State of the Unit
From the Director's Chair : Doctor K Talks About Patient K+
K = Potassium
Prescription for Health: Treating High Potassium (High K)
Can you find your way through the K maze?
Letting Go
State of the Unit
John Hensey, Administrator
“Hey everyone out there…sit up and pay attention…here are some important announcements from WDI!”
- March was Social Work and Nutrition Month. Staff recognized the social workers: Helen and Anastasia and dietitians: Ann and Fran for their contributions to patients and families.
- WDI has Internet Access! Have you ever wanted to bring your laptop to the center for work or for fun, but thought you wouldn’t be able to go online? Well you can now. WDI has internet access available to you and your laptop during your dialysis treatment just for the asking! Please let the charge nurse or social worker know if you want to be “plugged in” to the world of the internet.
- UW Health Pharmacy Services offers more options with the Medication Management Mail Service Program. With this program a pharmacist is available 24/7, medications can be delivered anywhere in the US , the payment system is easy, and the shipping is free. Call 1-866-894-3784 to find out more about this program.
- The American Association for Kidney Patients (AAKP) will hold its 34 th Annual Convention in St. Louis , MO August 30- September 2, 2007 . To learn more, call 1-800-749-AAKP, visit them on-line at www.aakp.org. , or talk with your dialysis social worker.
- Attention to all those interested in learning more about the miracle of transplant; you are invited to the Transplant Wisconsin, Inc 2 nd Annual Bowling Event on Saturday 4/14 from 2:00 – 5:00 PM at Schwoegler’s Park Town Lanes in Madison. $12.00/person will cover the cost of 2 games, shoe rental and food. Plus you get to mingle with others with transplants or preparing for one. If you are interested please RSVP at the web address: transplantwisconsin@yahoo.com.
- Two more Living Well with Chronic Illness classes to be offered! 6-Fridays April 13-May 18 from 1:30-4:00 PM at the Oregon Senior Center and 6-Mondays April 16- May 21 from 12:45-3:15 at the St. Ann Parish in Stoughton . WDI offers scholarships to WDI patients. You can call Janie Riebe at 261-9700 or contact your social worker to register. Other WDI patients have attended and found this program to be very helpful and fun.
- Memorial Gifts: WDI would like to recognize and thank the family of Roger Wentorf. Roger was a hemodialysis patient with WDI July 1994 to December 2006. He was a thoughtful, caring patient who had many friends at WDI. The family has graciously directed all memorials to go the WDI Patient Fund. The WDI Patient Fund provides financial assistance to serve the program, education and support needs of WDI patients and their families. If you would like to learn more about donating to WDI please contact us at 270-5638.
- Nurses Week: Nurses week is May 6-12 th. WDI wishes to recognize the crowning achievements of: Lila, Sandy, Dawn, Linda, Jan, Karen, Sharon, Sally, Theresa, Cheryl, Maria, Sherry M, Tamaria, Carla, Kelly, Carmen, Sherri L, Jackie, LeAnn, Kathleen, Therese, Karl and Carol. Her Royal Highness, Queen Elizabeth said “…technological improvements do not do away with the importance of having that link with an individual, that response from another human being, which is what nursing perhaps defines most clearly.” No need to bow or curtsy, a simple thank you is what the nurses would appreciate!
From the Director’s Chair
Doctor K Talks About Patient K+
Paul Kellerman, MD
On the periodic table of the elements, K is the symbol for potassium. In Latin, potassium is “kalium”, thus the letter K for the symbol. But it is called potassium in English because it is isolated from the mineral ore called potash thus, the confusion of potassium being represented by the symbol K. In dialysis, this is even more confusing, for the symbol P is for phosphorus, another important chemical in your body.
K + plays a very important role in the body. It is the major cation (positively charged chemical) in all of our cells, and most importantly it regulates “excitable cells”, such as those in the heart. We accumulate potassium in our blood from two sources: what we eat, and also from turnover of cells that happens naturally every day in our body. The main way we get rid of potassium is through the kidneys, with a tiny amount lost through our stool.
When kidney function is very poor, the kidneys have trouble getting rid of potassium and it builds up in the blood stream. Mild buildup of potassium is not harmful, but above certain levels in the blood, it becomes dangerous. Changes in potassium outside the cells, in the blood, can change the electric current in the heart and therefore change how well heart cells contract. When the potassium gets above 6 to 6.5, the heart can have serious rhythm disturbances, and the heart can actually stop beating.
So how do we keep your potassium in an acceptable range (below 6 before dialysis is acceptable)? First, we can lower the potassium bath against which you are dialyzed, so that more potassium is taken off with each dialysis. Every month, we look at the potassium blood levels and adjust the dialysis bath so that it is optimal. We not only want to be sure that we keep your potassium low enough, but we don’t want to dialyze your potassium too low, for that too can cause heart rhythm disturbances. What can you doto assure that your potassium stays safe? First and foremost, come to every dialysis session, so that we can remove the excess potassium. Second, avoid high potassium foods. With these methods, most people keep safe levels in their blood stream before and after dialysis. Feel free to talk to your dietitian about potassium containing foods, or your nurses and doctors about your potassium levels if you have concerns.
K = Potassium
Jennifer Gunness, Dietetic Intern
Fran Kittell, MS, RD
What is K?
Potassium, or K, is an essential nutrient found in fruits and vegetables, dairy products, whole grains, nuts and meats. K in the body helps to control fluid and electrolyte balance. K also plays an important role in muscle contractions, including your heart muscle.
Your body absorbs about 90% of the K you eat from your diet. In most people, the kidneys remove any excess K through the urine. People with kidney disease need to pay close attention to K intake so that K does not build up in the blood.
Why do K lab values matter?
Having too much or too little K in the body can lead to serious complications. Too low of K values, can cause weakness, muscle cramps, fatigue and constipation. It can lead to irregular heartbeats, which decreases the heart’s ability to pump blood to the body. Too high of K in the blood, can cause nausea, irregular heartbeat and slow, weak, or absent pulse. This can lead to cardiac arrest if left untreated.
The K levels in your body should be between 3.5 – 5.5 mEq/L. You can find your K lab values on your monthly lab report card. Your lab values reflect your food intake. So your lab values can dictate your dietary allowances.
What foods are high in K?
Dairy products are rich in K and may need to be limited. K content varies greatly among brands. Eight ounces contains:
- 1% milk: 381 mg
- Chocolate milk: 425 mg
- Soy milk: 345 mg
- Rice Dream milk: 69 mg
- Low fat fruit yogurt: 490 mg
High K fruits and vegetables include:
- Avocado: 549 mg
- Banana: 451 mg
- ½ c pinto beans: 400 mg
- ½ c kidney beans: 358 mg
- V8 juice: 464 mg
- Dried fruits: 600 mg
- Potato: 610 mg
Nuts are also high sources of K . One ounce of nuts contains:
- Almonds: 211 mg
- Cashews: 160 mg
- Pistachios: 295 mg
- Walnuts: 148 mg
What foods are low in K?
Fruit and vegetables that have 150 mg or less of K are considered low K foods. ½ cup contains the following:
- Applesauce: 78-92 mg
- Blueberries: 65 mg
- Cranberry juice: 31 mg
- Grapes: 100 mg
- Raspberries: 94 mg
- Broccoli: 127 mg
- Cucumber: 84 mg
- Iceberg lettuce: 87 mg
Tips to managing K intake
You can decrease the amount of K in vegetables (like potatoes) by soaking and cooking.
- Pre-soaked for at least 2 hours.
- Discard soaking water prior to cooking.
Do not use salt substitutes made with potassium chloride, like No Salt or Lite Salt.
Read food labels. Be aware that although the food may not have K listed on its label, it may still contain K.
Prescription for Health: Treating High Potassium (High K)
Kim Holdener, PharmD
High potassium (also known as high K) can be life threatening. People who are on dialysis are more likely to have high K than people with normal kidney function because K is removed from the body by the kidneys. High K is actually very rare in people with normal kidney function. There are often no symptoms when one’s K is high, therefore, you might not know that you are in danger. People with life-threateningly high K need immediate treatment, usually through the emergency room.
If symptoms do occur with high K, they usually only occur when the K is very high, above 7 mmol/L. Symptoms that may occur include muscle weakness and changes in the conduction of signals through the heart. The changes in heart function can be detected with an electrocardiogram (also called an ECG or EKG). When changes in heart function due to high K can be detected by an ECG, it can lead to cardiac arrest (failure of the heart to pump) and death. The level of K that can cause cardiac arrest is different for each person.
In people who have heart changes detected by an ECG, calcium is given intravenously to protect the heart and prevent cardiac arrest. This treatment only lasts one hour at most. In the meantime, another treatment should be started to lower the K levels. Drug treatments can either eliminate K from the body or shift potassium from the blood stream into the cells. Shifting K into the cells is temporary. The most common medication used to shift K into the cells is insulin. Insulin should be given intravenously so it can act quickly. Intravenous glucose or dextrose is also given to prevent blood glucose levels from becoming too low from the insulin. This treatment takes effect within one hour but usually only lasts 4 hours at most. Sometimes sodium bicarbonate is given to shift K into the cells. However, this treatment usually works best in people who have low bicarbonate levels and who have kidney function.
In order to lower K to a safe level and keep it there, K must be eliminated from the body. There are several ways to remove K, but for dialysis patients the best way is with dialysis. K is removed from the body during each dialysis treatment. It is the fastest and most efficient way to lower K. Therefore, it is the treatment of choice for high K in a dialysis patient. There are two medications that can also be used to remove K from the body. Diuretics, such as furosemide (Lasix), given intravenously can be used to remove K through the urine. However, in patients who are on dialysis, diuretics do not work. The rate of elimination of K from the body with diuretics is also not very fast. Another medication that is used is sodium polystyrene (Kayexalate). This is a medication that is taken orally and removes K through the stool with a bowel movement. It takes up to 4 hours for it to take effect. Therefore, if quick K removal is needed due to life-threatening heart rhythm abnormalities, sodium polystyrene is not ideal. Most people do not like the taste of sodium polystyrene. This medication can also be given rectally as an enema.
The best way to treat high K is to prevent it! K enters the body through the foods we eat. Controlling the amount of K in the diet is absolutely essential for people on dialysis in order to avoid the life-threatening effects it can have on the body when it gets too high. It is much better to keep the K in your body at safe levels that can be removed with your regularly scheduled dialysis treatments. If you have any questions about foods that contain K and how to control K in your diet, be sure to talk to your dietician.
Can you find your way through the K maze?
As you might have guessed, the majority of the Pathways Newsletter is devoted to Potassium or what we now call K. Scientists have denoted Potassium as K on the periodic table. To follow suit, WDI has begun promoting Potassium as K too. Why the change? Well, at times, Potassium has been confused with another important word known as Phosphorus. Potassium and Phosphorus are different and are essential terms that you, as a dialysis patient, must understand in order to monitor your lab values and your diet. So, in an attempt to avoid confusion, we now call Potassium K. Look through this newsletter, the patient bulletin board or participate in the education initiative to improve your understanding of Potassium as K and the concept of K in your health. Remember…. Potassium = K and K = Potassium! We hope this new strategy will work for you!
Letting Go
Chaplain Penny Andrews
Because the topic for this newsletter is potassium, I considered what the practical application might be to the spiritual aspect of one’s life. The topic that came forward is letting go.
On this journey that life is, we are constantly called to let go of things. Because nothing in life is permanent, we are asked to embrace wholeheartedly what is in our lives. Then with as much grace as possible, to let that go and embrace what comes next.
Letting go actually bumps into how we view the future. It is fully a mystery. We can set our goals, and steer in that direction, but things will unfold based on many factors, which force us to let go and proceed in another direction with the same or new goals.
Sage writer and expert in world mythology, James Campbell has put it this way:
"We must be willing to let go of the life we have planned, so as to accept the life that is waiting for us."
In talking with dialysis patients over the years, I know that there is much letting go. That has to happen. In order to successfully navigate health issues, cultivating flexibility is very important. Flexibility is believed to be the key quality central to aging well just as flexibility is essential for learning, adapting and change.
For example, what starts out as dietary choice quickly bumps into a universal principle of life—that of letting go. Food and food choices are so central to our personal goals and sense of well-being. But you, as a kidney patient, are asked to be flexible and think of food in a much different way and you are asked to let go.
Luckily, we humans are not only flexible and able to let go, we also have the enormous potential for resilience. We all have the resilience to change, resilience to be flexible and the resilience in the face of letting go.
So as you come to something you know requires letting go, be on the lookout for those aspects that involve the principle of resilience. It may not be the simplest thing we do, But it makes life more worthwhile and definitely, interesting.
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April 25th is Administrative Professional’s Day. Here is a poem for our secretaries.
Why do you Like Us?
You send out memos and make our coffee,
clean all our messes when we get sloppy.
Answer phones every time it rings,
and help many of our patients with insurance, taxi rides and things.
What would we all do
if we didn’t have you?
You take the minutes, tend the flowers,
and type away for endless hours.
Help patients with travels to here and yonder,
with all you do there is no one we hold fonder
then all of you
and that’s the truth!
So a special thank you goes out to Tricia and Kris and Jacqui and Terri
and also a thank you to Easton and Mary.
You keep our clinic ship into shape
And know where and how to find us when we try to escape!
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