Oral Liquid Potassium Chloride Dosing Pathway in a Tertiary Care Veteran Affairs Academic Medical Center

Synergistic Machine Learning Accelerated Discovery of Nanoporous Inorganic Crystals as Non-Absorbable Oral Drugs

Machine learning (ML) has taken drug discovery to new heights, where effective ML training requires vast quantities of high-quality experimental data as input. Non-absorbable oral drugs (NODs) have unique safety advantage for chronic diseases due to their zero systemic exposure, but their empirical discovery is still time-consuming and costly. Here, a synergistic ML method, integrating small data-driven multi-layer unsupervised learning, in silico quantum-mechanical computations, and minimal wet-lab experiments is devised to identify the finest NODs from massive inorganic materials to achieve multi-objective function (high selectivity, large capacity, and stability). Based on this method, a NH4-form nanoporous zeolite with merlinoite (MER) framework (NH4-MER) is discovered for the treatment of hyperkalemia. In three different animal models, NH4-MER shows a superior safety and efficacy profile in reducing blood K+ without Na+ release, which is an unmet clinical need in chronic kidney disease and Gordon's syndrome. This work provides a synergistic ML method to accelerate the discovery of NODs and other shape-selective materials.

Geriatric Pharmacotherapy Case Series: Thiazide-Induced Hypokalemia

Introduction The patient was a 72-year-old man with a history of hypertension, hyperlipidemia, benign prostatic hyperplasia, and oropharyngeal cancer. His home medications include amlodipine, atorvastatin, hydrochlorothiazide, and tamsulosin. He lives alone and eats a soft, bland, nutrient-poor diet. During his annual primary care visit, he is found to have a serum potassium level of 3.3 mEq/L (reference range 3.5-5.0). Assessment The use of hydrochlorothiazide, a thiazide diuretic, as well as his low consumption of dietary potassium, have likely contributed to his mild, asymptomatic hypokalemia. Outcome The patient’s serum potassium normalizes following replenishment with a 10 mEq microencapsulated potassium chloride (KCl) extended release (ER) tablet three times a day with meals for one week. A registered dietitian was consulted to provide recommendations for a well-balanced diet, consistent with his dietary texture needs. Conclusions Hypokalemia is a commonly encountered electrolyte disorder, occurring in about 3 to 4% of community-dwelling elders.1 Though asymptomatic hypokalemia is often an incidental finding, it is associated with an increased risk of major adverse cardiovascular events if left untreated and thus should be promptly corrected when discovered.2

Impaired Absorption of Extended-Release Potassium Chloride in a Patient With a High-Output Ileostomy

BACKGROUND

Best practices in the management of ileostomies include use of immediate release (IR) medications and elimination of enteric coated and prokinetic agents. Extended-release (ER) potassium chloride is designed for postpyloric release rather than colonic absorption and is postulated to be an appropriate option for potassium repletion in this patient subset.

CASE

We present a patient with an ileostomy who received intravenous ER and IR oral potassium chloride supplementation following diverting loop ileostomy. Clinical responsiveness to ER potassium chloride was poor; 15 to 40 mEq was required to replace 0.1 mEq/L of potassium. However, upon transition to IR potassium chloride, only 6.67 mEq was required to replace 0.1 mEq/L of potassium.

CONCLUSIONS

Our experience in this case suggests that patients with surgical alterations to their gastrointestinal tracts who fail to have expected rises in serum potassium levels may benefit from early conversion to IR potassium chloride.