Letter: Mouth ulceration and slow-release potassium tablets

Injuries at the BMX Cycling European Championship, 1989

At the BMX Cycling European Championship in 1989 with 976 participants of both sexes, aged between six and 40 years, all injuries were registered. A total of 6.3% of the participants sustained injuries (1.6% per individual start), 52.5% required medical attendance and 3.3% necessitated hospital admission. Women were injured twice as frequently as men. Most injuries, 72.1%, were minor, 6.6% were fractures with 75% of the fractures affecting the upper limbs. BMX bicycle riding has the high injury risk of 1190 injuries per 1000 competition hours.

Pouching of medications in the mouth: a case report

Foods or medicines can be pouched or held in the mouth to prolong taste, enjoyment, or effect. This article describes a patient who pouches medications. The oral injury that occurred from this behavior is reported.

Jejunal perforation possibly induced by slow-release potassium in a patient with Crohn's disease

A case of small bowel ulceration and perforation possibly due to therapy with Klotrix in a patient with Crohn's disease is presented. Following emergent surgery with creation of a diverting loop jejunostomy, subsequent reestablishment of intestinal continuity was carried out with excellent clinical results. Gastrointestinal mucosal lesions possibly due to wax-matrix potassium chloride preparations are reviewed.

The effect of oral potassium chloride on upper gastrointestinal mucosa in healthy subjects: healing of lesions despite continuing treatment

The effects of two dosage forms of wax-polymer matrix potassium chloride on the upper gastrointestinal mucosa were compared with placebo in 44 healthy volunteers. After 2 weeks of potassium chloride treatment, mucosal toxicity was observed. There was no correlation between the presence of lesions and symptoms. Six of seven volunteers with lesions healed spontaneously despite continuing treatment with potassium chloride.

Effects on upper gastrointestinal mucosa of three delivery systems of potassium as supplement to frusemide administration

Thirty healthy volunteers were recruited into a study to determine the effects on the gastrointestinal mucosa of 3 different delivery systems of oral potassium supplementation associated with diuretic therapy (Diumide-K ContinusR tablets, Napp; Lasikal tablets, Hoechst; Lasix and Slow-KR tablets, Hoechst, Ciba). The volunteers were gastroscoped initially and after one week of treatment with one of the three therapies. There was a 60% incidence of erosions in the Lasix + Slow-K group, a 40% incidence in the Lasikal group, but no erosions in the group receiving Diumide-K Continus tablets. It is therefore concluded that Diumide-K Continus tablets incorporate the potassium in a delivery system which is unlikely to cause disruption to the gastrointestinal mucosa.

Current approaches to management of potassium deficiency

Current issues related to oral potassium supplementation are reviewed, with emphasis on recommendations for the appropriate use of potassium supplementation for both replacement and preventive therapy. Dietary potassium intake, potassium-sparing diuretics, and the various forms of oral potassium supplements are reviewed in terms of indications for use, advantages, and limitations. Attention is given to controversial areas, i.e., gastrointestinal tolerance of controlled-release potassium oral dosage preparations and the need for potassium supplementation in hypertensive patients treated with diuretics.

Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial

The effects of a new microencapsulated potassium chloride formulation on upper gastrointestinal tract mucosa was compared with that of a popular wax-matrix formulation in 48 healthy volunteers. After a week of KCl, subjects were gastroscoped, the endoscopist being blind to the type of preparation taken. Wax-matrix formulations were associated with a higher incidence of upper gastrointestinal lesions. The lesions were not accompanied by epigastric symptoms. Glycopyrrolate, given to some volunteers to decrease gastric emptying, aggravated the effects of potassium chloride.

Preparation and release characteristics of potassium chloride microcapsules

The release characteristics of potassium chloride was studied when it was coated with a selection of polymers; from the results obtained, a suitable batch was microencapsulated using a gelatin-gum arabic coacervate system. The microencapsulated product offers better controlled release for this drug when compared to standard table and powder forms.

Bioavailability of potassium from controlled-release tablets with and without water loading

The relative availability of potassium from a controlled-release multiple-units tablet (Kalinorm) and a single-unit tablet (Slow-K) were compared in 13 volunteers on a low potassium diet (less than 30 mmol), by observing changes in urinary potassium excretion after administration of a single dose of 32 mmol potassium, either with or without water loading. Irrespective of procedure, the two products had the same extent of availability. The use of water loading, and special precautions about the level of dietary potassium and its composition when studying urinary potassium excretion, are discussed. It is suggested that water loading should be avoided when investigating the rate of potassium excretion.

Complications of "slow-K" therapy

(1) The failure of ;Slow-K' tablets to disintegrate prevents rapid release but allows them to be trapped by their bulk in the intestine.(2) Two cases are reported. In the first the tablet was trapped in a caecal diverticulum and the patient developed an abcess. In the second, abdominal pain developed which subsided when ;Slow-K' was stopped. Later ;Slow-K' was again started and the patient developed dysphagia.(3) The possibility of abdominal complications with this treatment should be remembered.(4) Effervescent KC1 preparations may replace ;Slow-K' but KC1 supplementation may be necessary only in cardiac disease.