The potential for current sodium and potassium production to support a global switch to the use of potassium-enriched salt: a desktop research study

OBJECTIVE

Switching regular salt (sodium chloride) for salt enriched with potassium chloride (25% potassium chloride, 75% sodium chloride) has been shown to reduce blood pressure and the risk of cardiovascular diseases. We sought to define the potential for current production of sodium chloride and potassium chloride to support a global switch to the use of potassium-enriched salt.

DESIGN

We summarised data from geological surveys, government reports and trade organisations describing the global production and supply of sodium chloride and potash (the primary source of potassium chloride) and compared this to potential requirements for potassium-enriched salt.

SETTING

Global.

SUBJECTS

N/A.

RESULTS

Approximately 280 million tonnes of sodium chloride were produced in 2020 with China and the United States the main producers. Global production of potash from which potassium chloride is extracted was about 44 million tonnes with Canada, Belarus, Russia and China providing 77% of the world's supply. There were 48 countries in which potassium-enriched salt is currently marketed with 79 different brands identified. Allowing for loss of salt between manufacture and consumption, a full global switch from regular salt to potassium-enriched salt would require about 9.7 million tonnes of sodium chloride to be replaced with 9.7 million tonnes of potassium chloride annually.

CONCLUSIONS

Significant up-scaling of the production of potassium chloride and the capacity of companies able to manufacture potassium-enriched salt, as well as a robust business case for the switch to potassium chloride, would be required.

Potassium Chloride as an Effective Alternative to Sodium Chloride in Delaying the Thermal Aggregation of Liquid Whole Egg

The potential of potassium chloride (KCl) to be used as a substitute for sodium chloride (NaCl) was studied by monitoring the effects of salt treatment on thermal behavior, aggregation kinetics, rheological properties, and protein conformational changes. The results show that the addition of KCl can improve solubility, reduce turbidity and particle size, and positively influence rheological parameters such as apparent viscosity, consistency coefficient (K value), and fluidity index (n). These changes indicate delayed thermal denaturation. In addition, KCl decreased the content of β-sheet and random coil structures and increased the content of α-helix and β-turn structures. The optimal results were obtained with 2% KCl addition, leading to an increase in Tp up to 85.09 °C. The correlation results showed that Tp was positively correlated with solubility, α-helix and β-turn but negatively correlated with ΔH, turbidity, β-sheet and random coil. Overall, compared to NaCl, 2% KCl is more effective in delaying the thermal aggregation of LWE, and these findings lay a solid theoretical foundation for the study of sodium substitutes in heat-resistant liquid egg products.

An unusual stroke mimic: A case report

Hypokalaemic paralysis is a rare disorder characterized by rapid onset of symmetrical flaccid skeletal muscle weakness in the presence of reduced serum potassium levels. It is categorized as primary or secondary depending on the aetiology. Asymmetric or unilateral muscle weakness in hypokalaemic patients is a rare presentation. In patients with comorbid cardiovascular risk factors, this atypical manifestation can mimic acute stroke. Only a few of such cases have been reported in the literature. This report discusses the case of a 46-year-old hypertensive Ghanaian woman who presented to a District Hospital with sudden-onset right-sided flaccid weakness and a high blood pressure. Acute stroke was ruled out with computed tomography scan of the brain. Further laboratory evaluation demonstrated reduced serum potassium level, which was corrected with subsequent dramatic resolution of the muscle weakness.

Successful Non-surgical Management of Cesarean Scar Pregnancy

Ectopic pregnancy in the scar of a previous cesarean section contributes to significant maternal morbidity in the first trimester due to a significantly higher risk of uterine rupture if left undetected. The routine scans done in the first trimester serve as an important screening tool in the detection of such an ectopic pregnancy. Early detection can aid in making a paradigm shift from a surgical to a more conservative approach for the management of such pregnancies. Here, we report a case of a cesarean scar pregnancy diagnosed in the sixth week of gestation which was managed non-surgically with methotrexate and intracardiac potassium chloride injection.

Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

BACKGROUND

Although acute diarrhoea is a self-limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea.

OBJECTIVES

To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022.

SELECTION CRITERIA

We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma-Lyte with 0.9% saline solution, for rapid rehydration.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2.

MORTALITY

Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8.

ADVERSE EVENTS

We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

Characteristics of the included studies We included five studies with 465 children. Data for meta-analysis were available from 441 children. Four studies were conducted in low- and middle-income countries and one study in two high-income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma-Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) -0.35 days, 95% confidence interval (CI) -0.60 to -0.10; 2 studies; moderate-certainty evidence). However, the evidence is very uncertain about the effect of the balanced solutions on mortality during hospitalization in severely dehydrated children (risk ratio (RR) 0.33, 95% CI 0.02 to 7.39; 1 study, 22 children; very low-certainty evidence). Secondary outcomes Balanced solutions probably produce a higher increase in blood pH (MD 0.06, 95% CI 0.03 to 0.09; 4 studies, 366 children; low-certainty evidence) and bicarbonate levels (MD 2.44 mEq/L, 95% CI 0.92 to 3.97; 443 children, four studies; low-certainty evidence). Furthermore, balanced solutions likely reduces the risk of hypokalaemia after the intravenous correction (RR 0.54, 95% CI 0.31 to 0.96; 2 studies, 147 children; moderate-certainty evidence). Nonetheless, the evidence suggests that balanced solutions may result in no difference in the need for additional intravenous fluids after the initial correction; in the amount of fluids administered; or in the mean change of sodium, chloride, potassium, and creatinine levels.

AUTHORS' CONCLUSIONS

The evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, balanced solutions likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalaemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference between balanced solutions and 0.9% saline in the incidence of hyponatraemia.

Corrigendum

In the paper by Yamashita et al. [Acta Cryst. (2022), C78, 749-754], an incorrect phrase is updated.

Cation Composition Influences the Toxicity of Salinity to Freshwater Biota

The effects of salinization on freshwater ecosystems have been estimated by testing sodium chloride (NaCl) since it is the most widely used salt as a deicing agent and Na⁺ and Cl^- ions are the most representative in seawater composition. However, calcium, magnesium, and/or potassium are starting to be proposed as potential surrogates for NaCl, but for which ecotoxicological effects are less explored. This study aimed to identify (i) the less toxic salt to freshwater biota to be suggested as a safer alternative deicer and (ii) to contribute to the lower tiers of salinity risk assessment frameworks by identifying a more suitable surrogate salt than NaCl. The battery of ecotoxicity assays with five key trophic level species showed that among the tested salts (MgCl₂, CaCl₂, and KCl), KCl and CaCl₂ seemed to induce the highest and lowest toxicity, respectively, compared with NaCl. CaCl₂ is suggested as a safer alternative for use as a deicer and KCl as a surrogate for the risk assessment of seawater intrusion in coastal regions. These results enrich the salt toxicity database aiming to identify and propose more suitable surrogate salts to predict the effects of salinization to a broader extent.

Hydrate formation at extreme conditions

The article of Yamashita et al. [Acta Cryst. (2022), C78, 749–754] on water intercalation into the B1 structure of KCl under high pressure illustrates the ability of in situ crystal growth to by-pass kinetic barriers between phases, demonstrating the importance of this approach in phase discovery.

Impact of Different Crystalloids on the Blood Glucose Levels of Nondiabetic Patients Undergoing Major Elective Surgeries

Background This study aimed to compare intraoperative blood sugar level fluctuations between a group of patients receiving Ringer's lactate (RL) fluid as maintenance fluid and another group receiving 0.45% dextrose normal saline with 20 mmol/liter potassium. Materials and methods  This randomized double-blind study was conducted on 68 nondiabetic patients undergoing elective major surgeries at R. Laxminarayanappa Jalappa Hospital, Sri Devaraj Urs Medical College, Kolar, during the academic year from Jan 2021 to May 2022. Informed consent was obtained from these patients concerning their participation in this study. There were two groups of patients: Ringer lactate (RL) was administered to group A, and 0.45% dextrose normal saline and 20 mmol/L potassium chloride (KCl) were administered to group B. The vitals and blood glucose levels were measured among the patients. A p-value of 0.05 was considered statistically important. Results The mean age of the patients was found to be 43.60 ± 15 years, with comparable age and gender distribution between the groups. On comparison of the mean blood glucose levels immediately after induction was not important between the groups. The mean levels were comparable between the groups (p>0.05). After completion of the surgery, the mean blood glucose level significantly increased in group B patients when compared to those in group A (p<0.05). Conclusion The study found a substantial increase in intraoperative blood glucose levels among patients receiving 0.45% dextrose normal saline with 20 mmol/liter potassium instead of RL solution as maintenance fluid.

Crystal structure of potassium chloride monohydrate: water intercalation into the B1 structure of KCl under high pressure

A new hydrate form of potassium chloride, KCl·H₂O, is identified for the first time by in situ single-crystal X-ray diffraction under high pressure. It has a monoclinic structure with lattice parameters of a = 5.687 (7), b = 6.3969 (3), c = 8.447 (3) Å and β = 107.08 (8)° at 2.23 (4) GPa and 295 K. The structure of this hydrate has K-Cl alignments similar to the B1 phase of anhydrous KCl, while water molecules intercalate among the ionic species. The coordination structures of the K and Cl atoms can be regarded as the intermediate states between the B1 and B2 phases of KCl. This finding provides a perspective on the structural interpretation of multicomponent materials and an additional candidate for bound water in salt-water systems under high pressure, such as inside of icy bodies.

Development of an In Vitro Drug Release Method to Enable In Vitro-In Vivo Correlation of Potassium Chloride Extended-Release Tablets

An in vitro drug release test was developed to establish a level A in vitro-in vivo correlation (IVIVC) for predicting the in vivo performance of potassium chloride extended-release (ER) matrix tablets. Three ER formulations of potassium chloride with different in vitro release rates were designed using the USP dissolution test, and their urinary pharmacokinetic profiles were evaluated in healthy subjects. Due to the lack of IVIVC with the USP method, experiments were designed to investigate the effects of in vitro test conditions on drug release in order to match in vitro drug release with in vivo behaviors of different formulations. The evaluated in vitro variables included the type of USP apparatus, surfactant, and ionic strength of the dissolution medium. Based on the study findings and data analysis, a discriminatory drug release method was successfully developed that enabled the establishment and validation of a level A IVIVC model of the potassium chloride ER tablet using urinary pharmacokinetic data. This method uses USP apparatus I at 50 rpm in 900 mL of 150 mM NaCl solution containing 40 mM sodium dodecyl sulfate at 37 °C. The current study highlights the value of investigating test conditions in developing a predictive in vitro test method for establishing IVIVC.

Effects of Short-Term Potassium Chloride Supplementation in Patients with CKD

BACKGROUND

Observational studies suggest that adequate dietary potassium intake (90-120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown.

METHODS

This is a prespecified analysis of the run-in phase of a clinical trial in which 191 patients (age 68±11 years, 74% males, 86% European ancestry, eGFR 31±9 ml/min per 1.73 m2, 83% renin-angiotensin system inhibitors, 38% diabetes) were treated with 40 mmol potassium chloride (KCl) per day for 2 weeks.

RESULTS

KCl supplementation significantly increased urinary potassium excretion (72±24 to 107±29 mmol/day), plasma potassium (4.3±0.5 to 4.7±0.6 mmol/L), and plasma aldosterone (281 [198-431] to 351 [241-494] ng/L), but had no significant effect on urinary sodium excretion, plasma renin, BP, eGFR, or albuminuria. Furthermore, KCl supplementation increased plasma chloride (104±3 to 105±4 mmol/L) and reduced plasma bicarbonate (24.5±3.4 to 23.7±3.5 mmol/L) and urine pH (all P<0.001), but did not change urinary ammonium excretion. In total, 21 participants (11%) developed hyperkalemia (plasma potassium 5.9±0.4 mmol/L). They were older and had higher baseline plasma potassium.

CONCLUSIONS

In patients with CKD stage G3b-4, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. This may result in hyperkalemia in older patients or those with higher baseline plasma potassium. Longer-term studies should address whether cardiorenal protection outweighs the risk of hyperkalemia.Clinical trial number: NCT03253172.

Microbial Safety and Sensory Analyses of Cold-Smoked Salmon Produced with Sodium-Reduced Mineral Salts and Organic Acid Salts

Cold-smoked (CS) salmon contains high levels of sodium salts, and excess dietary sodium intake is associated with an array of health complications. CS salmon may also represent a food safety risk due to possible presence and growth of the foodborne pathogen Listeria monocytogenes which may cause fatal human infections. Here we determine how reformulated CS salmon using commercial sodium-reduced salt replacers containing KCl (e.g., Nutek, Smart Salt, SOLO-LITE) and acetate-based preservative salts (Provian K, proviant NDV) affect sensory properties, quality, and microbial safety. Initial sensory screening of sodium-reduced CS salmon was followed by L. monocytogenes growth analyses in selected variants of reformulated CS salmon, and finally by analyses of CS salmon variants produced in an industrial smokehouse. Projective mapping indicated overall minor sensory changes in sodium-replaced samples compared with a conventional product with NaCl. Growth of L. monocytogenes was temperature-dependent (4 °C vs. 8 °C storage) with similar growth in sodium-reduced and conventional CS salmon. The addition of 0.9% of the preservative salts Provian K or Provian NDV gave up to 4 log lower L. monocytogenes counts in both sodium-reduced and conventional cold-smoked salmon after 29 days of chilled storage. No changes in pH (range 6.20−6.33), aw levels (range 0.960−0.973), or weight yield (96.8 ± 0.2%) were evident in CS salmon with salt replacers or Provian preservative salts. Analyses of CS salmon produced with selected mineral salt and preservative salt combinations in an industrial salmon smokery indicated marginal differences in sensory properties. Samples with the preservative salt Provian NDV provided L. monocytogenes growth inhibition and low-level total viable counts (<2.8 log/g) dominated by Photobacterium and Carnobacterium during storage. Production of sodium-reduced CS salmon with inhibiting salts provides a simple method to achieve a healthier food product with increased food safety.

Effect of Packaging and Salt Content and Type on Antioxidant and ACE-Inhibitory Activities in Requeson Cheese

Requeson cheese is obtained from whey proteins. The production of this cheese is the most economical way to recover and concentrate whey proteins, which is why it is frequently made in some Latin American countries. Four requeson cheese treatments were prepared with different concentrations and combinations of salts (sodium chloride and/or potassium chloride) and were conventionally or vacuum packed. Proteolysis, peptide concentration, angiotensin-converting enzyme (ACE) inhibitory and antioxidant (DPPH and ABTS) activities were evaluated over time (one, seven and fourteen days). Requeson cheese presented antioxidant and ACE inhibitory activities, however, these values vary depending on salt addition, type of packaging and time of storage. The highest values of antioxidant activity (ABTS) were found in cheese added with 1.5% NaCl and 1.5% (NaCl/KCl, 1:1). Cheese without added salt and vacuum packed presented the highest ACE inhibition percentage at day seven. Therefore, it can be concluded that requeson cheese elaborated exclusively of sweet whey, presents antioxidant and ACE inhibition activity. However, for a cheese with ACE inhibitory capacity, it is recommended not to add salts or add at 1% (NaCl) and vacuum pack it. Additionally, for a cheese with antioxidant activity, it is recommended to add salt at 1.5% either NaCl or (1:1) NaCl/KCl and pack it either in a polyethylene bag or vacuum. In conclusion, requeson cheese elaborate with 100% sweet whey is a dairy product with antioxidant and ACE inhibition activity, being low in salt and fat.

Thermal Stability, Optical Properties, and Gamma Shielding Properties of Tellurite Glass Modified with Potassium Chloride

The synthesized glass system with a composition of (80-x) TeO2-10P2O5-10Nb2O5-xKCl mol% (where x = 5, 10, 15, 20, and 25) was successfully fabricated. The density (ρ) and molar volume (Vm) have been calculated. The investigated glasses were characterized using different analysis methods (differential thermal analysis (DTA) and UV-VIS-NIR spectroscopy). The radiation shielding effectiveness of the synthesized glass system was evaluated using different shielding parameters, such as mass and linear attenuation coefficients (MAC, LAC), half-value layer (HVL), mean free path (MFP), effective atomic number (Zeff), and effective electron number (Neff). The results showed that with the increasing potassium chloride (KCl) concentration and decreasing tellurium oxide (TeO2) concentration, the density, refractive index, Urbach energy (Eu), and glass transition temperature (Tg) decreased, while the optical energy gap (Eopt) and thermal stability increased. As the KCl concentration increases, the values of MAC, LAC, and Zeff increase in the following order: TPNK5 % > TPNK10 % > TPNK15 % > TPNK20 % > TPNK25 %. Additionally, the shielding effectiveness of TPNK glass system showed good performance compared with some standard materials. The synthesized glass with a minimum KCl content has both good shielding effectiveness and good optical properties, in addition to reasonable thermal stability, which makes it suitable for shielding and optical applications.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

The Use of Potassium Chloride and Tapioca Starch to Enhance the Flavour and Texture of Phosphate- and Sodium-Reduced Low Fat Breakfast Sausages Manufactured Using High Pressure-Treated Meat

The objective of this study was to investigate the use of potassium chloride (KCl) and tapioca starch (TS) to reduce salt levels below 1.5% in sausages manufactured using previously high pressure (HP) processed pork (150 MPa). A 3 × 2 × 1 factorial design was used to formulate breakfast sausages with three salt levels (0.5%, 1.0%, and 1.5%), two ingredient levels (no added ingredient or added as a combination of KCl\TS), and one pressure level (150 MPa). Partial replacement of NaCl with KCl and addition of TS had beneficial effects on the water binding abilities of sausage batters by decreasing (p < 0.05) total expressible fluid (%) and increasing water holding capacity (%). Overall, results indicated that the use of KCl\TS imparted some beneficial effects to salt-reduced low fat breakfast sausages and has the potential to reduce salt levels in the breakfast sausages to 1.0% while still maintaining the organoleptic and functional properties traditionally associated with these meat products.

Extravasation of Concentrated Potassium Chloride: A Case Report

Background

The extravasation of potassium chloride will cause serious harm, especially if it is not diagnosed or treated promptly. Objective:to report the clinical course of a patient who was suffering a potassium extravasation and to discuss steps that can be done to decrease the chances of this event from occurring in other patients.

Methods

After discontinuation of infusion device and withdrawal of intravenous catheter, wet packing with magnesium sulfate and local injection of papaverine and lidocaine were applied.

Results

After 11 days, the extravasation injury had recovered.

Conclusions

To avoid a repeat of such an adverse event, proper sites for administering, accurate dilution of potassium chloride solutions, close observation, and increased awareness of trained personnel of extravasation dangers are vital. Once extravasation occurs, timely wet application with magnesium sulfate and local injection of papaverine and lidocaine may have been useful in producing a favorable recovery.

Clinical Course of 60 Cesarean Scar Pregnancies

Early diagnosis and therapy are important in a cesarean scar pregnancy (CSP), which can cause uterine rupture with resultant massive bleeding. However, there are some reports of CSPs continued to term. The optimal management of CSPs remains unclear; therefore, we investigated the clinical courses of CSPs diagnosed and treated at perinatal institutions in the Chugoku and Shikoku regions of Japan. We enrolled 60 women diag-nosed with CSP at 21 institutions from January 2006 to December 2015. Of the 60 women diagnosed with CSP, 57 were treated. Pregnancy was terminated in 48 women and continued in 9. Thirteen women underwent transabdominal hysterectomy; they experienced no postoperative complications or allogeneic blood transfu-sion. Nine women received therapies such as dilation and curettage, and 26 received non-surgical therapies such as methotrexate and topical administration of potassium chloride. Among 9 women who chose to con-tinue with their CSP, 7 successfully delivered newborns, 2 had uterine ruptures in the second trimester, and all women required transabdominal hysterectomy. Diagnosis and therapy in the first trimester of pregnancy are important in the management strategy of a CSP. When continuing a CSP, the risk of uterine rupture and trans-abdominal hysterectomy must be considered.

Potassium chloride-based replacers: modeling effects on sodium and potassium intakes of the US population with cross-sectional data from NHANES 2015-2016 and 2009-2010

BACKGROUND

Sodium intake in the USA exceeds recommendations. The replacement of added sodium chloride (NaCl) with potassium chloride (KCl) provides a potential strategy to reduce sodium intake.

OBJECTIVE

The purpose of this study was to quantitatively estimate changes in intakes of sodium and potassium by the US population assuming use of potassium-based NaCl replacers in top dietary sodium sources.

METHODS

Data collected in the What We Eat in America (WWEIA) component of the 2015-2016 and 2009-2010 NHANES were used to identify top-ranking sources of dietary sodium among the population aged 2 y and older based on contributions from food categories aligning with the FDA draft guidance for voluntary sodium reduction. Predicted nutrient intakes were estimated in models assuming total and feasible and practical (F&P) replacement of added NaCl with KCl in foods and ingredients within the top food sources of sodium. An expert elicitation was conducted to collect information on the F&P KCl replacement of added NaCl.

RESULTS

Using 2015-2016 consumption data, the total replacement of added NaCl with KCl in the 18 top-ranking sources of dietary sodium results in a predicted sodium intake of 2004 mg/d from the replacement of 1406 mg/d sodium with 1870 mg/d potassium as KCl. Modeled F&P replacement predicted sodium intakes of 3117 mg/d (range of 2953 to 3255 mg/d) from the replacement of 294 mg/d sodium (155 to 457 mg/d) with 390 mg/d potassium (206 to 608 mg/d). Similar results are seen with 2009-2010 data.

CONCLUSIONS

The F&P replacement of NaCl with KCl in top-ranking sources of dietary sodium modeled in this study can result in decreased sodium to a level consistent with the short-term intake goal targeted by the FDA of 3000 mg/d, with the mean potassium intake remaining in the range recommended for the apparently healthy population.

A simple and rapid HPLC method for determination of parabens and their degradation products in pharmaceutical dosage forms

A stability-indicating HPLC method was developed for the simultaneous determination of paraben mixture and its degradation products in effervescent potassium chloride tablets. The chromatographic separation was achieved on a Waters Cortecs C18 column (2.7 μm, 4.6 × 150 mm) using gradient elution. The optimized mobile phase consisted of 0.1% orthophosphoric acid in purified water as solvent A and purified water, acetonitrile, and orthophosphoric acid (100:900:1, v/v) as solvent B. The flow rate was 0.8 mL/min, and column temperature was maintained at 35°C. The injection volume was 10 μL, and UV detection was carried out at 254 nm. The selectively developed method has optimal separation among p-hydroxybenzoic acid, methylparaben, ethylparaben, propylparaben, and butylparaben peaks in the presence of specified and unspecified degradation products in the determination of drug product. The mass balance obtained from forced degradation studies was ≥95% and thus proves the stability-indicating property of the developed method. The developed reversed-phase HPLC method has been validated according to the International Conference on Harmonization guidelines. The correlation coefficients for all the peaks were >0.9999. The results of the other validation parameters were found within the limits. Finally, the optimized method was used in the quality control lab for stability analysis.

Salt Replacement Changed the Bacterial Community Composition and Physicochemical Characteristics of Sodium-Reduced Fermented Sausages during Fermentation and Ripening

The impact on fermented sausages with 25% replacement of the sodium chloride content by 14% potassium chloride, 10% calcium ascorbate and 1% calcium glutamate during fermentation and ripening was evaluated based on the bacterial community composition and physicochemical and sensory characteristic analysis. Our results showed that the use of salt replacement varied the composition of the bacterial community and reduced the diversity of that in sodium-reduced fermented sausages. Moreover, the decrease in pH and the moisture content of fermented sausages with salt replacement accelerated the drying and ripening processes. The texture profile and color analysis did not reveal marked differences between normal fermented sausages and sodium-reduced products with salt replacement; however, salt replacement reduced resilience and lightness of fermented sausages. In addition, as shown in the principal component analysis, the comprehensive parameters of the fermented sausages with salt replacement were similar to those of normal salt products. These results indicate that the complex blends of salt replacement have great potential to be used to produce sodium-reduced fermented sausages.

Reduction of Sodium Intake from Papaya Salad with the Use of Sodium-Reduced Fermented Fish in Producing Traditional Seasoning Sauce

Fermented fish is a common seasoning used in Northeastern Thailand and Laos to give food a salty taste. It is also used as a basic ingredient for preparing various seasoning sauces for many local dishes. This study examined the effect of sodium reduced fermented fish (SRFF) on reducing the sodium content in prepared traditional papaya salad. Three local producers provide fermented fresh water fish produced with either normal salt (FF) or 60% sodium-reduced salt (SRFF) that were then used by 3 local sauce producers to make papaya salad seasoning sauces. Three local street food vendors then were used these sauces as the main ingredients for preparing their papaya salads. Sodium contents of the FFs, SRFFs, and papaya salads were analyzed using Inductively Coupled Plasma-Optical Emission Spectrometer. Significant differences between sodium contents in sauces and papaya salads were evaluated using the t-test. Results showed that the SRFF contained 54% less sodium than the FF, while sodium in the SRFF sauces was approximately 42% less than from FF sauces. The papaya salads prepared from SRFF sauces contained on average 492±27 mg sodium per 100 g, which was 33% lower than those prepared from FF sauces. The use of SRFF could significantly reduce sodium content in traditional papaya salad by up to one-third, which could be beneficial in lowering the risk of hypertension among Norteastern Thai and Laotain people with minimal change in eating behaviors.

Comparison of Effects of Sodium Chloride and Potassium Chloride on Spray Drying and Redispersion of Cellulose Nanofibrils Suspension

Cellulose nanofibrils (CNFs) were exposed to the same levels of potassium chloride (KCl) and sodium chloride (NaCl) before being subjected to spray drying. The effect of NaCl and KCl on the size of atomized droplets and the hydrogen bond retardation between CNFs was investigated by characterizing product morphology, particle size distribution, dispersion stability in aqueous system, and surface chemistry. The results showed that the CNF suspensions treated with KCl could be atomized into smaller droplets during spray drying, and then CNF powder with smaller sizes could be obtained. As the agglomeration was less, and the CNF with KCl addition had good dispersion stability after redispersion compared with CNF treated by NaCl. Therefore, KCl treatment was an effective method to reduce the agglomeration of CNF during spray drying.

Concomitant oral potassium chloride and anticholinergic therapy is associated with upper gastrointestinal bleeding: A cohort study

AIM

To determine whether oral potassium chloride (KCI) therapy with concomitant anticholinergic exposure among hospitalized patients is associated with an excess risk for upper gastrointestinal bleeding (UGIB).

METHODS

A retrospective controlled study among hospitalized patients between January 2007 and April 2019 who were treated with oral KCI. Patients were divided into two groups: with or without concomitant exposure to agents with anticholinergic activity. Outcome was defined as any UGIB.

RESULTS

The final sample included 13 728 subjects who received oral KCI treatment, of them 3542 (25.8%) had at least one documented overlap with an anticholinergic agent. Mean age was 67.6 (±17.2) and 6893 (50.2%) were females. Median KCI dose was 2.4 g (interquartile range [IQR] 1.2-5.4, n = 9416) with the majority (90.4%) being treated with the wax-matrix form (Slow-K). Twenty-six (0.2%) patients experienced an UGIB event. Univariate analysis demonstrated a significantly higher rate of UGIB among patients concomitantly treated with oral KCI and anticholinergics (0.3%) compared to those without anticholinergic exposure (0.1%, P = 0.018), with median 7 days (IQR 3-16.8) from first KCI dose to bleeding event. Multivariate analysis demonstrated that concomitant anticholinergic exposure (Odds Ratio 2.48, 95% Confidence Interval 1.11-6.51, P = 0.022) and anticoagulation treatment among patients with hemato-oncologic disease (OR 6.61, 95% CI 1.96-22.25, P = 0.002) were significantly associated with UGIB.

CONCLUSION

Hospitalized patients treated concomitantly with oral KCI and anticholinergic agents have significantly increased risk for UGIB.

Quantification of Process Lethality (5-Log Reduction) of Salmonella and Salt Concentration during Sodium Replacement in Biltong Marinade

Salt (sodium chloride, NaCl) is commonly used in ready-to-eat (RTE) meat products such as biltong, a South African style dried beef product for flavor, enhanced moisture loss, and reduction of microbial growth. However, increased consumption of high sodium content foods is commonly associated with high blood pressure and heart disease. This study evaluated the use of alternative salts, potassium chloride (KCl) and calcium chloride (CaCl₂) in the biltong marinade to achieve a ≥ 5-log reduction of Salmonella, a pathogen of concern in beef products. Beef pieces (1.9 cm × 5.1 cm × 7.6 cm) were inoculated with a five-serovar mixture of Salmonella (Salmonella Thompson 120, Salmonella Enteritidis H3527, Salmonella Typhimurium H3380, Salmonella Heidelberg F5038BG1, and Salmonella Hadar MF60404), vacuum-tumbled in a traditional biltong marinade of salt, spices, and vinegar containing either NaCl, KCl or CaCl₂ (2.2% concentration) followed by an 8-10 day drying period at 23.9 °C (75 °F) and 55% relative humidity. Microbial enumeration of Salmonella was conducted following inoculation, after marination, and after 2, 4, 6, 8, and 10 days of drying in a humidity/temperature chamber. Biltong produced with CaCl₂, NaCl, or KCl achieved a > 5-log reduction of Salmonella after 6, 7, and 8 days, respectively. The Salmonella reduction trends with biltong made with NaCl or CaCl₂ were not significantly different (p < 0.05) while both were significantly different from that made with KCl (p > 0.05). Sodium, calcium, and potassium ion concentrations were measured using ion-specific electrode meters following biltong processing and drying. As expected, the biltong made with the corresponding salt had the most abundant ion in the sample. Regardless of the salt used in the marinade, the potassium ion levels were moderately elevated in all samples. This was determined to be from potassium levels naturally present in beef rather than from other ingredients. Sampling of several commercial brands of biltong for sodium content showed that some were significantly above the allowable level of claims made on package ingredient statements. The substitution of NaCl with KCl or CaCl₂ during biltong processing can also provide a 5-log reduction of Salmonella to produce a safe product that can be marketed as a more healthy low-sodium food alternative that may appeal to consumers who need to reduce their blood pressure and are conscientious of sodium levels in their diet.

The pretreatment of rats with nebivolol ameliorates bladder contractile dysfunction caused by ischemia-reperfusion injury

OBJECTIVE

The present study aimed to investigate the protective effect of nebivolol in the bladder isolated from rats exposed to ischemia-reperfusion (IR) injury.

METHODS

Sprague-Dawley rats were divided into control, IR, and nebivolol+IR groups. In the nebivolol+IR group, nebivolol was administered (0.4 mg/kg, subcutaneous) in rats prior to IR insult. At the end of the experimental protocol, the urinary bladder was rapidly isolated and bladder strips were mounted in an organ bath. After the equilibration period, potassium chloride (KCl, 20-100 mM) or carbachol (0.01-10 μM) was cumulatively added to the organ bath to generate cumulative concentration-response curves (CCRCs). Oxidative stress and interleukin 6 (IL-6) levels were also evaluated in the bladder tissue.

RESULTS

The CCRCs of KCl and carbachol were significantly reduced in the IR group compared to those of the control, and this inhibition was reversed by the pretreatment of rats with nebivolol (P < .05). The IR group's total antioxidant status was significantly lower with a concomitant increase in IL-6 levels than that of the control and nebivolol+IR groups (P < .05).

CONCLUSIONS

The present study indicates that pretreatment of rats with nebivolol (0.4 mg/kg) could improve bladder contractile dysfunction caused by IR injury through suppression of increased oxidative stress and IL-6 levels.

Evaluation of NaCl and KCl Salting Effects on Technological Properties of Pre- and Post-Rigor Chicken Breasts at Various Ionic Strengths

The objective of this study is to evaluate the effects of NaCl and KCl salting on technological properties of pre- and post-rigor chicken breasts at various ionic strengths. The following factorial arrangement was used: 2 salt types (NaCl and KCl) × 2 rigor statuses (pre- and post-rigor) × 4 ionic strengths (0.086, 0.171, 0.257, and 0.342). Hot-boned and ground chicken breasts were salted within 30 min postmortem after slaughter (pre-rigor salting) or 24 h postmortem (post-rigor salting) with varying concentrations of NaCl (0.50%, 1.00%, 1.50%, and 2.00%) or KCl (0.64%, 1.28%, 1.91%, and 2.55%) corresponding to the four ionic strengths. KCl caused higher pH value in salted chicken breasts than NaCl (p < 0.05). However, KCl decreased total and myofibrillar protein solubilities in post-rigor salted chicken breasts compared to NaCl (p < 0.05), but those were similar to pre-rigor chicken breasts, regardless of the salt type (p > 0.05). Different salt types had no significant impact on cooking loss and textural properties. This study shows that NaCl and KCl had similar effects on technological properties at the same ionic strength (within 0.342), but the use of KCl may have the possibility to decrease protein solubility, depending on rigor status of raw meat at the different salting time.

Hypokalemia Leading to Postoperative Critical Arrhythmias: Case Reports and Literature Review

Perioperative arrhythmias can develop due to many reasons, rarely life-threatening, but hypokalemia plays an important role in their development. We report two cases of severe postoperative hypokalemia leading to ventricular fibrillation (VF). Case 1: A young healthy lady developed perioperative severe hypokalemia leading to repeated episodes of VF requiring cardiopulmonary resuscitation (CPR), direct current (DC) shock and anti-arrhythmic therapy, apart from rapid replacement of intravenous potassium. She recovered fully without any neurological or cardiac sequelae. Case 2: A 78-year-old male patient, a known case of hypertension controlled with medications developed postoperative repeated VF due to hypokalemia requiring 210 mmol of potassium chloride, antiarrhythmic therapy, DC shock, and CPR. He recovered, but complicated into acute myocardial infarction requiring therapy. Perioperative severe hypokalemia can lead to life-threatening cardiac arrhythmias. Early recognition and aggressive correction are essential for better outcomes.

Evaluation of Potassium Sources, Rates and Pattern on the Yield and Quality Traits of Fertigated Wheat Grown in Sandy Soil

BACKGROUND AND OBJECTIVE

Fertigation provide efficient method for fertilizer and irrigation of water in order to evaluate some potassium sources on wheat (Giza 168) production in sandy soil at El-Sadat City, El-Menoufia Governorate, Egypt, amid the two winter seasons 2016/2017 and 2017/2018.

MATERIALS AND METHODS

A split-split plot design in a randomized complete block arrangement was used with 3 replications. The main plots were allocated to the 2 potassium sources (potassium sulfate and potassium chloride) 3 potassium rates (60, 120 and 180 kg ha-1 K2O beside one treatment without potassium fertilization) were devoted to sub-plot and three patterns (1, 2 weeks and 1 month) were devoted to sub-sub plot.

RESULTS

The results showed that potassium had essentially influenced the yield and yield components of wheat and potassium fertilizers such as K2SO4 and KCl improved the quantity and quality of wheat. These results suggest that potassium application at 180 kg ha-1 associated with one pattern under fertigation can be good for obtaining an optimum yield of wheat.

CONCLUSION

From this study can be concluded that the potassium application influence at 180 kg ha-1 K2O gave highly yield and chemical constituents under fertigation.

Investigation on the Intrinsic Potential of Using Potassium Chloride for Partially Replacing NaCl in Kimchi and the Effect of Information on Consumer Acceptance of Sodium-Reduced Kimchi According to Age

The high sodium content of kimchi is a contradicting factor from its fame as a healthy food. With the aim of reducing the sodium content of kimchi, the objective of this study was to understand the effect of providing "sodium-reduced" information on the acceptance of kimchi according to the age of consumption. Six sodium-reduced kimchi samples, prepared with different percentages of sodium reduction (25% and 50%) and potassium chloride concentration (none, 0.47%, and 0.93%), were compared to control kimchi (2.0% w/v NaCl). Sensory characterization of the samples was obtained using descriptive analysis. A total of 167 kimchi consumers with balanced proportion of the young (below 40) and the old (above 40) evaluated seven kimchi samples in either of the two conditions: blind testing condition or informed testing condition where each of the samples was provided with a label that informed about "sodium reduction percentage" and "whether a salt replacer was used or not." The results showed that in terms of healthiness perception, Korean female consumers believed that kimchi with a high sodium reduction rate would contribute to health in general, though an unfavorable notion of using a salt replacer was also observed. Also, the results suggested that promoting information about sodium reduction in kimchi would generally increase consumer acceptance. However, this phenomenon was influenced not only by the sample for which the information was provided, but also by the age of consumers with different health interests and kimchi experience. PRACTICAL APPLICATION: The findings of this study showed simply reducing sodium and promoting it with a health claim showed limitation in achieving a high level of sodium reduction, such as a 50% reduction rate, which implied the importance of using supplementary material such as potassium chloride that can fulfill the missing saltiness and flavors of the original product. Promotion of "sodium-reduced" claims in kimchi generally results in increased consumer acceptance. However, the effectiveness of the information was dependent on which sample was provided and the age of the consumers, among whom health interests and kimchi experience differ.

Impacts of pre-rigor salting with KCl on technological properties of ground chicken breast

The objective of this study was to determine the impact of pre-rigor salting using KCl on the technological properties of ground chicken breast. Chicken breast muscle (M. pectoralis major and minor) was hot-debonded and salted with 2% NaCl (w/w), 1% NaCl+1% KCl mixture, or 2% KCl, respectively, within 30 min after slaughter. Post-rigor salting treatment was prepared with 2% NaCl at 24 h postmortem. All pre-rigor salting treatments showed higher ultimate pH, protein solubility, and final yield than post-rigor salting treatment (P < 0.05). However, the positive effects of pre-rigor salting on chicken breast differed by salt type. Pre-rigor salting with KCl resulted in higher ultimate pH and R-values of chicken breast than pre-rigor salting with NaCl (P < 0.05). Despite the high ultimate pH, pre-rigor salting with KCl resulted in lower protein solubility, final yield, and hardness of chicken breast than pre-rigor salting with NaCl (P < 0.05). These results indicate that pre-rigor salting with KCl could contribute to the maintenance of relatively excellent technological properties of pre-rigor chicken breasts compared to post-rigor salted chicken breast. However, this current study also suggests that the impact of KCl on technological properties in pre-rigor chicken breast, such as water-holding capacity, protein solubility, and texture, could be less effective than pre-rigor salting with NaCl at an identical percentage concentration.

Potassium supplementation mitigates corticosteroid-induced neuropsychiatric effects in pediatric oncology patients

Corticosteroids play an essential role in the treatment of pediatric malignancies, but have many untoward side effects including behavioral and mood disturbances which can be quite burdensome to families. Potassium chloride has been used anecdotally to decrease these neuropsychiatric effects but this experience has not been studied systematically. We therefore retrospectively reviewed our experience utilizing KCl supplementation to reduce corticosteroid-induced neuropsychiatric effects among children with acute lymphoblastic leukemia. Thirteen of 16 patients (81%) had a objective benefit with KCl at a median dose of 0.5 mEq/kg/day, with no reported adverse effects. Further prospective study is required to confirm these data.

High-potassium preconditioning enhances tolerance to focal cerebral ischemia-reperfusion injury through anti-apoptotic effects in male rats

Imbalances between cellular K⁺ efflux and influx are considered to be involved in cerebral ischemia-reperfusion (I/R) injury. High-potassium pretreatment alleviates this injury, but the underlying molecular mechanism is unclear. In this study, we sought to investigate whether high-potassium preconditioning enhances cerebral tolerance to I/R injury through an anti-apoptotic mechanism. Adult male Sprague-Dawley rats were randomly divided into four groups (n = 40/group): a sham-operated group, normal saline group (3.2 ml/kg saline, intravenous (IV)), and low-dose and high-dose potassium chloride (KCl) groups (40 and 80 mg/kg KCl solution, IV, respectively). Subsequently, the rats underwent 90 min of middle cerebral artery occlusion (MCAO) followed by 24 hr of reperfusion (MCAO/R). Neurological deficit scores, 2,3,5-triphenyltetrazolium chloride (TTC) staining, hematoxylin and eosin staining, and TUNEL assay were used to assess neural injury. The expression of apoptotic proteins, brain potassium levels, mitochondrial function and oxidative stress were detected to explore the potential mechanism. After 24 hr of reperfusion, in both KCl treatment groups, neurological deficits and the cerebral infarct volume were reduced, and the apoptosis index of neurons was decreased. Furthermore, high-potassium preconditioning increased brain K⁺ , adenosine triphosphate (ATP), cytochrome c oxidase (COX) levels, reduced malondialdehyde level, improved Na⁺ /K⁺ -ATPase, succinic dehydrogenase and superoxide dismutase activities, upregulated anti-apoptotic protein expression, and downregulated pro-apoptotic protein expression. This study suggests that high-potassium preconditioning enhanced cerebral tolerance to I/R injury in a rat MCAO/R model. The protective mechanism may involve apoptosis inhibition via preservation of intracellular K⁺ and improvement of mitochondrial function.

Evaluating the Effects of KCl on Thermal Behavior and Reaction Kinetics of Medium Density Fiberboard Pyrolysis

The effects of potassium chloride (KCl) on the pyrolysis of medium density fiberboard (MDF) were investigated by using thermogravimetry/Fourier-transfer infrared spectroscopy (TG-FTIR). Five MDF samples treated with different KCl concentrations (0%, 0.5%, 1%, 2% and 3%) were heated with a heating rate of 20 °C/min. The thermogravimetry (TG) results showed that KCl caused the primary pyrolysis stage towards lower temperatures. The FTIR results indicated that with the concentrations of KCl, the formation of CH₄ and C=O functional groups decreased while the formation of CO₂ and CO increased. To figure out the reason for the observed phenomena, the kinetic parameters in primary pyrolysis and the secondary charring reaction were estimated by a differential evolution (DE) optimization algorithm. The prediction indicated that KCl shifted the initial degradation temperature of each component of MDF towards a lower temperature. Char and gas yields increased with the concentration of KCl, whereas the tar yield reduced. The changes in activation energies revealed that KCl played a catalyst role in the reaction of resin, hemicellulose and cellulose in primary pyrolysis. For lignin, KCl had little effect. In the secondary charring reaction, KCl apparently promoted the reaction of tar. The catalytic effect of KCl on MDF pyrolysis was the combination of primary pyrolysis and the secondary charring reaction. Finally, the optimal catalytic concentration for KCl on MDF pyrolysis was analyzed.

Tocotrienols Stimulate Insulin Secretion of Rat Pancreatic Isolated Islets in a Dynamic Culture

BACKGROUND

Tocotrienols (T3) are the naturally occurring vitamin E derivatives that possess antioxidant properties and therapeutic potential in diabetic complications. The bioactivities of the derivatives are determined by the number and arrangement of methyl substitution on the structure.

OBJECTIVE

The objective of this study was to determine the effects of T3 derivatives, σ-T3, γ-T3 and α-T3 on insulin secretion of rat pancreatic islets in a dynamic culture.

METHOD

Pancreatic islets isolated from male Wistar rats were treated with T3 for 1 h at 37°C in a microfluidic system with continuous operation that provided a stable cell culture environment. Glucose (2.8 mM and 16.7 mM, as basal and stimulant, respectively) and potassium chloride (KCl) (30 mM) were added to the treatment in calcium free medium. The supernatant was collected for insulin measurements.

RESULTS

Short-term exposure (1 h) of σ-T3 to β cells in the stimulant glucose condition significantly potentiated insulin secretion in a dose-dependent manner. γ-T3 and α-T3 also displayed dosedependent effect but were less effective in the activation of insulin secretion. Essentially, KCl, a pancreatic β cell membrane depolarizing agent, added into the treatment further enhanced the insulin secretion of σ-T3, γ-T3 and α-T3 with ED50 values of 504, 511 and 588 µM, respectively.

CONCLUSION

The findings suggest the potential of σ-T3 in regulating glucose-stimulated insulin secretion (GSIS) in response to the intracellular calcium especially in the presence of KCl.

Safety, Efficacy, and Timeliness of Intravenous Potassium Chloride Replacement Protocols in a Pediatric Cardiothoracic Intensive Care Unit

OBJECTIVE

Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K⁺). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K⁺ replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols.

DESIGN

A retrospective cohort review of pediatric patients placed on intravenous K⁺ replacement protocols over 1 year was used to determine efficacy and safety of the protocols. A prospective single-blinded review of K⁺ repletion was used to determine timeliness.

PATIENTS

Pediatric patients with congenital or acquired cardiac disease.

SETTING

Twenty-four-bed cardiothoracic intensive care unit in a tertiary children's hospital.

INTERVENTIONS

Efficacy was defined as fewer supplemental potassium chloride (KCl) doses, as well as a higher protocol to total doses ratio per patient. Safety was defined as a lower percentage of serum K⁺ levels ≥4.8 mEq/L after a dose of KCl. Between-group differences were assessed by nonparametric univariate analysis.

RESULTS

There were 138 patients with a median age of 3.0 (interquartile range: 0.23-10.0) months. The incidence of K⁺ levels ≥4.8 mEq/L after a protocol dose was higher in the high-dose protocol versus the tiered-dosing protocol but not different between the low-dose and tiered-dosing protocols (high dose = 2.2% vs tiered dosing = 0.5%, P = .05). The ratio of protocol doses to total doses per patient was lower in the low-dose protocol compared to the tiered-dosing protocol (P < .05). Protocol doses were administered 45 minutes faster (P < .001).

CONCLUSION

The tiered-dosed, nurse-driven K⁺ replacement protocol was associated with decreased supplemental K⁺ doses without increased risk of hyperkalemia, administering doses faster than individually ordered doses; the protocol was effective, safe, and timely in the treatment of hypokalemia in pediatric patients after cardiac surgery.

[Effect of nitrogen, phosphorus and potassium fertilizers on Flos Sophorae Immaturus yield and quality in hilly area of Chongqing]

With Sophora japonica at the flowering stage as the object, the effect of nitrogen, phosphorus and potassium fertilizers on the yield composition factors, yield and quality of Flos Sophorae Immaturus (FSI) was studied. The results indicated that in early spring, nitrogen, phosphorus and potassium fertilizer on the amplification rate of S. japonica, FSI yield composition, yield and quality were different significantly, middle to high nitrogen (1.5-2.0 kg/plant) significantly increased the level of panicled clusters, raceme and flower bud number and yield. Phosphorus (1.5-2.0 kg/plant) could significantly increase the total buds of flower number and yield, potassium showed no significant increase in yield and yield components. Comprehensively considering yield and quality of FSI, nitrogen 1.5-2.0 kg/plant, phosphorus 1.5-2.0 kg/plant and potassium 0.6-0.9 kg/plant are appropriate.

Effects of potassium supplements on glucose metabolism in African Americans with prediabetes: a pilot trial

Background: Low potassium has been identified both as a risk factor for type 2 diabetes and as a mediator of the racial disparity in diabetes risk. Low potassium could be a potentially modifiable risk factor, particularly for African Americans.Objective: We sought to determine the effects of potassium chloride (KCl) supplements, at a commonly prescribed dose, on measures of potassium and glucose metabolism.Design: Among African-American adults with prediabetes, we conducted a double-blinded pilot randomized controlled trial that compared the effects of 40 mEq K/d as KCl supplements with a matching placebo, taken for 3 mo, on measures of potassium and glucose metabolism, with measures collected from frequently sampled oral-glucose-tolerance tests (OGTTs).Results: Twenty-seven of 29 recruited participants completed the trial. Participants had high adherence to the study medication (92% by pill count). Participants in both groups gained weight, with an overall mean ± SD weight gain of 1.24 ± 2.03 kg. In comparison with participants who received placebo, urine potassium but not serum potassium increased significantly among participants randomly assigned to receive KCl (P = 0.005 and 0.258, respectively). At the end of the study, participants taking KCl had stable or improved fasting glucose, with a mean ± SD change in fasting glucose of -1.1 ± 8.4 mg/dL compared with an increase of 6.1 ± 7.6 mg/dL in those who received placebo (P = 0.03 for comparison between arms). There were no significant differences in glucose or insulin measures during the OGTT between the 2 groups, but there was a trend for improved insulin sensitivity in potassium-treated participants.Conclusions: In this pilot trial, KCl at a dose of 40 mEq/d did not increase serum potassium significantly. However, despite weight gain, KCl prevented worsening of fasting glucose. Further studies in larger sample sizes, as well as with interventions to increase serum potassium more than was achieved with our intervention, are indicated to definitively test this potentially safe and inexpensive approach to reducing diabetes risk. This trial was registered at clinicaltrials.gov as NCT02236598.

Potassium Chloride-Based Salt Substitutes: A Critical Review with a Focus on the Patent Literature

High dietary sodium intake (DSI) represents a major health-related public issue in most countries all over the world. Such a diet can lead to increased risk of hypertension and related cardiovascular diseases. This situation has resulted in important public policies for various salt reduction strategies. One of these is based on the use of salt substitutes or salts with reduced sodium content. Among several options, potassium chloride (KCl) has proved to be a key nutritional ingredient for this purpose. It provides similar properties like common salt (NaCl), but with several unwanted side effects, of which the most important have relatively offensive side tastes: bitter, acrid, and metallic. To successfully formulate KCl-based salt substitutes, numerous taste-improving agents and formulation concepts have been used. The field of salt substitutes is mainly described in the patent literature. Since patents are both scientific and legal documents, careful and critical consideration is required when using them as a source of scientific information. This review brings a deep insight into the area of KCl-based salt substitutes with a focus on the patent literature through the eyes of food science and technology. The most important classes of taste-improving agents that have been employed in numerous formulation concepts of KCl-based salt substitutes are nutritionally acceptable mineral salts; food acids, amino acids, and their nutritionally acceptable salts; simple carbohydrates and sugar substitutes; food polymers; umami ingredients; spices, vegetables, and flavors; miscellaneous taste improvers; as well as a plethora of their specific combinations. A critical review of the respective patent literature is given.

A Randomized Clinical Study to Evaluate the Efficacy of an Experimental 3.75% (w/w) Potassium Chloride Dentifrice for the Relief of Dentin Hypersensitivity

OBJECTIVES

To evaluate the clinical efficacy of an experimental "Test" dentifrice containing 3.75% (w/w) potassium chloride (KCl) in reducing dentin hypersensitivity (DH) compared with that of a standard fluoride "Reference" dentifrice after eight weeks' twice-daily brushing.

METHODS

This was a randomized, controlled, examiner-blind, stratified, parallel-group, single-center study in healthy subjects with selfreported and clinically diagnosed DH. After an initial lead-in period, subjects were randomized to either the Test (n = 67) or the Reference dentifrice (n = 66) and instructed to brush twice daily for the next eight weeks. DH was assessed at baseline and following two, four, and eight weeks of dentifrice use by response to an evaporative air stimulus (as evaluated by Schiff sensitivity score and 100 mm visual analog scale [VAS]) and by response to a tactile stimulus (tactile threshold).

RESULTS

Both dentifrices were associated with statistically significant reductions in DH from baseline after two, four, and eight weeks' use, as determined by all efficacy measures (all p < 0.0001). The reduction in Schiff sensitivity score was significantly greater in the Test dentifrice group compared with the Reference dentifrice group at all time points (p < 0.0001). There was a statistically significantly greater increase in tactile threshold in the Reference dentifrice group compared with the Test dentifrice group after eight weeks (p < 0.05); however, reductions in DH as determined by VAS were not significantly different between the treatment groups at any time point. Both dentifrices were generally well tolerated.

CONCLUSIONS

Throughout eight weeks of use, the experimental 3.75% (w/w) KCl dentifrice was more effective than the Reference fluoride dentifrice in reducing DH, as determined by the primary endpoint of Schiff sensitivity score. Secondary assessment measures of change in DH (VAS score and tactile threshold) were not consistent with this finding.

Effects of magnesium sulfate on airway smooth muscle contraction in rats

Aim To investigate the effect of magnesium sulfate (MgSO4) at different doses on isolated tracheal smooth muscle contraction in rats induced by different mechanisms. Methods Twelve rats' tracheas were placed into organ bath. Consecutively, acetylcholine (10-6,10-5,10-4 M), histamine(10-8,10-5,10-3 M) and KCl (30,60 mM) solutions was administered for contractions. MgSO4 from 10-4 to 10-1 M concentrations were subsequently administered after each constrictive agent and relaxation degrees were recorded. Results In the acetylcholine and KCl groups, dose dependent strong contractions were observed, but not in the histamine group and that group was excluded. Significant relaxation occurred with gradually increasing doses of MgSO4. In the high dose KCl group, a slight increase in contractions after the administration of 10-4 and 10-3 M MgSO4 was recorded. Conclusion We suggest that MgSO4 is effective in relaxing airway smooth muscle contractions caused by different factors; however, it must be considered that low doses of MgSO4 may only lead to a slight increase in contractions.

The effect of replacing oil with water and NaCl with KCl on soybean oil hydrolysis and oxidation in canned skipjack tuna fish at the end of the 18-month shelf life

The effects of replacing oil with water (0, 3, 6, and 10% based on total net weight of the product) and replacing NaCl with KCl (0, 50, and 100%) at different replacement levels were surveyed. Hydrolysis (acidity number), peroxide value, and thiobarbituric acid (TBA) index were evaluated at the end of the 18-month shelf life in canned skipjack tuna fish. Results showed that the TBA index was not affected, whereas the peroxide value was affected by replacing oil with water and NaCl with KCl (p>0.05), so that by increasing in replacing oil with water and replacing NaCl with KCl, the peroxide value was significantly decreased (p<0.05). Hydrolysis (acidity number) was affected by replacing oil with water (p<0.05); however, it was not affected by replacing NaCl with KCl (p>0.05). It was found out the best suggestion is 10% replacing oil with water and 50% replacing NaCl with KCl.

Effects of Sodium Chloride, Potassium Chloride, and Calcium Chloride on the Formation of α-Dicarbonyl Compounds and Furfurals and the Development of Browning in Cookies during Baking

Effects of NaCl, KCl, CaCl₂, NaHCO₃, and NH₄HCO₃ on the formation of glucosone, 1-deoxyglucosone, 3-deoxyglucosone, glyoxal, methylglyoxal, diacetyl, 5-hydroxymethyl-2-furfural, and 2-furfural and browning were investigated in cookies. The presence of 1.5% NaCl, 1% KCl, and 1% CaCl₂ on flour basis had no effect on α-dicarbonyl compounds, except 1-deoxyglucosone increased in the presence of KCl and CaCl₂. The increase in 5-hydroxymethyl-2-furfural formation in the presence of NaCl, KCl, and CaCl₂ did not relate to 3-deoxyglucosone formation and pH changes. NaCl, KCl, and CaCl₂ increased browning in cookies. Model reaction systems indicated that NaCl, KCl, and CaCl₂ enhance browning by increasing furfurals in caramelization. NaCl, KCl, and CaCl₂ decreased browning intensity in a heated glucose-glycine system. Use of CaCl₂ in cookies may considerably increase furfurals but not α-dicarbonyl compounds. Sodium reduction can be obtained by replacement with potassium without sacrificing the desired consequences of caramelization in sugar-rich baked goods.

Poly(vinyl Alcohol) Borate Gel Polymer Electrolytes Prepared by Electrodeposition and Their Application in Electrochemical Supercapacitors

Gel polymer electrolytes (GPEs) have been studied for preparing flexible and compact electrochemical energy storage devices. However, the preparation and use of GPEs are complex, and most GPEs prepared through traditional methods do not have good wettability with the electrodes, which retard them from achieving their performance potential. In this study, these problems are addressed by conceiving and implementing a simple, but effective, method of electrodepositing poly(vinyl alcohol) potassium borate (PVAPB) GPEs directly onto the surfaces of active carbon electrodes for electrochemical supercapacitors. PVAPB GPEs serve as both the electrolyte and the separator in the assembled supercapacitors, and their scale and shape are determined solely by the geometry of the electrodes. PVAPB GPEs have good bonding to the active electrode materials, leading to excellent and stable electrochemical performance of the supercapacitors. The electrochemical performance of PVAPB GPEs and supercapacitors can be manipulated simply by adjusting the concentration of KCl salt used during the electrodeposition process. With a 0.9 M KCl concentration, the as-prepared supercapacitors deliver a specific capacitance of 65.9 F g(-1) at a current density of 0.1 A g(-1) and retain more than 95% capacitance after 2000 charge/discharge cycles at a current density of 1 A g(-1). These supercapacitors also exhibit intelligent high voltage self-protection function due to the electrolysis-induced cross-linking effect of PVAPB GPEs.

Inadvertent injection of potassium chloride instead of sodium chloride during treatment of chronic low back ache with epidural injection leading to paraplegia

Epidural injection of steroid is given for back pain resistant to other conservative management. Normal saline (NS) is used as diluent in 80 mg methylprednisolone and a local anesthetic. Due to a similar looking ampoule of NS and potassium chloride (KCl), there is a probability of accidental use of KCl instead of NS. We present a case of a 50-year-old male patient having low back ache refractory to other conservative treatments. Epidural injection of steroid was given, but accidently KCl was mixed with methylprednisolone instead of NS. He developed severe cramps in the lower limbs, pruritus, and sweating, and finally paraplegia. Electrocardiography and blood showed features suggestive of hyperkalemia. He was given calcium gluconate and potassium chelating agent along with supportive measures. The patient recovered within 8 h. It is concluded that calcium gluconate and potassium chelating agent can be used if accidentally KCl is injected in epidural space.

The effect of partial substitution of NaCl with KCl on the physicochemical, microbiological and sensory properties of Akkawi cheese

BACKGROUND

Studies have shown a direct relationship between increased dietary sodium intake and chronic diseases such as hypertension, cardiovascular disease and osteoporosis. Potassium chloride is the most widely used salt substitute for sodium chloride in different processed foods. Akkawi cheese, commonly consumed as fresh cheese, has a semi-hard curd, chalky color, firm texture and salty flavor. The effect of partial replacement of NaCl with KCl on the chemical, textural, microbiological and sensory characteristics of fresh and mature Akkawi cheese was investigated.

RESULTS

Salt treatment (NaCl reduction) had a significant effect on pH, lactic acid, sodium and potassium contents of cheeses. Texture profile analysis revealed a significant effect of salt treatment on adhesiveness, chewiness and hardness of cheese. All tested microorganisms increased with storage but in general did not differ between salt treatments, specifically between control (100% NaCl) and (70% NaCl, 30% KCl) samples. Descriptive analysis showed that salt treatment had a significant effect on bitterness, crumbliness and hardness, whereas the age of cheese was significant for color and fermented flavor. Salt treatment had no effect on acceptability variables for all experimental 2-week Akkawi samples.

CONCLUSION

The above results suggest that a 30% substitution of NaCl by KCl (70% NaCl, 30% KCl brine) is acceptable.

Gene expression microarray analysis of the spinal trigeminal nucleus in a rat model of migraine with aura

Cortical spreading depression can trigger migraine with aura and activate the trigeminal vascular system. To examine gene expression profiles in the spinal trigeminal nucleus in rats following cortical spreading depression-induced migraine with aura, a rat model was established by injection of 1 M potassium chloride, which induced cortical spreading depression. DNA microarray analysis revealed that, compared with the control group, the cortical spreading depression group showed seven upregulated genes–myosin heavy chain 1/2, myosin light chain 1, myosin light chain (phosphorylatable, fast skeletal muscle), actin alpha 1, homeobox B8, carbonic anhydrase 3 and an unknown gene. Two genes were downregulated–RGD1563441 and an unknown gene. Real-time quantitative reverse transcription-PCR and bioinformatics analysis indicated that these genes are involved in motility, cell migration, CO₂/nitric oxide homeostasis and signal transduction.