Potassium-magnesium citrate versus potassium chloride in thiazide-induced hypokalemia

Kidney Int. 2000 Feb;57(2):607-12. doi: 10.1046/j.1523-1755.2000.00881.x.

Abstract

Background: The purpose of this study was to compare the value of potassium-magnesium citrate (KMgCit) with potassium chloride in overcoming thiazide-induced hypokalemia.

Methods: Sixty normal subjects first took hydrochlorothiazide (HCTZ; 50 mg/day). After three weeks of treatment (or earlier if hypokalemia developed), they were randomized to take KMgCit (42 mEq K, 21 mEq Mg, and 63 mEq citrate/day) or potassium chloride (42 mEq/day) for three weeks while continuing on HCTZ.

Results: KMgCit significantly increased the serum potassium concentration from 3.42 +/- 0.30 mEq/L on HCTZ alone to about 3.8 mEq/L (P < 0.001). Potassium chloride produced a similar increase in serum potassium concentration from 3.45 +/- 0.44 mEq/L to about 3.8 mEq/L (P < 0. 001). KMgCit significantly increased the serum magnesium concentration by 0.11 to 0.12 mEq/L (P < 0.01), whereas potassium chloride produced a marginal decline or no significant change. KMgCit was less effective than potassium chloride in correcting HCTZ-induced hypochloridemia and hyperbicarbonatemia. KMgCit, but not potassium chloride, significantly increased urinary pH (by about 0.6 unit), citrate (by about 260 mg/day), and urinary magnesium.

Conclusions: KMgCit is equally effective as potassium chloride in correcting thiazide-induced hypokalemia. In addition, KMgCit, but not potassium chloride, produces a small but significant increase in serum magnesium concentration by delivering a magnesium load, and it confers alkalinizing and citraturic actions.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Citrates / administration & dosage*
  • Citrates / adverse effects
  • Citrates / urine
  • Diuretics
  • Double-Blind Method
  • Drug Combinations
  • Female
  • Humans
  • Hydrochlorothiazide / adverse effects*
  • Hydrogen-Ion Concentration
  • Hypokalemia / chemically induced*
  • Hypokalemia / drug therapy*
  • Hypokalemia / urine
  • Kidney Calculi / chemically induced
  • Magnesium / blood
  • Magnesium Compounds / administration & dosage*
  • Magnesium Compounds / adverse effects
  • Male
  • Middle Aged
  • Potassium Chloride / administration & dosage*
  • Potassium Chloride / adverse effects
  • Potassium Compounds / administration & dosage*
  • Potassium Compounds / adverse effects
  • Sodium Chloride Symporter Inhibitors / adverse effects*

Substances

  • Citrates
  • Diuretics
  • Drug Combinations
  • Magnesium Compounds
  • Potassium Compounds
  • Sodium Chloride Symporter Inhibitors
  • Hydrochlorothiazide
  • Potassium Chloride
  • Magnesium
  • potassium-magnesium citrate