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The Effect of Varying Molar Ratios of Potassium-Magnesium Citrate on Thiazide-Induced Hypokalemia and Magnesium Loss

Lisa-Ann Wuermser, MD

John Poindexter, BS

Charles Y. C. Pak, MD

Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas

This study was conducted to compare the value of an older formulation of potassium-magnesium citrate (K₄MgCit₂) with newer formulations (K₃MgHCit₂ and K₅MgCit₂Cl) with rspect to the correction of thiazide-induced hypokalemia and magnesium loss, alkalinizing effect, and citraturic action. Sixty-two healthy volunteers first took hydrochlorothiazide 50 mg/day. After 3 weeks of thiazide treatment (or earlier if hypokalemia developed), they were randomized to take one of three drugs for 3 weeks while continuing thiazide: K₄MgCit₂ (49 mEq K, 25 mEq Mg, and 74 mEq citrate/day), K₃MgHCit₂ (49 mEq K, 33 mEq Mg, and 98 mEq citrate/day), and K₅MgCit₂Cl (49 mEq K, 20 mEq Mg, 10 mEq Cl and 59 mEq citrate/day). Outcome measures were changes in serum potassium and magnesium, and urinary potassium, magnsium, pH, and citrate. The three drugs were equally effective in correcting thiazide-induced hypokalemia. K₃MgHCit₂ and K₄MgCit₂ produced a small but significant increase in serum magnesium concentration, whereas K₅MgCiftCl did not. Athough all three supplements significantly increased urinary pH and citrate, these effects were more marked with K₃MgHCit₂ and K₄MgCit₂ than with K₅MgCit₂Cl. All three supplements were generally well tolerated, with the lowest side effect profile obtained with K₄MgCit₂. The new formlation of K₃MgHCit₂ exerts similar correction of thiazidinduced hypokalemia and magnesium loss, and enhancment of urinary pH and citrate, compared with the older K₄MgCit₂. However, it is less well tolerated. The newformlation of K₅MgCit₂Cl does not avert magnesium loss, and has less prominent alkalinizing and citraturic effects than the older preparation.

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				O. Bonny, A. Rubin, C.-L. Huang, W. H. Frawley, C. Y.C. Pak, and O. W. Moe Mechanism of Urinary Calcium Regulation by Urinary Magnesium and pH J. Am. Soc. Nephrol., August 1, 2008; 19(8): 1530 - 1537. [Abstract] [Full Text] [PDF]