CZ:Featured article/Current: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Chunbum Park
imported>Chunbum Park
(→‎Pulmonary embolism: Potassium in nutrition and human health)
Line 1: Line 1:
== '''[[Pulmonary embolism]]''' ==
== '''[[Potassium in nutrition and human health]]''' ==
----
----
'''Pulmonary embolism''' (PE) is form of [[embolism and thromboembolism]] in which a blockage of the [[pulmonary artery]] (or one of its branches), usually when a [[deep vein thrombosis]] (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs.<ref name="pmid18322285">{{cite journal |author=Tapson VF |title=Acute pulmonary embolism |journal=N. Engl. J. Med. |volume=358 |issue=10 |pages=1037–52 |year=2008 |month=March |pmid=18322285 |doi=10.1056/NEJMra072753 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18322285&promo=ONFLNS19 |issn=}}</ref> This process is termed ''thromboembolism''.
To maintain [[Life|life]] and [[health]], the diet of humans must contain the chemical element,<b>[[potassium]]</b>, in its ionic form (K<sup>+</sup>), usually consumed as potassium salts of organic acids in food (e.g., potassium citrate), found most abundantly in non-grain plant foods (vegetables and fruits)
{{TOC|right}}
In 2004-2006, and again in 2010, the ''Institute of Medicine of the National Academies of Science''&nbsp;<ref name=ottendribook>Otten JJ, Hellwig JP, Meyers LD (editors) (2006) Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. National Academies Press. Pages 370-379. ISBN 0-309-65646-X</ref> and its ''Food and Nutrition Board''&nbsp;<ref name=napdri04>Panel on Dietary Reference Intakes for Electrolytes and Water. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board. Institute of Medicine of The National Academies (2004) [http://books.nap.edu/openbook.php?record_id=10925&page=186/ Dietary Reference Intakes For Water, Potassium, Sodium, Chloride, and Sulfate] “Potassium” pp. 186-268. The National Academies Press, Washington, D.C.</ref> <ref name=ai-k>[http://www.dietaryguidelines.gov Dietary Guidelines for Americans, 2010]. [http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf PDF (p40]. U.S Dpartment of Agriculture. U.S. Department of Health and Human Services.</ref> recommended that adult humans consume 4700 milligrams (mg) of potassium per day, or more, which, calculated from the atomic mass of potassium (39.1 mg per [[Mole (unit)|mmol)]], corresponds  to 120 millimoles (mmol) potassium per day: 4700 mg/39.1 mg/mmol=120 mmol.  That recommended intake of potassium substantially exceeds estimates from recent surveys of average intakes by the general population, raising the possibility that a persisting state of suboptimal body potassium content, and rate of throughput of potassium, prevails in the general population.&nbsp;<ref name=03-04K>[http://www.ars.usda.gov/Services/docs.htm?docid=14958 What We Eat in America, NHANES 2003-2004, Tables. 1. Nutrient Intakes: Mean Amounts Consumed per Individual, One Day, 2003-2004 (Downloadable PDF File)]</ref>&nbsp;<ref name=05-06K>[http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/0506/Table_1_NIF_05.pdf Nutrient Intakes: Mean Amounts Consumed per Individual, One Day, 2005-2006.]&nbsp;U.S. Department of Agriculture, Agricultural Research Services, Fast Facts, Reports/Articles, and Tables (2005-2006).</ref>&nbsp;<ref name=eatk2010>[http://www.ars.usda.gov/Services/docs.htm?docid=18349 What We Eat in America, 2009-2010]. USDA. Downladable pdf Tables.</ref>
===Pathophysiology===
 
The development of thrombosis is classically due to a group of causes named [[Virchow's triad]] (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.
Subsequent sections will discuss potassium intake recommendations for children and special groups, as well as more recent perspectives on the 'optimal' requirements for dietary potassium in humans.
* ''Alterations in blood flow'': immobilization (after surgery, [[Physical trauma|injury]] or [[Economy class syndrome|long-distance air travel]]), [[pregnancy]] (also procoagulant), [[obesity]] (also procoagulant)
 
* ''Factors in the vessel wall'': of limited direct relevance in VTE
==General considerations==
* ''Factors affecting the properties of the blood'' (procoagulant state):
Potassium ranks as the most abundant cation (positive ion) inside animal [[Cell (biology)|cells]] (intracellular), and as such contributes critically in numerous important ways to the optimal functioning of cells and therefore to optimal functioning of the organ systems and individuals they compose.  Among other metabolic functions, potassium plays a role in the synthesis of proteins and in the biochemical transformations required for carbohydrate metabolism.
** [[Estrogen]]-containing [[hormonal contraception]]
 
** Genetic thrombophilia ([[factor V Leiden]][[protein C deficiency]], [[protein S deficiency]], [[antithrombin]] deficiency, [[hyperhomocysteinemia]] and [[plasminogen]]/[[fibrinolysis]] disorders). The role of [[prothrombin]] mutation G20210A, is  unclear.<ref name="pmid19531787">{{cite journal |author=Segal JB, Brotman DJ, Necochea AJ, ''et al.'' |title=Predictive value of factor V Leiden and prothrombin G20210A in adults with venous thromboembolism and in family members of those with a mutation: a systematic review |journal=JAMA |volume=301 |issue=23 |pages=2472–85 |year=2009 |month=June |pmid=19531787 |doi=10.1001/jama.2009.853 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19531787 |issn=}}</ref>
Potassium plays an esential role in maintaining the electrical potential difference across the cell's plasma membrane, the intra- to extra-cellular electrical potential difference, typically referred to as the 'membrane potential'. That physicochemical regulatory function importantly enables normal transmission of information along nerves (nerve impulse transmission), normal contraction of muscle fibers, and normal functioning of the heart. The concentration of potassium inside cells (the intracellular fluid) exceeds that outside cells (the extracellular fluid) by an order of magnitude (~30 times), whereas the extracellular concentration of sodium exceeds that of its intracellular concentration by an order of magnitude (~10 times), the reverse of the situation with potassium. Those concentration differences between potassium ions and sodium ions generates the membrane potential, the inside potential negative with respect to the outside potential. A protein-based ion-pumping mechanism located within the lipid bilayer of the....
** Acquired thrombophilia (malignancy, [[antiphospholipid syndrome]], [[nephrotic syndrome]], [[paroxysmal nocturnal hemoglobinuria]])
 
===Diagnosis===
By influencing the electrical potential difference across the cell membrane, the ratio of the [[concentration]]s of potassium in intracellular fluid (ICF) to that in the cells' surrounding extracellular fluid (ECF) has important effects on the rate of transmission of electrical activity (pulses) along nerve fibers and skeletal muscle cells, which, among other things, affects the degree of contraction of the smooth muscles of arteries and arterioles (vascular tone).<ref name=moczydlowski2009>Moczydlowski EG. (2009) Electrophysiology of the Cell Membrane. In: Boron WF, Boulpaep EL (editors), Medical Physiology, 2nd ed. Saunders/Elsevier: Philadelphia. ISBN 9781416031154.</ref> Inasmuch as extracellular potassium varies in the 3-6 mmol/L range, while intracellular potassium concentrations average about 145 mmol/L, small changes in extracellular potassium concentration have a greater effect on the ICF-to-ECF potassium concentration ratio than similar small changes in intracellular potassium concentration.  Subsequent sections discuss the implication of changes in the ICF-to-ECF potassium concentration ratio in human physiology.
The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation ([[shortness of breath]], [[chest pain]]) cannot be definitively differentiated from other causes of chest pain and shortness of breath.<ref name="pmid14657070">{{cite journal |author=Chunilal SD, Eikelboom JW, Attia J, ''et al'' |title=Does this patient have pulmonary embolism? |journal=JAMA |volume=290 |issue=21 |pages=2849–58 |year=2003 |pmid=14657070 |doi=10.1001/jama.290.21.2849 |issn=}}</ref> Patients can present with atypical syndromes such as unexplained exacerbations of chronic obstructive pulmonary disease.<ref name="pmid16549851">{{cite journal |author=Tillie-Leblond I, Marquette CH, Perez T, ''et al'' |title=Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors |journal=Ann. Intern. Med. |volume=144 |issue=6 |pages=390–6 |year=2006 |month=March |pmid=16549851 |doi= |url= |issn=}}</ref>
 
''[[Pulmonary embolism|.... (read more)]]''
''[[Potassium in nutrition and human health|.... (read more)]]''


{| class="wikitable collapsible collapsed" style="width: 90%; float: center; margin: 0.5em 1em 0.8em 0px;"
{| class="wikitable collapsible collapsed" style="width: 90%; float: center; margin: 0.5em 1em 0.8em 0px;"
|-
|-
! style="text-align: center;" | &nbsp;[[Pulmonary embolism#References|notes]]
! style="text-align: center;" | &nbsp;[[Potassium in nutrition and human health#References|notes]]
|-
|-
|
|
{{reflist|2}}
{{reflist|2}}
|}
|}

Revision as of 22:27, 12 October 2012

Potassium in nutrition and human health


To maintain life and health, the diet of humans must contain the chemical element,potassium, in its ionic form (K+), usually consumed as potassium salts of organic acids in food (e.g., potassium citrate), found most abundantly in non-grain plant foods (vegetables and fruits). In 2004-2006, and again in 2010, the Institute of Medicine of the National Academies of Science [1] and its Food and Nutrition Board [2] [3] recommended that adult humans consume 4700 milligrams (mg) of potassium per day, or more, which, calculated from the atomic mass of potassium (39.1 mg per mmol), corresponds to 120 millimoles (mmol) potassium per day: 4700 mg/39.1 mg/mmol=120 mmol. That recommended intake of potassium substantially exceeds estimates from recent surveys of average intakes by the general population, raising the possibility that a persisting state of suboptimal body potassium content, and rate of throughput of potassium, prevails in the general population. [4] [5] [6]

Subsequent sections will discuss potassium intake recommendations for children and special groups, as well as more recent perspectives on the 'optimal' requirements for dietary potassium in humans.

General considerations

Potassium ranks as the most abundant cation (positive ion) inside animal cells (intracellular), and as such contributes critically in numerous important ways to the optimal functioning of cells and therefore to optimal functioning of the organ systems and individuals they compose. Among other metabolic functions, potassium plays a role in the synthesis of proteins and in the biochemical transformations required for carbohydrate metabolism.

Potassium plays an esential role in maintaining the electrical potential difference across the cell's plasma membrane, the intra- to extra-cellular electrical potential difference, typically referred to as the 'membrane potential'. That physicochemical regulatory function importantly enables normal transmission of information along nerves (nerve impulse transmission), normal contraction of muscle fibers, and normal functioning of the heart. The concentration of potassium inside cells (the intracellular fluid) exceeds that outside cells (the extracellular fluid) by an order of magnitude (~30 times), whereas the extracellular concentration of sodium exceeds that of its intracellular concentration by an order of magnitude (~10 times), the reverse of the situation with potassium. Those concentration differences between potassium ions and sodium ions generates the membrane potential, the inside potential negative with respect to the outside potential. A protein-based ion-pumping mechanism located within the lipid bilayer of the....

By influencing the electrical potential difference across the cell membrane, the ratio of the concentrations of potassium in intracellular fluid (ICF) to that in the cells' surrounding extracellular fluid (ECF) has important effects on the rate of transmission of electrical activity (pulses) along nerve fibers and skeletal muscle cells, which, among other things, affects the degree of contraction of the smooth muscles of arteries and arterioles (vascular tone).[7] Inasmuch as extracellular potassium varies in the 3-6 mmol/L range, while intracellular potassium concentrations average about 145 mmol/L, small changes in extracellular potassium concentration have a greater effect on the ICF-to-ECF potassium concentration ratio than similar small changes in intracellular potassium concentration. Subsequent sections discuss the implication of changes in the ICF-to-ECF potassium concentration ratio in human physiology.

.... (read more)