Dr. Kara Fitzgerald receives the Rosalind Franklin Society Special Award in Science
Recently, we discussed the role of zinc in optimizing hydroxychloroquine (HCQ) antiviral benefit.
We’ve also been talking about profound potassium (K+) deficiency (hypokalemia) apparently being caused by CoV-2 hijacking of ACE2 receptors.
You’re probably aware that while millions of doses of HCQ have been given without issue—it’s been in use since the 1940’s—there is a small possibility that vulnerable individuals are at risk of sudden cardiac death through drug-induced QT prolongation. The American College of Cardiology (ACC) released safety considerations for the use of HCQ, which we’re reprinting below.
Note that potassium of 3.5mEq/L or below scores two points towards increasing risk of QTc prolongation. ACC notes that serum potassium levels should be obtained at baseline and then daily while hospitalized. Levels should be optimized. Of course, K+ isn’t the only risk, but it’s important. And given that CoV-2 itself may cause significant K+ depletion, and given that most of us don’t get enough K+ in our diets, and given the fact that heart disease by a variety of mechanisms has been noted in COVID19, the need for us to keep up on K+ intake throughout this pandemic cannot be understated.
Finally, K+ is potently anti-inflammatory, shown to inhibit inflammasome NLRP3 (thought to be a chief player in the CoV-2 cytokine storm). It looks like HCQ may actually do the same thing, and be a reason for its benefit, too.
Potassium food sources are listed below, from Romilly Hodges, my Nutrition Programs Director.
Table 1. Risk Score For Drug-Associated QTc Prolongation 9
| Risk Factors | Points |
| Age ≥68 y | 1 |
| Female sex | 1 |
| Loop diuretic | 1 |
| Serum K+ ≤3.5 mEq/L | 2 |
| Admission QTc ≥450 ms | 2 |
| Acute MI | 2 |
| ≥2 QTc-prolonging drugs | 3 |
| sepsis | 3 |
| Heart failure | 3 |
| One QTc-prolonging drug | 3 |
| Maximum Risk Score | 21 |
| K+ indicates potassium; and MI, myocardial infarction. | |
A Tisdale score of ≤ 6 predicts low risk, 7-10 medium risk, and ≥ 11 high risk of drug-associated QT prolongation (Table 2).
Table 2. Risk Levels For Drug-Associated QT Prolongation9
| Low risk = ≤6 points |
| Moderate risk = 7-10 points |
| High-risk = ≥11 points |
Tables Source
From Romilly Hodges: On Potassium
Potassium is an essential nutrient. Adequate potassium intake is set at 2,600 mg/day for women and 3,400 mg/day for men, by the Food and Nutrition Board of the National Academy of Medicine. Targets are lower for children and adolescents, those with reduced kidney function, and higher during pregnancy and lactation.
Underconsuming potassium does not usually lead to frank hypokalemia. However, insufficient intake can precipitate hypokalemia when other risk factors are present. Plus, there are other benefits for optimizing potassium intake (and sodium-potassium balance) including reduced risk for stroke, kidney stones, high blood pressure, and osteoporosis.
The safest way to increase your potassium intake is through food. Supplemental potassium should be used cautiously and under physician supervision to monitor serum potassium concentrations.
Potassium content of selected potassium-rich foods:
| Food | Serving | Potassium (mg) |
| Potato, with skin | 1 medium | 926 |
| Apricots, dried | ½ cup | 755 |
| Lentils, cooked | 1 cup | 731 |
| Salmon, cooked | ½ filet (178 g) | 683 |
| Beet greens, cooked | ½ cup | 654 |
| Mushrooms, portabella, grilled | 1 cup | 630 |
| Coconut water | 1 cup | 600 |
| Sweet potato, cooked | 1 cup | 545 |
| Yogurt, plain | 8 ounces | 531 |
| Lima beans, cooked | ½ cup | 478 |
| Acorn squash, cooked | ½ cup cubes | 448 |
| Cod, steamed | 1 small filet (170 g) | 427 |
| Banana | 1 medium | 422 |
| Spinach, cooked | ½ cup | 419 |
| Pork, lean, cooked | 3 oz | 407 |
| Morton’s Lite Salt | ¼ tsp | 350 |
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