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I respectfully disagree. We lose a ton of K and Mg with the diarrhea, and that makes us feel weaker. Don’t need blood tests; if your kidneys are normal, your body can handle the K and Mg you need. If your kidneys are NOT healthy, that’s the only time K becomes an issue; you pee out what you don’t need otherwise, just like excess B and C vitamins, sodium, and all the other stuff we ingest that isn’t in perfect harmony with our body’s needs of the moment.

I say this as a recently retired MD who manages her own electrolyte issues so as to avoid the ER, despite a short gut and 20-30x bms/day on meds.

Dehydration is a part of it, but water and sports drinks won’t fix it if you have significant diarrhea still. Orange juice, bananas, leafy greens (if you can tolerate them) are good for K; Mg is equally important, as it’s what keeps your muscles from cramping, among many other things. Mg highest in nuts (which are hard for many of us w IBD/pouches to tolerate), and oysters, but supplements can help.

Word of caution: you probably don’t want a Magnesium Oxide supplement—which means most of the ones in the drugstore. Mag sulfate bad, too. Both are used to treat constipation, so they won’t be helpful for diarrhea-induced Mg loss—can make it worse.

There is a form available on Amazon called magnesium taurate; it is one of the only formulations I’ve found that doesn’t worsen diarrhea. It’s a giant horse pill, unfortunately, but I crush it to help absorption.

Potassium tastes pretty bitter and nasty, so I’ve found electrolyte mix packets highest in K and Mg to taste gross on their own. Just add lemon juice or a nice tube of crystal light, or whatever you feel like, and it’s drinkable.

Please, please be careful about electrolyte loss. If drinking water doesn’t make you feel better, you will want to supplement yours. It is safe; these are all sold without prescription and are USP grade. And don’t forget, you lose sodium, too. It’s not a bad idea to have a bit of sodium added to the drink if your diet doesn’t already contain much.

When I’m low on sodium, I feel nauseous, with a bad headache and brain fog. If I don’t head it off quickly, I vomit, and can’t stop. It’s ugly. Now I recognize that feeling and eat something salty or drink pickle juice or chicken broth; has kept me out of the ER more than once.

Low K and Mg are more that feeling of weakness, the spent feeling after a bad day of runs. Muscles don’t contract well without Mg, and nothing works as well when K is low. I know when my body is feeling worse than usual that I need to load up. It definitely helps; keeping electrolyte packets on hand and the Mg tablets has stopped me from having terrible cramps in hands, feet, calves bc of diarrhea.

Good luck! It’s not all dehydration—you really are losing precious electrolytes that normally would get resorbed into the bloodstream with the water... the colon had an important job, conserving water loss and electrolytes, concentrating wastes for expulsion. That’s the only reason ‘normal’ stools are solid; reabsorption of water content. Over time as small bowel adapts, it gets better at compensating, but it depends on how much small bowel you have left. That’s how antidiarrheals like lomotil and imodium work; they slow down the motility of the intestine, giving the body time to absorb more water from the stools. More water in stools equals more diarrhea, and more urgency.

@athena I certainly agree that sports drink and rehydration solution levels of supplementation are generally quite safe, and while dehydration is the most common problem for J-pouchers, electrolytes can also get out of whack. However, supplements come in many strengths, some of them extreme - if you suggest supplementation without data and without dosing guidelines some folks will go too far. Healthy kidneys are indeed good at this, but assuming low potassium without a single lab test to confirm it unnecessarily invents a problem, when IMO it should merely be suspected. Assuming healthy kidneys in someone you don’t know much about can also lead to trouble. Are you really advising @maddie18 to *not* get her potassium checked? That’s really all I suggested.

I would think a non-sugary electrolyte replacement beverage like Nuun would be sufficient to offset electrolyte loss due to diarrhea.

I had wild fluctuations with my sodium and potassium immediately after the colon came out, and in fact remember vividly a nurse rushing into my room telling me I had low potassium and telling me I had to drink some liquid potassium.  I remember it was blood red in color and had a vile test and I took like a guppy sip or two and the nurse practically tore my head off. She said I had to drink it NOW and I then did.  I later read that at that time (early 1990s) there had been some cardiac arrests associated with giving potassium by IV in these low potassium situations, and this is why Mount Sinai made me drink this liquid potassium concoction that looked like blood.  I know that you can't bombard the body suddenly with a high dose of potassium as by injection or it will cause a cardiac event, but drinking it should allow kidneys to do the job.

On that note however, I was hospitalized with a severe sodium overdose at my 30 days after takedown sodium party after eating anchovy pizza, Lays potato chips and V8 juice.  They had put me on a high sodium diet, I took it to extreme.  There was at 3 am or so the most severe pain in my side where my kidneys are, I was rushed to the ER, and the Doc said it was the highest sodium level he had ever seen and asked me what the hell I did and then told me to never do that again.  I was young and quite stupid at the time.  This was circa 1992.

Last edited by CTBarrister

Here’s the thing. Lab test every time you have extensive diarrhea/feel weak is impractical and unhelpful with what we have. Bodily K changes pretty rapidly, like everything the kidneys regulate.

Yes, I am saying exactly that a lab test for K is pointless for this before treating. For so many reasons.

Healthy kidneys means you can supplement it yourself safely with OTC hydration packets. Do you measure the lytes you consume daily? Regulate your diet precisely for micronutrients every day? No, because we don’t have to as long as kidneys work. Just like we can take multivitamins or 1000 percent of daily vitamin c without adjusting what we eat—we pee out the excess if it’s water soluble, like electrolytes and B and C vitamins.

It only becomes a risk when the kidneys are not healthy. That’s the only real lab test needed, which we all have preop before these surgeries. If that is normal and stays there, K levels at one point in time (or many) don’t help you manage a chronic problem that we know depletes K.

You don’t have to be below normal on a lab test to feel symptoms from being low in K or Mg. If you wait that long to treat, you’re letting it become dangerous. Lab levels for K reflect normal range based on cardiac risk, not the negative musculoskeletal effects and fatigue/weakness that come before you get below ‘normal’. Don’t let it come to that before you fix it.

K levels are too low in standard US diet. RDA is kept low to account for those with kidney disease and the elderly (who may not know they have kidney disease). Folate levels too low also. Vitamin D as well, though that has improved a bit lately; we don’t pee that out, but it’s hard to get to toxic levels. That’s why OTC supps w 2000 IU are available and safe for healthy people, even w RDA of 400 IU (and most of us are deficient as a result of such a low target).

Sodium is too high in American diet, by contrast. But we survive if gut is normal and kidneys are, bc they hold onto all the k and let out the extra na. Our diseased guts let the k spill, though, and na, and mg. Basic gut physiology of diarrhea. We just eat a lot more sodium normally, so we don’t often have hyponatremia except when the diarrhea is really bad. We are low in K and Mg a lot faster, bc so much less in diet to begin with. Can’t afford to lose what we do ingest.

Docs often recommend Gatorade for diarrhea, which is unfortunately sugary and has lots of sodium but minimal or no K. Not helpful. A group of athletes is selling some better versions with higher K and Mg bc that is what is needed (Body Armor—compare electrolyte levels and sugar to Gatorade or Powerade; BA is better). Even those are not enough if diarrhea is chronic, though.

The packets I use have about 17 pct of recommended daily K. Not at all dangerous w normal kidneys. I actually take an additional med that helps me retain more of it, and double the packets, but that’s because I know that’s what it takes to feel better. Never been high on labs for K unless the sample was hemolyzed (ruined by shearing of rbcs during the draw, which falsely elevates K)... I eat a ton of green leafy vegetables, too, but I don’t worry—kidneys are taking care of it, should I ever be so fortunate as to achieve ‘excess’ K consumption. Drinking the supplement has another benefit—the liter of water you mix it with will ensure the kidneys get well flushed.

But I do understand why what I’m saying seems odd to you. I had to study all of this for years  before ever getting sick in the first place. This knowledge, thoughtfully applied, has kept me out of the ER for ten years of illness, and let me survive long days while doing surgeries, many long and very delicate, for eight of them.

That’s why I post on this site about stuff like this; none of my surgeons or GI docs had anything better than Gatorade to suggest for home, bc we don’t learn to read product labels in med school or residency. Their job is to reconstruct and medicate and manage pouchitis and all that hard stuff, which is plenty to master; as patients, we are often left with the day to day challenges.  I had to supplement my training with reading labels to find what I needed to help mitigate the fatigue and depleted feeling, the cramps, all of it.

Anyway, huge difference between ordinary dehydration (for which Gatorade or water is usually fine) and diarrhea-induced dehydration, which comes with significant electrolyte wasting, much more than through sweating. There are a lot of things like this that we treat presumptively because it’s more logical to do so. You’ll see ‘hydration packets’ at Costco and the drugstore now that were not sold ten years ago; the best ones have more K and Mg, less Na and sugar. It’s widely sold because it’s considered safe for public consumption, as long as kidneys are normal. There’s a warning label for renal disease, but safe for the rest of us, no labs required.

In the end you have to decide what you can handle mentally as far as what you can do on your own. It is entirely safe to use these things yourself, as long as your kidneys are fine. Lab work won’t tell you why you feel weak unless you’re well beyond symptoms, in dangerous territory.

My surgeon (Remzi) always gave me extra K in hospital, even if I was technically normal on daily labs; he wanted to ‘tank me up’ for the diarrhea losses, tried to get me to at least 4.5 before discharge so I’d have a bit longer before feeling lousy. But normal is 3.3-3.5 depending on the lab standard; he just knew to aim a lot higher because this is what he does, day in and out, as an IBD surgeon and pouch specialist. I don’t think you’ll get that in an ER or regular doctor’s office if it isn’t their specialty. They’re just going to see ‘normal’ or ‘abnormal’ and not understand what to treat and why, until it’s way late.
Oh, and I absolutely hate getting blood drawn when I’m depleted. Veins go into hiding, very likely to have sheared cells from the difficult draw, and  thus a serum K that looks higher than it really is, from hemolysis. A complete waste.

Sorry for the long reply. I just want to be clear that this is not empiricism run rampant. The funny thing in medicine is that we learn over time what the limitations of tests are, and we learn to use them less, esp. where they aren’t going to change management. The less providers know, the more tests they order; it’s sad but true, demonstrated in studies. And patients usually think more tests are better, bc they’re supposed to be ‘definite’, when that isn’t actually true much of the time. This is one of those times.

Hi All

I have not taken a potassium supplement ever on my own in the last 35 years of dealing with this issue. As a matter of fact, the only time I have been given potassium orally over those years in hospital was in 2020. 

I have once again started using a powdered supplement for athletes. I find that when I take a little bit of that powder and add it to my water that I have less bowel movements and that they are a little bit firmer but not much.

And with the supplement I took in hospital I found that bowel movements were further apart and that they were firmer because I took a tablet.  I was told in hospital not to supplement and when I had my test done it was at 3.5. According to hospital that is the right rate but I know I don't feel strong and that I need the potassium.

I am not a big eater so I cannot eat my potassium.  I am seriously thinking of supplementing.  Can someone please suggest what the recommended dosage would be to maintain a steady level of potassium?

I've recently been prescribed Potassium by my Dr.  It's a prescription, not an OTC.  I had a low level in my blood tests.  After 1 month, my level only went up a little bit.  On my 2nd month now.  I never knew that this could be caused by diahrea from my J-pouch. Interesting and informative discussion. Thanks!

I have mixed feeling about this. I 100% agree that focusing on electrolyte replacement in the presence of severe diarrhea, particularly with short bowel syndrome. I also agree that consuming potassium rich foods and electrolyte replacement fluids are completely safe. People who have known advanced kidney disease know their limitations.

My only concern would be for people who misinterpret a recommendation to apply to any source of potassium. We have a wide variety of people here and some may be on medications that already are potassium sparing and/or taxing to the kidneys, but dietary sources are seldom a problem. Some people get odd ideas that if a little is good, a lot is great.

You can have a fair amount of kidney damage before it even shows up on screening tests. A case in point is myself. Just a few weeks ago my doctor placed me on a low dose of an ACE inhibitor to protect my kidneys, as I had some mild kidney disease that cropped up in the past six months or so (protein in urine). Fortunately, my doctor did screening tests one week after starting the drug. My creatinine more than doubled and my potassium went from 4.5 to 5.5 in that short time. I even saw some changes on my EKG. I didn’t even take in any additional potassium. My potassium had been stable at around 4.5 for decades. Of course, this was drug induced, so a different story.

Just saying that treating weakness with potassium may be too simplistic, just like B-12 is not a panacea. How do you know your kidneys are healthy if you have not been screened?


Last edited by Jan Dollar

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