IM INA HOSPITAL

Re: More than just bananas
May be time to quote this post of BBB's ---

Cigars are a good way to relax; I've been able to smoke a few about a year ago, but promised myself not to pick it up again. I bought some in Miami after a cruise, and shared a pack of 50 with a friend. We bought them where Arnold buys his monthly supply in Little Havana. I smoked two and gave the rest away; mostly to joeinchicago. Our 40-year old son smokes cigarettes, but not inside the house. I still enjoy beer and wine with my meals.

Re: More than just bananas


Very little of the K+ is released from the banana due to the thick cellulose walls found on the banana cells and of course because human saliva lacks the enzyme cellulase, needed to hydrolyze the cellulose.

Haggis!!! McTag's trying to kill farmer!

Be well, Tweety!

Horse apples.

Avocados are my favorite tuber . . .

Mar Twain culdnt have said it better. As he produced an editorial column for a Tennessee agricultural paper that constantly gave instructions as how to gently shake pumpkins from the trees so as not to bruise them as they fell.
For one of his articles, I understand, he came very close to getting shot by a farmer-critic.


Avocados are only good for wagon wheel axle grease.

Farmerman
Farmerman, I was surprised that orange juice was not included on the list I poster earlier. It is a great source of potassium.

The medical history is different than yours, but I thought you might find it of interest. ---BBB

CLINICAL VIGNETTE
Outpatient Hyperkalemia
Katrina Posta, M.D.
Case Report

A 62-year-old man presented with positional vertigo. His past medical history was significant for type-2 diabetes for 3-4 years and borderline hypertension and hyperlipidimia that had not been previously treated. The only medication that he was taking at the time of the initial evaluation was glyburide.

His physical exam was remarkable for BP of 150/100 and pulse of 110. His ear and neurologic exams were normal. An EKG revealed ectopic atrial tachycardia, with a normal axis and nonspecific ST and T wave changes.

The patient\'s vertigo was thought to be due to labrynthitis, and supportive care was recommended. A basic metabolic panel with thyroid function was drawn for further evaluation of his vertigo and tachycardia, and the patient was started on beta-blocker, diuretic, and aspirin.

His initial electrolyte panel showed sodium 137, potassium 5.8, chloride 101, CO2 29, creatinine 1.1, BUN 10 and glucose 105. The rest of his blood tests were normal, including a normal CBC without evidence of intravascular hemolysis. The following day, his sodium was 134, potassium 5.3, chloride 99, CO2 25, creatinine 1.2, BUN 14, and glucose 170.

The patient continued to have mildly elevated potassium levels, with otherwise normal electrolytes over the next several visits. He vehemently denied taking any medications other than those described, including vitamins, minerals, over the counter medications or herbal supplements.

Finally, after taking a comprehensive dietary history in connection with the management of his diabetes, he admitted to drinking approximately one gallon of orange juice every day. The patient was educated about the high potassium and glucose content in orange juice and advised to discontinue drinking it. On subsequent follow-up, the patient\'s hyperkalemia completely resolved.

Discussion

This case illustrates some important factors to consider when evaluating patients with mild hyperkalemia. When evaluating asymptomatic hyperkalemia in the outpatient population, physicians should first consider the validity of the laboratory results. Hemolysis of red blood cells is a common reason for falsely elevated potassium. Technical problems with the collection and processing of a blood sample may lead to hemolysis. When the patient has a difficult vein for the blood draw and a small gauge needle or \"butterfly\" is used, some hemolysis may result at the time of specimen collection. Mechanical hemolysis at the time of collection is common in infants with heel stick samples. If the plasma and blood cells are not separated within 4 hours of collection, significant amounts of potassium can leak out of the red blood cells and result in artificially elevated potassium levels.1 Thus, in the case of unexplained and asymptomatic hyperkalemia, the physician should first confirm that the specimen collection and analysis were correctly preformed.

Pseudo-hyperkalemia can also result from leukocytosis in myeloproliferative syndromes or reactive thrombocytosis when potassium is released from platelets during the initial phases of coagulation. Pseudo-hyperkalemia can be excluded by comparing serum and plasma potassium levels.2

Hyperkalemia can be caused by problems with potassium redistribution, inadequate potassium excretion or excessive potassium intake. Problems with potassium redistribution are usually seen in an acute setting and include acidosis, hypertonicity (e.g. hyperglycemia) or acute hormone deficiency (insulin, aldosterone, or epinephrine). Rare causes include excessive exercise, arginine hydrochloride infusion, and periodic paralysis.3,4

Decreased potassium excretion is more common than problems with redistribution. Drugs are the most likely causes of low potassium excretion. Diuretics, beta-blockers, ACE inhibitors, NSAIDs, heparin, digoxin, immunosuppressives, and some antibiotics can cause low potassium excretion.5 Renal failure patients have difficulty excreting potassium and are at high risk for developing hyperkalemia. If the renal tubules cannot acidify or dilute urine adequately, hyperkalemia can result even when glomerular filtration rate is normal. Aldosterone or renal insufficiency can also lead to hyperkalemia by impairing the tubular secretion of potassium. A patient may also have pseudohypoaldosteronism, where renin and aldosterone levels are normal, but the patient has primary renal resistance to aldosterone. Certain connective tissue disorders, sickle-cell disease, amyloidosis, and post-renal transplant syndrome can also lead to inadequate potassium excretion by causing direct damage to the renal tubules.3,4

Finally, as this clinical case demonstrates, potassium supplementation may lead to hyperkalemia. Another case of orange juice-induced hyperkalemia with more severe consequences has previously been reported.6 Endogenous sources of increased potassium load include muscle trauma, intravascular hemolysis, and gastrointestinal bleeding. Exogenous sources include vitamin and herbal supplements, salt substitutes, high potassium foods, drugs, and alcohol.3,4 Representative values of potassium content in fruits and vegetables are found in Table 1. Given the high amounts of potassium in orange juice, cranberry juice may be a more appropriate treatment for hypoglycemia in the diabetic population who are at higher risk for hyperkalemia.6

Patient populations at higher risk for hyperkalemia include the elderly and people with diabetes, renal insufficiency, hyporeninemia, hypoaldosteronism, other endocrine disturbances, or neuromuscular disorders. Patients in these populations are much more susceptible to electrolyte imbalances from exogenous intake.3

Yes, and popcorn is my favorite fruit.

All that your irrational dislike for the noble avocado means to me is less competition for the available supply . . .

fm wrote-



That's not true fm. That's another assertion.

Avocado pears are quite good for selling to those certain types of upwardly mobile lower-middle-class ladies who give dinner parties where that wine is drunk which the "in" chef-of-the-moment has declared to have a delicate bouquet suitable to complement the pile of shite he has demonstated how to prepare for six guests with severe eating disorders. The videos I saw of Dover at the time of the "transfer of wealth" suggested the town may have shops selling Avocado pears to such ladies in quantities sufficient to make it pay.

There's a lot of UMLMC ladies around these days now that we have made so much money we hardly know what to do next with it and in trying further increase the quantity (fine word) and you can make money selling them Avocado pears and anything you can make money out of has a lot of uses.

Perhaps when the oil runs out money could be made growing Avocado pears for use as axle-grease. I should imagine a lot of axle-grease will be needed when the oil runs out.

Anyway fm- I'm sorry to see you are in hospital. I hope it is as good as the one I visited recently when I went to see someone having a by-pass op. It was science fiction come true to me. 12 months old and it sat like an ocean liner in a sea of greenery marred only by the double-yellow lines which were everywhere so you had to pay to park. This land is our land eh? There was loads of parking space on the golf-course next door.
I'll bet the bloke who owns the golf course looks enviously at those car parks which would all fit on the fairway of the first hole. £3 ($6) for 2 hours and hundreds of cars all day long.

All completely free here. Feel a bit wobbly-dial 999- sirens wailing- into the lift ready wired up- stabilised- prepared- opened up, switch some pipes about- stitch you up- build you back up and send you out good for another thirty years of gluttony. All free as is the back-up which is extensive. We can't have bloody consumers dying. They're the backbone of the economy.

So I hope you are doing okay.

avocados = $.69 in Nevada...

yummy

They're a buck where i'm at, and cheap at the price . . .

Two dollars in GA!!

Hey there, fman!

Had some avocado in your honour while in New York. Definitely could have used your help while I was discussing foraminifers with a CUNY grad student at a global warming exhibit on Governor's Island. I'm proud to say that I earned my certificate in foraminifer identification there!

drop and draw me a Globigerina.

I just found some five-day old homemade guacamole in the refrigerator. Amazing color! It would make excellent axle grease.

What's the best way to preserve guacamole? Five days old?

Heehee, that sound dirty.

dunno, it seldom lasts more than an hour or two around here. I had a bunch of ripe avocados this time and made up a large batch. It got shoved toward the back of the fridge. I don't know how long is too long, but it's less than five days.

Less than five days is stretching it alot. I have a problem within six minutes!

Did you leave the pit in? Put any lemon juice (not too much) in the guacamole?

I never made a big batch like that, and never left it 5 days, scarfffff, but leaving the pit in with it was said to help.