About all

Normal blood k levels: Low Potassium Levels (Hypokalemia)


Low Potassium Levels (Hypokalemia)


What does having low potassium levels in your blood mean?

Low potassium levels in your blood is also called hypokalemia. Normal levels of potassium range from 3.5 mmol/L to 5.1 mmol/L in adults. (Reference ranges are not the exact same at every laboratory). Usually, levels under 2.5 mmol/L are considered to be very serious.

What does potassium do for your body?

Potassium levels are very important in keeping your muscles, nerves, and heart working well. Potassium, an electrolyte, is also important for digestive health and for bone health.

Symptoms and Causes

What causes low potassium levels?

Low potassium can be caused by:

  • Frequent vomiting and/or diarrhea, including diarrhea from abusing laxatives
  • Excessive sweating
  • Drinking too much alcohol
  • Drugs, including diuretics (which cause urination), antibiotics, and corticosteroids
  • Not taking in enough potassium due to a poor diet (less common)
  • Adrenal disorders (rarely, overactive adrenal disorders such as Cushing’s syndrome, primary aldosteronism)
  • Kidney disease (rarely, renal tubular acidosis)
  • Rarely: colon villous polyps, certain medications, and some rare disorders, such as Liddle syndrome, Bartter’s syndrome, and Gitelman syndrome

What are the symptoms of low potassium levels?

Mild cases of low potassium might not cause symptoms. More severe cases might cause:

Diagnosis and Tests

How are low potassium levels diagnosed?

  • Blood tests
  • Urine tests
  • Electrocardiogram to check the heart

Management and Treatment

What is the treatment for low potassium levels?

Potassium supplements are generally prescribed for low potassium levels. If the situation is severe, potassium might be given as an intravenous (IV) solution. If there is a condition that causes the hypokalemia, such as low levels of magnesium or an overactive thyroid, the other condition must be treated also.

What foods provide potassium?

The following is a list of some, but not all, foods that provide potassium:

  • Apricots
  • Artichokes
  • Bananas
  • Beans
  • Beef
  • Broccoli
  • Brussels sprouts
  • Cantaloupes
  • Chicken
  • Fish (many types)
  • Kiwi fruit
  • Lentils
  • Milk
  • Mushrooms
  • Nuts (many kinds)
  • Orange juice
  • Pomegranate
  • Soy milk
  • Spinach
  • Tomatoes and tomato products
  • Zucchini

Hyperkalemia (High Blood Potassium): Symptoms, Causes & Treatment


What is hyperkalemia (high potassium)?

Hyperkalemia occurs when potassium levels in your blood get too high. Potassium is an essential nutrient found in foods. This nutrient helps your nerves and muscles function. But too much potassium in your blood can damage your heart and cause a heart attack. You can’t always tell when your potassium levels are high.

What is a safe or normal potassium level?

A typical potassium level for an adult falls between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia occurs when levels go above 5.5 mmol/L. A reading above 6.5 mmol/L can cause heart problems that require immediate medical attention.

Who might have hyperkalemia (high potassium)?

Anyone can get hyperkalemia, even children. You may be more at risk if you have:

Symptoms and Causes

What causes hyperkalemia (high potassium)?

Your kidneys filter potassium from the foods and drinks you consume. Your body gets rid of excess potassium when you pee. With hyperkalemia, your body has too much potassium for your kidneys to remove. As a result, potassium builds up in your blood.

In addition to conditions like kidney disease, these factors also contribute to hyperkalemia:

  • A high-potassium diet, which can result from potassium supplements and salt substitutes.
  • Medications that contain potassium, such as certain high blood pressure medicines.

What are the symptoms of hyperkalemia (high potassium)?

Many people with mild hyperkalemia have no signs or ones that are easy to dismiss. Symptoms often come and go and may come on gradually over weeks or months. Dangerously high potassium levels affect the heart and cause a sudden onset of life-threatening problems. Hyperkalemia symptoms include:

Diagnosis and Tests

How is hyperkalemia (high potassium) diagnosed?

Because most people don’t have symptoms, you might not know you have high potassium until you get a routine blood test. A serum potassium test measures potassium levels in blood. Your healthcare provider may also order an electrocardiogram (EKG). This test shows changes in heart rhythm caused by hyperkalemia.

Management and Treatment

What are the complications of hyperkalemia (high potassium)?

Severe hyperkalemia can come on suddenly. It can cause life-threatening heart rhythm changes (arrhythmia) that cause a heart attack. Even mild hyperkalemia can damage your heart over time if you don’t get treatment.

How is hyperkalemia (high potassium) managed or treated?

Treatment varies depending on the potassium level. Options include:

  • Diuretics: Also called water pills, these drugs make you pee more often. Your body gets rid of potassium mainly in urine.
  • Intravenous (IV) therapy: Extremely high potassium levels need immediate treatment. You’ll receive an IV infusion of calcium to protect your heart. Next, you get an infusion of insulin that helps move potassium into the blood cells. You may also inhale an asthma medication called albuterol to further lower potassium levels.
  • Medication management: Many people see improvement after stopping or changing certain blood pressure medications or other drugs that raise potassium levels. Your healthcare provider can determine what medication changes to make.
  • Potassium binders: A daily medication binds to excess potassium in the intestines. You pass the potassium when you poop. Your provider may recommend binders if other treatments don’t lower potassium levels. Potassium binders come in oral and enema form.
  • Dialysis: If potassium levels remain high, or you experience kidney failure, you may need dialysis. This treatment helps your kidneys remove excess potassium from blood.


How can I prevent hyperkalemia (high potassium)?

If you’ve had hyperkalemia or are at risk for it, a low-potassium diet is the best way to protect your health. You may need to cut back on, or completely cut out, certain high-potassium foods, such as:

  • Asparagus.
  • Avocados.
  • Bananas.
  • Citrus fruits and juices, such as oranges and grapefruit.
  • Cooked spinach.
  • Melons like honeydew and cantaloupe.
  • Nectarines.
  • Potatoes.
  • Prunes, raisins and other dried fruits.
  • Pumpkin and winter squash.
  • Salt substitutes that contain potassium.
  • Tomatoes and tomato-based products like sauces and ketchup.

Outlook / Prognosis

What is the prognosis (outlook) for people who have hyperkalemia (high potassium)?

Changes to your diet and medication often resolve mild cases of hyperkalemia. With the right care, most people don’t have long-term complications from hyperkalemia. Your healthcare provider may order more frequent blood tests to ensure your potassium levels stay within a healthy range.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Difficulty breathing.
  • Extreme muscle weakness or fatigue.
  • Severe abdominal pain, vomiting or diarrhea.
  • Weak pulse, chest pain or signs of a heart attack.

What questions should I ask my doctor?

If you have hyperkalemia (high potassium), you may want to ask your healthcare provider:

  • Why did I get hyperkalemia?
  • How often should I get blood tests to check for hyperkalemia?
  • How much potassium should I get in my daily diet?
  • What foods or supplements should I avoid?
  • What, if any, salt substitutes can I use?
  • What are the treatment risks and side effects?
  • Am I at risk for kidney failure or other problems due to hyperkalemia?
  • What follow-up care do I need after treatment?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Because hyperkalemia rarely causes symptoms, you may be surprised when a blood test shows that your potassium levels are high. A low-potassium diet can protect your health. Your healthcare provider can determine how much potassium you need or connect you with a dietitian, if needed. A dietitian can help you create meal plans that ensure you get just the right amount of potassium in your diet. Your provider may also change your medications. Potassium levels that reach a dangerously high level can be life-threatening. If you’re at risk for hyperkalemia, your provider will closely monitor your potassium levels.

High vs. Low, Normal K Level

In the right amounts, the mineral potassium helps your nerves and muscles “talk” to each other, moves nutrients into and waste out of your cells, and helps your heart function.

Kidney disease is a common cause of a high potassium level. Either high or low potassium levels can cause heart problems. Low potassium can cause muscle cramps.

You often have a blood test with your yearly physical that checks for your potassium levels. If you have any of the conditions mentioned above, your doctor may want you to be tested. The blood sample can check to see whether your potassium levels are in the normal range.

What Is Potassium?

As a nutrient, potassium is found in a number of foods. Some foods with a lot of this mineral include:

  • Avocados
  • Bananas
  • Beets
  • Oranges and orange juice
  • Pumpkins
  • Spinach

Potassium is one mineral that plays an important role in controlling the amount of fluid in the body. Another is sodium. Too much sodium — which the body mainly gets from salt — leads to the body retaining fluid. This can lead to high blood pressure (hypertension) and other issues. Potassium balances the effects of sodium and helps keep fluid levels within a certain range.

Your body should maintain a specific amount of potassium in the blood, ranging from 3.6 to 5.2 millimoles per liter (mmol/L).

Why Would I Get This Test?

Your doctor may want you to get a blood test to check for potassium levels if they suspect you’re having health issues like:

Other terms used to describe this test are:

  • BMP (basic metabolic panel)
  • Chem 7
  • Electrolyte panel

In addition to potassium levels, the test may check your blood for chloride, sodium, and urea nitrogen (BUN).

How Do I Prepare?

Your doctor may ask you not to eat for at least 6 hours before the test, and to drink only water.

They’ll probably want to talk with you about your medical history and any medicines you’re taking. Some medicines may affect the results, so they might advise you not to take them before the test.

To do a test, a lab tech sticks a needle in a vein and takes a blood sample. Sometimes it’s hard to find a good vein, so they will tighten an elastic band around your upper arm and ask you to open and close your hand into a fist. The needle is attached to a tube, which collects the blood specimen.

This usually takes less than 5 minutes.

Blood tests are very common and have very few risks. However, any needle stick may cause bleeding, bruising, infection, or cause you to feel faint. Pay attention to the directions your doctor gives you, including applying pressure to the area and keeping it clean.

What Do My Results Mean?

Depending on the lab, you should get the results back within a few days. (If there’s a lab at your doctor’s office, the results may be returned in less than an hour).

Your doctor will go over the results with you. If your potassium level is high (a condition called hyperkalemia) you may have:

If your potassium level is low (hypokalemia), you may have:

  • Kidney disease
  • Diabetic ketoacidosis
  • Folic acid deficiency (Folic acid is an important B vitamin that helps make new cells in your body.)

Hypokalemia may also be caused by:

Sometimes, a blood sample may be poorly taken or poorly tested, which can affect the test results. To make sure of the diagnosis, your doctor might ask you to take a second blood test. Or, they might ask you to take a urine test.

Patients who have already been diagnosed with kidney disease or other ailments may take potassium blood tests regularly.

Potassium (K) in Blood Test

Test Overview

A potassium test checks how much potassium is in the blood. Potassium is both an electrolyte and a mineral. It helps keep the water (the amount of fluid inside and outside the body’s cells) and electrolyte balance of the body. Potassium is also important in how nerves and muscles work.

Potassium levels often change with sodium levels. When sodium levels go up, potassium levels go down, and when sodium levels go down, potassium levels go up. Potassium levels are also affected by a hormone called aldosterone, which is made by the adrenal glands.

Potassium levels can be affected by how the kidneys are working, the blood pH, the amount of potassium you eat, the hormone levels in your body, severe vomiting, and taking certain medicines, such as diuretics and potassium supplements. Certain cancer treatments that destroy cancer cells can also make potassium levels high.

Many foods are rich in potassium, including bananas, orange juice, spinach, and potatoes. A balanced diet has enough potassium for the body’s needs. But if your potassium levels get low, it can take some time for your body to start holding on to potassium. In the meantime, potassium is still passed in the urine, so you may end up with very low levels of potassium in your body, which can be dangerous.

A potassium level that is too high or too low can be serious. Abnormal potassium levels may cause symptoms such as muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, confusion, irritability, paralysis, and changes in heart rhythm.

Other electrolytes, such as sodium, calcium, chloride, magnesium, and phosphate, may be checked in a blood sample at the same time as a blood test for potassium.

Why It Is Done

A blood test to check potassium is done to:

  • Check levels in people being treated with medicines such as diuretics and for people having kidney dialysis.
  • Check to see whether treatment for too low or too high potassium levels is working.
  • Check people with high blood pressure who may have a problem with their kidneys or adrenal glands.
  • Check the effects of extra nutrition (total parenteral nutrition [TPN]) on potassium levels.
  • Check to see whether certain cancer treatments are causing too many cells to be destroyed (cell lysis). Cell lysis syndrome causes very high levels of some electrolytes, including potassium.

How To Prepare

In general, there’s nothing you have to do before this test, unless your doctor tells you to.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.


How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.


There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.


A potassium test checks how much potassium is in the blood. Potassium is an electrolyte and mineral.

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Blood potassium levels also vary with age.

Results are ready in 1 day.

Many conditions can affect potassium levels. Your doctor will talk with you about any abnormal results that may be related to your symptoms and past health.

High values

  • High blood potassium levels may be caused by damage or injury to the kidneys. This prevents the kidneys from removing potassium from the blood normally.
  • High blood potassium levels can also be caused by conditions that move potassium from the body’s cells into the blood. These conditions include severe burns, crushing injuries, heart attack, and diabetic ketoacidosis.
  • Taking too many potassium supplements can also cause high levels of potassium in the blood.
  • Too much acid (pH) in the blood makes potassium levels higher by causing the potassium in the body’s cells to “leak” out of cells and into the blood.
  • Some medicines, such as aldosterone antagonists and angiotensin-converting enzyme (ACE) inhibitors, can cause high potassium levels.

Low values

  • Low blood potassium levels can be caused by high levels of aldosterone (hyperaldosteronism) made by the adrenal glands.
  • Other conditions that can cause low blood potassium levels include severe burns, cystic fibrosis, alcohol use disorder, Cushing’s syndrome, dehydration, malnutrition, vomiting, diarrhea and certain kidney diseases, such as Bartter’s syndrome. Bartter’s syndrome is a condition characterized by enlargement of certain kidney cells. It is more common in children and may be linked to an abnormally short stature (dwarfism). The cause of Bartter’s syndrome is not fully known.
  • Medicines, such as diuretics, are a common cause of low potassium levels.



  1. Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.


Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
Adam Husney MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Martin J. Gabica MD – Family Medicine

Current as of: September 23, 2020

Healthwise Staff

Medical Review:Adam Husney MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & Martin J. Gabica MD – Family Medicine

Hyperkalemia (High Potassium) – Managing Side Effects


Care During Chemotherapy and Beyond

What Is Hyperkalemia?

Hyperkalemia is an electrolyte
imbalance and is indicated by a high level of potassium in the blood. 
The normal adult value for potassium is 3.5-5.3 mEq/L.

Potassium is one of many electrolytes in your body. It is found inside of cells.
Normal levels of potassium are important for the maintenance of heart, and nervous
system function.

What Causes Hyperkalemia?

One way your body regulates blood potassium levels is by shifting potassium into
and out of cells.  When there is a breakdown or destruction of cells, the electrolyte
potassium moves from inside of the cell to outside of the cell wall.  This
shift of potassium outside of the cells causes hyperkalemia.

Potassium is excreted (or “flushed out” of your system) by your kidneys. Any damage
to your kidneys, when they are not working properly, may cause an increase in potassium
levels leading to hyperkalemia.

As seen with tumor lysis syndrome – when you receive chemotherapy, the drugs will
act by breaking down the tumor cells. When there is a rapid amount of cellular destruction,
the components of the cells (including potassium), will move outside of the cell,
and into the blood stream. People, who receive chemotherapy for leukemia, lymphoma,
or multiple myeloma, may be at risk for tumor lysis syndrome, if there is a large
amount of disease present.

Other causes of hyperkalemia include:

  • If you are diabetic, an insulin deficiency may cause hyperkalemia.
  • If you are bleeding internally, you may have hyperkalemia.
  • Some medications that contain potassium, or medications that preserve the amount
    of potassium that is excreted through your kidneys, can cause hyperkalemia. These
    may include Angiotensin Converting Enzyme (ACE) inhibitors, such as Lisinopril,
    or potassium-sparing diuretics, such as Spironolactone (e.g., Aldactone).
  • If your kidneys are not able to process and excrete potassium and other electrolytes,
    due to renal (kidney) failure, you may be at risk for hyperkalemia.
  • Your adrenal glands are important regulators of potassium in your blood.  Endocrine
    or hormonal problems (such as Adrenal insufficiency) can cause hyperkalemia.
  • Salt substitutes (containing potassium) or excessive intake of potassium can lead
    to hyperkalemia.

Hyperkalemia Symptoms:

  • You may not have any symptoms, unless your blood potassium levels are significantly
  • Muscle weakness.
  • Diarrhea (with very high potassium levels).
  • Chest pain, or heart palpitations.

Things You Can Do for Hyperkalemia:

  • Follow your healthcare provider’s instructions regarding lowering your blood potassium
    level. If your blood levels are severely elevated, he or she may prescribe medications
    to lower the levels to a safe range.
  • If you are taking heart medication, and you have a chronic (long-term) elevated
    blood potassium level, you may be advised to eat a low potassium diet. Foods that
    are high in potassium include most fresh fruits and vegetables. Some specific examples

    • Oranges and orange juice
    • Leafy green vegetables, such as spinach and greens (collard and kale)
    • Potatoes
  • Take all of your medications as directed
  • Follow all of your healthcare provider’s recommendations for follow up blood work
    and laboratory tests.
  • Avoid caffeine and alcohol, as these can cause you to have electrolyte disturbances.

Drugs That May Be Prescribed by Your Doctor for Hyperkalemia:

  • Your doctor or healthcare provider may prescribe medications to lower your blood
    potassium levels if your blood test results show hyperkalemia. These may include:

    • Loop Diuretics – are also known as “water pills” as they work to decrease blood
      potassium levels, by making you urinate out extra fluid. When you lose fluid through
      the kidneys, you will lose potassium as well. 
    • Sodium polystyrene sulfonate (e.g.Kayexalate) – This medication works to lower blood
      potassium levels by binding with the potassium in your stomach or gut. You may take
      this medication by mouth, or by enema. If you are given this medication and become
      constipated, you must take a special laxative (called sorbitol) to relieve your
    • Insulin/Calcium/Bicarbonate – These medications are given usually intravenously,
      to drive the potassium electrolyte from your bloodstream, back into the cells. This
      is usually given with another potassium lowering therapy.
    • Hemodialysis – If your blood test results indicate a severely elevated blood
      potassium level, and you are currently in kidney failure, your healthcare provider
      and a kidney specialist may order dialysis treatments.

When to Contact Your Doctor or Health Care Provider:

  • Nausea that interferes with your ability to eat, and is unrelieved by prescribed
  • Vomiting (vomiting more than 4-5 times in a 24 hour period).
  • Severe constipation, unrelieved by laxatives, lasting 2 to 3 days.
  • Muscle weakness, poor appetite that does not improve.
  • Feeling your heart beat rapidly (palpitations).

Return to list of Blood
Test Abnormalities

Note:  We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org

Uses, Side Effects, Procedure, Results

A blood potassium test is one of the most commonly ordered lab tests and may be done for a wide variety of medical conditions. As an electrolyte that is critical in muscle contraction and nerve conduction, both elevated and decreased levels can be very serious. We will look at the reasons why your doctor may recommend this test, the normal range in adults and children, potential causes of high (hyperkalemia) or low (hypokalemia) levels, and what further testing may be recommended depending upon your results.

A very high or very low blood potassium test can be a medical emergency.

Purpose of Test

Potassium is an extremely important electrolyte in the body, playing a crucial role in muscle contraction (both skeletal muscles and the heart muscle), the conduction of nerve impulses, and more. As such, it is ordered frequently in both the clinic and hospital setting.

The test may be ordered for a variety of reasons, including:

  • As part of a general chemistry or electrolyte panel during routine health exams
  • To evaluate and monitor many chronic conditions, including heart conditions, high blood pressure, lung conditions, kidney conditions, endocrine conditions, and more
  • To detect abnormalities in those who are experiencing vomiting, diarrhea, or dehydration
  • If you have symptoms of high or low potassium, such as muscle weakness, palpitations or an irregular heart rhythm on an EKG (it’s important to note that abnormal potassium levels can be very serious even if symptoms are not present)
  • To monitor medications, especially those that can result in a high or low potassium level
  • To monitor acid-base balance in the body
  • When intravenous fluids are given
  • During cancer treatments that cause cell death (cell lysis or breakdown can result in the release of large amounts of potassium into the blood)

Significance of Blood Potassium

Evaluating blood potassium is very important in the management of many medical conditions, and can sometimes alert physicians to problems before potentially life-threatening complications develop. Potassium levels reflect how well the kidneys are working, the actions of hormones such as aldosterone in the body, the effect that medications may be having on the body, and how much potassium is taken into the body via the diet (although intake alone rarely causes abnormal levels when the kidneys are functioning well).

It’s important to note, however, that while a blood potassium test is one of the more helpful tests, blood potassium levels do not necessarily represent the body stores or cellular levels of potassium. Only around 2% of potassium in the body is found in the blood. This concept must be kept in mind in conditions such as diabetic ketoacidosis, when body stores of potassium may remain critically low even if blood levels appear to return to normal.


As with most medical tests, there are some limitations in interpreting potassium levels in the blood.

Results are less accurate (may be falsely elevated) in people who have a high white blood cell or platelet count.

There is also significant variability with potassium blood tests done on whole blood, according to a 2018 Mayo Clinic study. Both an inaccurate reading of high potassium (pseudohyperkalemia) and low potassium (pseudohypokalemia) occur frequently, and this finding needs to be considered when interpreting the test results.

Similar Tests

At the current time there is not an approved home potassium blood test, though this is being investigated.

Research is also in progress looking for non-invasive ways to detect elevated potassium levels via EKG readings. A 2019 study published in JAMA found that applying artificial intelligence to continuous or remote EKG monitoring may be helpful in the future for detecting even small changes in potassium level in people at high risk.

Complementary Tests

Potassium is usually ordered along with other electrolytes, including sodium, chloride, phosphate, and magnesium. This is important for many reasons. For example, low magnesium levels are common, and when low, magnesium must be replaced in order for potassium replacement to be effective. Kidney function tests are important if potassium levels are abnormal.

Risks and Contraindications

Since potassium is a simple blood test, there are few risks other than bruising related to the blood draw. It is important to note, however, that the potassium level that is returned may not reflect what is really happening in the body (the total body stores of potassium), and lab errors sometimes occur. Since potassium is mostly present inside the cells, if the blood cells are damaged during blood draw or transportation, the potassium level may be spuriously high. A repeat blood draw is usually indicated in these circumstances.

Before The Test

Before having your potassium test, your doctor will explain the purpose for this as well as other tests recommended. It is important that your doctor is aware of your medical history, especially any history of kidney disease or abnormal potassium levels in the past. If you have had recent lab tests done at outside clinics or hospitals, obtaining these records is helpful in order to make comparisons.

Some doctors recommend fasting for several hours prior to the blood test, especially if other tests such as cholesterol levels are being drawn at the same time.


A potassium test is frequently done at the same time as a clinic visit, and results may be available during your visit. In other cases, your doctor may call you later with your results. As with many other lab tests, it’s helpful to ask your doctor both your level of potassium and the normal range, rather than simply whether it’s normal, high, or low.


A potassium blood test may be drawn in the hospital and many clinics. In a clinic setting, your blood may be drawn in an exam room, or you may be asked to go to a special area where blood tests are done.

What to Wear

It’s helpful to wear a short-sleeve shirt or a long-sleeve shirt with loose sleeves that can easily be rolled up.

Food and Drink

While many labs do not have food or water restrictions prior to a potassium blood test, drinking large amounts just prior to your test may interfere with your results.

Cost and Health Insurance

A potassium blood test is relatively inexpensive, and is covered by insurance for many medical conditions.

What to Bring

It’s important to bring your insurance card to your visit, as well as any recent lab tests from outside clinics or hospitals.

During the Test

When you arrive for your blood test, the technician will make sure you are comfortably seated in a chair. They will inspect your arm for accessible veins, and then cleanse the site where blood will be drawn with alcohol. A tourniquet may be applied to make the vein more visible.

While some technicians recommend fist clenching as a method to make veins more visible, this can result in falsely elevated potassium levels and should be avoided. Prolonged use of a tourniquet can also falsely elevate levels.

Fist clenching should be avoided as it can result in errors in your potassium level.

When the technician is ready, they will let you know that they are placing the needle in your arm and you may feel a sharp prick as it enters your skin. If you are bothered by blood draws or the site of blood it can be helpful to look at something else during the procedure. This discomfort is usually transient, though the procedure may sometimes need to be repeated more than once to obtain a sample.

The needle will be kept in place, attached to a test tube, and sometimes additional test tubes are placed to obtain further lab tests. You may feel some pressure while the needle remains in your arm.

When the technician has obtained the samples, they will remove the needle and cover the site with gauze or a bandage. You will be asked to hold pressure over the site for a few minutes to help stop any bleeding and reduce the chance of bruising. The entire process usually requires only a few minutes.

After the Test

After a few hours, you can usually remove the gauze or bandage that was placed on your arm. Some people may experience bruising, especially if more than one attempt is needed to obtain blood. People who have bleeding disorders or are taking blood thinners are also more likely to experience bruising.

Your doctor will let you know when you can expect to get your results. This may be as quickly as a few minutes following your blood draw or up to a week or more, depending on the lab and the urgency of the results.

Interpreting Results

When interpreting your results, it’s important to understand that the normal range of potassium can vary in individuals and in different situations. Serum potassium levels can vary with the time of day, especially in people with kidney disorders. Levels tend to be higher in pregnancy, and lower in Asians and blacks than in whites.

Lower average potassium levels in blacks are actually thought to be one reason why the incidence of type II diabetes is higher in blacks.

Reference Range

The results are reported in milli-equivalents per liter (mEq/l). The reference range for a normal potassium can vary somewhat between labs, but is most often in the range of:

  • 3.5 mEq/l to 5.0 mEq/l in adults
  • 3.4 mEq/l to 4.7 mEq/l in children
  • 4.1 mEq/l to 5.3 mEq/l in infants
  • 3.9 mEq/l to 5.9 m Eq/l in newborns

A high potassium (hyperkalemia) is considered to be a potassium greater than 5.0 mEq/l (or slightly higher depending on the lab). Levels higher than 5.5 mEq/l are considered very high, and levels over 6.5 mEq/l can be life-threatening in adults. In newborns, levels greater than 8.0 mEq/l are considered critical.

A low potassium (hypokalemia) is considered to be a potassium less than 3.5 mEq/l. Levels less than 2.5 mEq/l are very serious.

Low Potassium (Hypokalemia)

There are three primary mechanisms that may result in a low potassium level in the blood:

  • A low intake of potassium in the diet (this is uncommon)
  • Increased potassium loss from the body (either via the kidneys (often due to medications), gastrointestinal tract, or via sweating (rare).
  • Shift of potassium from the bloodstream into cells (with insulin, when the pH of the blood is low (metabolic acidosis), when stress hormones are released, or with periodic paralysis

Some potential causes of a low potassium level include:

  • Vomiting or diarrhea
  • Dehydration
  • Medications, including some diuretics such as Lasix (furosemide), laxatives, insulin, glucocorticoids, penicillin, and acetaminophen (with overdoses)
  • Trauma
  • Increased aldosterone due to primary hyperaldosteronism, Cushing’s syndrome, an excessive intake of European licorice, and more
  • Some kidney disorders, (chronic kidney disease (CKD) is the most common cause of chronic low potassium levels)
  • Magnesium deficiency
  • Barium poisoning
  • Uncommon genetic disorders such as Liddle syndrome, hypokalemic periodic paralysis, Bartter syndrome, or Gitelman syndrome
  • Low intake of potassium combined with high sodium intake (uncommon)
  • Factors such as chronic stress and alcoholism may also contribute

Symptoms are not usually present unless the potassium level drops below 3.0 mEq/l, and may include muscle cramps and weakness, fatigue, constipation, and when severe, paralysis or rhabdomyolysis. Seizures may also occur.

Treatment is usually accomplished with oral or intravenous potassium. When hypokalemia is chronic, treatment is often needed long after levels return to normal as total body stores may be very low despite blood levels appearing normal. Dietary potassium (eating foods rich in potassium) is not enough to improve a low potassium level due to diarrhea or diuretics.

High Potassium (Hyperkalemia)

Spurious high potassium levels (errors) may result from fist clenching during a blood draw, when hemolysis occurs in the sample, or in people who have very high white blood cell or platelet counts.

An Overview of Hyperkalemia

There are also three primary mechanisms that can result in a potassium level that is truly too high (hyperkalemia). These include:

  • Increased intake of potassium
  • Decreased potassium excretion by the kidneys (often related to medications or lack of insulin)
  • Shift of potassium from cells into the bloodstream

Potential causes of an elevated potassium level include:

  • Kidney disease (usually with acute renal failure rather than chronic kidney disease)
  • Type I diabetes (lack of insulin)
  • Metabolic acidosis
  • Physical stress (trauma, burns, infections, dehydration)
  • Medications such as potassium-sparing diuretics, angiotensin converting enzyme inhibitors (ACE inhibitors) such as Zestril (lisinopril), angiotensin receptor blockers (ARBs), direct renin inhibitors, aldosterone antagonists, calcium channel blockers, beta-blockers, non-steroidal antiinflammatory drugs such as ibuprofen (NSAIDs and hyperkalemia), digitalis, calcineurin inhibitors, proton pump inhibitors (such as omeprazole), heparin, cyclosporine, trimethoprin, mannitol, and pentamidine
  • Blood transfusion
  • Hypoaldosteronism (such as with Addison’s disease)
  • Tumor lysis syndrome (break down of cells due to cancer treatment)
  • Cirrhosis
  • Heart failure
  • Hemolytic anemia
  • Excessive intake via diet, supplements, or salt substitutes (uncommon unless other factors leading to high potassium levels are also present)
  • Some uncommon genetic disorders such as familial periodic paralysis
  • Eating disorders such as bulimia

Symptoms can be very serious and can range from muscle weakness to paralysis, and from palpitations to sudden death (due to dangerous heart rhythms). The combination of severe hyperkalemia and abnormal changes on an EKG is a medical emergency.

Treatment varies depending on the severity and may include insulin when needed, sodium bicarbonate, intravenous calcium, and dialysis when very serious. Long term treatment may include restricting potassium in the diet (low potassium diet), potassium wasting diuretics, medications that bind potassium, and more.

Further Testing

Verywell / Joshua Seong

if abnormalities are not severe, and if an obvious cause is not present, the first step may be to simply repeat the test. As noted, errors in potassium can be caused by a number of factors including fist clenching during the blood draw or the prolonged use of a tourniquet. If a high white blood cell or platelet count are present, a plasma potassium (rather than whole blood sample) may be done.

If an abnormal potassium is present, kidney function tests as well as a glucose level should always be done. Other electrolytes (such as sodium) should be evaluated as they may affect treatment, for example, a magnesium test should be done as magnesium deficiency must be treated for the treatment of potassium deficiency to be effective. Evaluation of acid-base balance in the body is also important. A complete blood count may be done to rule out causes such as hemolytic anemia and to look for an elevated white blood cell or platelet count.

If an obvious cause for hypokalemia is not present, a common next step is to check the potassium level in the urine (either with a random urine sample or sometimes with a 24-hour urine sample). If the level of potassium in the urine is low, causes such as loss from the gastrointestinal tract or a shift of potassium into cells may be the cause. If the potassium level in the urine is high, the cause is likely related to kidney disease. Further tests may be indicated based on other lab studies, such as evaluation of aldosterone and much more.


Follow-up will depend on many factors including the reason why the test was performed in the first place. If your levels are abnormal, it’s important to talk to your doctor about the reasons why, any further testing that is indicated, and when you should have a repeat potassium test. It’s helpful to write down any specific instructions or follow-up appointments.

Some people request copies of their blood work to keep their own records. This can be particularly helpful if you receive care from different doctors at different locations, or if you will be traveling.

You may wish to ask specific questions about what you can do yourself in regard to an abnormal potassium level. If you have a low potassium level, it’s important to understand that eating bananas alone is unlikely to be an effective treatment. But if you have a high potassium level, strict attention to a low potassium diet may be very important.

Since abnormal (and when severe, potentially life-threatening) arrhythmias are of concern with high potassium levels, people who have a history or are at risk for hyperkalemia should familiarize themselves with the symptoms of abnormal heart rhythms.

A Word From Verywell

It can be frightening to learn about the potential causes for an abnormal potassium level, and this can be compounded if you and your doctor are uncertain of the cause. Asking a lot of questions, and being an active participant in your care can help you stay in the driver’s seat of your health care and make sure you get the care you deserve.

Potassium and Chronic Kidney Disease

What is potassium and what does it do in the body?

Potassium is a mineral that controls nerve and muscle function. The
heart beats at a normal rhythm because of potassium. Potassium is also necessary for
maintaining fluid and electrolyte balance and pH level.

In order for potassium to perform these functions, blood levels must be kept between 3.5 and 5.5 mEq/L. The
kidneys help keep potassium at a normal level.

When is potassium too low or too high?

Low potassium

Potassium comes from the foods we eat. Healthy kidneys remove excess potassium in the urine to help maintain normal levels
in the blood.

Because most foods have potassium, low potassium (hypokalemia) is uncommon in people who eat a healthy diet.

Some of the effects of low potassium include muscle weakness, cramping and fatigue.

High potassium

When kidneys fail they can no longer remove excess potassium, so the level builds up in the body. High potassium in the blood
is called hyperkalemia, which may occur in people with advanced
stages of chronic kidney disease (CKD). Some of the effects of high potassium are nausea, weakness, numbness and
slow pulse.

For people with
stage 5 CKD (also known as end stage renal disease or ESRD),
dialysis is necessary to help regulate potassium. Between dialysis treatments, however, potassium levels rise
and high-potassium foods must be limited.

Have your potassium levels checked regularly and ask your
renal dietitian or
doctor about your potassium results.

How to prevent potassium levels from getting too high

Here are things you can do to keep your potassium at safe levels:

  • Talk to your renal dietitian about creating an eating plan.
  • Limit foods that are high in potassium.
  • Limit milk and milk products or replace with nondairy substitutes.
  • Discard liquids from canned fruits and vegetables.
  • Avoid salt substitutes and other seasonings with potassium.
  • Read labels on packaged foods and avoid potassium chloride.
  • Pay attention to serving size.
  • Don’t skip dialysis or shorten treatment times.
  • Leach high-potassium vegetables to remove some of the potassium. Learn how to do so in this
    DaVita article.

What to eat and what to limit

The suggestions and lists below are some high and low potassium foods.

Food Type Tip


  • Choose apples, berries or grapes,
    instead of bananas, oranges or kiwi.
  • Select watermelon,
    instead of cantaloupe or honeydew.
  • Eat peaches, plums or pineapple,
    instead of nectarines, mangos or papaya.
  • Choose dried cranberries,
    instead of raisins or other dried fruit.
  • Drink apple, cranberry or grape juice,
    instead of orange juice or prune juice.



  • Choose green beans, wax beans or snow peas,
    instead of dried beans or peas.
  • Prepare mashed potatoes or hash browns from leached potatoes,
    instead of eating baked potato or French fries.
  • Use summer squashes like crookneck or zucchini,
    instead of winter squashes like acorn squash.
  • Cook with onion, bell peppers, mushrooms or garlic,
    instead of tomatoes, tomato sauce or chili sauce.



  • Prepare pudding with nondairy creamer,
    instead of eating yogurt or pudding made with milk.
  • Enjoy sherbet, sorbet or a Popsicle®,
    instead of ice cream or frozen yogurt.



  • Choose vanilla- or lemon-flavored desserts,
    instead of chocolate desserts.
  • Eat unsalted popcorn or pretzels or rice cakes,
    instead of nuts or seeds.

High-potassium foods

Limit or avoid high-potassium foods.

Food Type High-potassium foods



  • Avocados

  • Bananas

  • Cantaloupe

  • Dried fruits

  • Honeydew

  • Kiwi

  • Mangos

  • Oranges & orange juice

  • Papaya

  • Prune juice



  • Artichoke

  • Dried beans and peas

  • Pumpkin

  • Potatoes, French fries

  • Spinach (cooked)

  • Sweet potatoes

  • Tomatoes, tomato sauce

  • Vegetable juices

  • Winter squash





  • Chocolate
  • Molasses
  • Salt substitute
  • Seeds and nuts

Low-potassium foods

Ask your dietitian about the amount you can safely eat.

Food Type Low-potassium foods


  • Apples
  • Berries
  • Fruit Cocktail
  • Grapes
  • Lemon
  • Peaches
  • Canned Pears
  • Pineapple
  • Plums
  • Watermelon


  • Carrots
  • Cabbage
  • Cauliflower
  • Cucumber
  • Eggplant
  • Green beans
  • Lettuce
  • Onion
  • Summer squash
  • Sweet peppers

Dairy substitutes

  • Nondairy creamers
  • Nondairy whipped topping
  • Rice milk (unenriched)
  • Sorbet or Popsicle®


  • Jelly Beans
  • Hard candies
  • Plain donuts
  • Popcorn (unsalted)
  • Pretzels (unsalted)
  • Red licorice

Disclaimer: The above lists don’t include all foods low in potassium. Consult your dietitian and
doctor about what to eat based on your individual requirements.

Keep track of your nutrient levels with the easy-to-use
DaVita Diet Helper™. Get pre-planned meals, shopping lists and more, all customized to your diet needs, including
potassium levels.

Hypokalemia: an overview of the current state of the problem | Averin

1. Gennari F.J .: Disorders of potassium homeostasis. Hypokalemia and hyperkalemia. Crit Care Clin 2002; 18: 273-288.

2. Cohn J.N., Kowey P.R., Whelton P.K., Prisant L.M .: New guidelines for potassium replacement in clinical practice: A contemporary review by the National Council on Potassium in Clinical Practice.Arch Intern Med 2000; 160: 2429-2436.

3. Liamis G., Rodenburg E. M., Hofman A., Zietse R., Stricker B. H., Hoorn E. J. Electrolyte Disorders in Community Subjects: Prevalence and Risk Factors. The American Journal of Medicine. 2013; 126: 256-263.

4. Ellison D.H., Hoorn E.J., Wilcox C.S. Diuretics. In: Taal M.W., Chertow G.M., Marsen P. A., Skorecki K., Yu S. L., eds. Brenner and Rector’s The Kidney. 9th ed. Philadelphia, PA: Elsevier; 2011.

5. Satlin L.M., Carattino M.D., Liu W., Kleyman T.R. Regulation of cation transport in the distal nephron by mechanical forces. Am J Physiol Renal Physiol. 2006; 291: F923-F931.

6. Whelton P.K., He J., Cutler J.A., et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997; 277 (20): 1624-32.

7. Geleijnse J.M., Kok F.J., Grobbee D.E. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomized trials. J Hum Hypertens 2003; 17 (7): 471-80.

8.Krishna G.G., Kapoor S.C. Potassium depletion exacerbates essential hypertension. Ann Intern Med. 1991; 115: 77-83.

9. Krishna G.G., Miller E., Kapoor S. Increased blood pressure during potassium depletion in normotensive men. N Engl J Med. 1989; 320: 1177-1182.

10. Liamis G1, Liberopoulos E 1, Barkas F1, Elisaf M. Diabetes mellitus and electrolyte disorders.World J Clin Cases. 2014: 16; 2 (10): 488-96

11. Elisaf M.S., Tsatsoulis A.A., Katopodis K.P., Siamopoulos K.C. Acid-base and electrolyte disturbances in patients with diabetic ketoacidosis. Diabetes Res Clin Pract 1996; 34: 23-27.

12. Yang L., Frindt G., Palmer L. G. Magnesium modulates ROMK channel-mediated potassium secretion.J Am Soc Nephrol 2010; 21: 2109-2116.

13. Minaker K.L., Rowe J.W. Potassium homeostasis during hyperinsulinemia: effect of insulin level, beta-blockade, and age. Am J Physiol 1982; 242: E373-E377.

14. Petersen K.G., Schlüter K.J., Kerp L. Regulation of serum potassium during insulin-induced hypoglycemia. Diabetes 1982; 31: 615-617.

15. Kreisberg R.A. Diabetic ketoacidosis: new concepts and trends in pathogenesis and treatment. Ann Intern Med 1978; 88: 681-695.

16. Kitabchi A.E., Umpierrez G.E., Murphy M.B., Kreisberg R.A. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 2739-2748.

17. Aburto N.J., Ziolkovska A., Hooper L., Elliott P., Cappuccio F.P., Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyzes. BMJ 2013; 346: f1326.

18. Wilcox C.S. Metabolic and adverse effects of diuretics. Semin Nephrol 1999; 19: 557-568.

19.Naismith D.J., Braschi A. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Br J Nutr 2003; 90 (1): 53-60.

20. Hunt B.D., Cappuccio F.P. Potassium intake and stroke risk: a review of the evidence and practical considerations for achieving a minimum target. Stroke 2014; 45 (5): 1519-22.

21.Seth A., Mossavar-Rahmani Y., Kamensky V., et al. Potassium intake and risk of stroke in women with hypertension and nonhypertension in the Women’s Health Initiative. Stroke 2014; 45 (10): 2874-80.

22. Chang H. Y., Hu Y. W., Yue C. S., et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 2006; 83 (6): 1289-96.

23.Palmer B.F. Regulation of potassium homeostasis. Clin J Am Soc Nephrol 2015; 10 (6): 1050-60.

24. Araki S., Haneda M., Koya D., et al. Urinary potassium excretion and renal and cardiovascular complications in patients with type 2 diabetes and normal renal function. Clin J Am Soc Nephrol 2015; 10 (12): 2152-8.

25. National Kidney Foundation.K / DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 43 (5 suppl 1): S 1-290.

26. Hayes C.P. Jr, McLeod M.E., Robinson R.R. An extravenal mechanism for the maintenance of potassium balance in severe chronic renal failure. Trans Assoc Am Physicians 1967; 80: 207-16.

27.Mathialahan T., Maclennan K.A., Sandle L.N., Verbeke C., Sandle G.I. Enhanced large intestinal potassium permeability in endstage renal disease. J Pathol 2005; 206 (1): 46-51.

28. Hayes J., Kalantar-Zadeh K., Lu JL, Turban S., Anderson J.E., Kovesdy C.P. Association of hypo- and hyperkalemia with disease progression and mortality in males with chronic kidney disease: the role of race. Nephron Clin Pract 2012; 120 (1): c8-16.

29. Einhorn L. M., Zhan M., Hsu V. D., et al. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med 2009; 169 (12): 1156-62.

30. Ahmed A., Zannad F., Love T.E., Tallaj J., Gheorghiade M., Ekundayo O.J., Pitt B. A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure.Eur Heart J. 2007 Jun; 28 (11): 1334-43.

31. Alper AB, Campbell RC, Anker SD, Bakris G., Wahle C., Love TE, Hamm LL, Mujib M., Ahmed A. A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure. Int J Cardiol. 2009 Sep 11; 137 (1): 1-8.

32. Coca S.G., Perazella M.A., Buller G.K. The cardiovascular implications of hypokalemia. Am J Kidney Dis 2005; 45: 233-47.

33. Schulman M., Narins R. G. Hypokalemia and cardiovascular disease. Am J Cardiol 1990; 65: 4E-9E.

34. Ascherio A., Rimm E.B., Hernan M. A., et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men.Circulation 1998; 98: 1198-204.

35. Lin H., Young D.B. Interaction between plasma potassium and epinephrine in coronary thrombosis in dogs. Circulation 1994; 89: 331-8.

36. McCabe R.D., Bakarich M.A., Srivastava K., Young D.B. Potassium inhibits free radical formation. Hypertension 1994; 24: 77-82.

37.McCabe R.D., Young D.B. Potassium inhibits cultured vascular smooth muscle cell proliferation. Am J Hypertens 1994; 7: 346-50.

38. Srivastava T.N., Young D.B. Impairment of cardiac function by moderate potassium depletion. J Card Fail 1995; 1: 195-200.

39. Brilla C.G., Rupp H., Funck R., Maisch B. The renin-angiotensin-aldosterone system and myocardial collagen matrix remodeling in congestive heart failure.Eur Heart J 1995; 16 (Suppl O): 107-9.

40. Ramires F. J., Mansur A., ​​Coelho O., et al. Effect of spironolactone on ventricular arrhythmias in congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy. Am J Cardiol2000; 85: 1207-11.

41. Zannad F., Dousset B., Alla F. Treatment of congestive heart failure: interfering the aldosterone-cardiac extracellular matrix relationship.Hypertension 2001; 38: 1227-32.

42. Brown M.J., Brown D.C., Murphy M.B. Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 1983; 309: 1414-9.

43. Pitt B., Remme W., Zannad F., et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.N Engl J Med 2003; 348: 1309-21.

44. Pitt B., Zannad F., Remme W. J., et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341: 709-17.

45. Petch M.C., McKay R., Bethune D.W. The effect of beta, adrenergic blockade on serum potassium and glucose levels during open heart surgery.Eur Heart J 1981; 2: 123-6.

46 Rosa R. M., Silva P., Young J.B., et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med 1980; 302: 431-4.

47. Frost L., Bottcher M., Botker H.E., Kristensen S.D., Norgaard A. Enalapril and exercise-induced hyperkalemia. A study of patients randomized to double-blind treatment with enalapril or placebo after acute myocardial infarction.Int J Cardiol 1992; 37: 401-5.

48. Zull D.N. Disorders of potassium metabolism. Emerg Med Clin North Am 1989; 7: 771-794.

49. Luo J., Brunelli S.M., Jensen D.E., Yang A. Association between serum potassium and outcomes in patients with reduced kidney function. Clin J Am Soc Nephrol 2016; 11 (1): 90-100.

50.Nordrehaug J.E. Hypokalemia, arrhythmias and early prognosis in acute myocardial infarction. Acta Med Scand 1985; 217 (3): 299-306.

51. Maciejewski P., Bednarz B., Chamiec T., Gôrecki A., Lukaszewicz R., Ceremuzynski L. Acute coronary syndrome: potassium, magnesium and cardiac arrhythmia. Kardiol Pol. 2003 Nov; 59 (11): 402-7.

52.Kovesdy C. P., Regidor D. L., Mehrotra R., et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol 2007; 2 (5): 999-1007.

53. Eliacik E., Yildirim T., Sahin U., Kizilarslanoglu C., Tapan U., Aybal-Kutlugun A., Hascelik G., Arici M. Potassium Abnormalities in Current Clinical Practice: Frequency, Causes, Severity and Management Med Princ Pract 2015; 24: 271-275.

54. Paltiel O., Salakhov E., Ronen I., Berg D., Israeli A. Management of severe hypokalemia in hospitalized patients: a study of quality of care based on computerized databases. Arch. Intern. Med. 2001; 161: 1089-1095.

55. Crop M.J., Hoorn E.J., Lindemans J., Zietse R. Hypokalaemia and subsequent hyperka-laemia in hospitalized patients.Nephrol. Dial. Transplant. 2007; 22: 3471-3477.

56. Hawkins R. C. Gender and age as risk factors for hypokalemia and hyperkalemia in a multiethnic Asian population. Clin. Chim. Acta 2003; 331: 171-172.

57. Toner J.M., Ramsay L.E. Thiazide-induced hypokalaemia: prevalence higher in women. Br. J. Clin. Pharmacol. 1984; 18: 449-452.

58. KDIGO Work Group. KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl2013; 3 (1): 1-150.

59. Raebel M. A., McClure D. L., Chan K. A., et al. Laboratory evaluation of potassium and creatinine among ambulatory patients prescribed spironolactone: are we monitoring for hyperkalemia? Ann Pharmacother 2007; 41 (2): 193-200.

60. Raebel M. A., McClure D. L., Simon S. R., et al. Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Pharmacoepidemiol Drug Saf 2007; 16 (1): 55-64.

61. Shah K.B., Rao K., Sawyer R., Gottlieb S.S. The adequacy of laboratory monitoring in patients treated with spironolactone for congestive heart failure.J Am Coll Cardiol 2005; 46 (5): 845-9.

62. Palmer B.F. Metabolic complications associated with use of diuretics. Semin Nephrol 2011; 31 (6): 542-52.

63. Roush GC, Sica DA. Diuretics for hypertension: a review and update. Am J Hypertens 2016; 29 (10): 1130-7.

64.Ram C.V., Garrett B.N., Kaplan N.M. Moderate sodium restriction and various diuretics in the treatment of hypertension. Arch Intern Med 1981; 141 (8): 1015-9.

65. Kaplan N.M., Carnegie A., Raskin P., Heller J.A., Simmons M. Potassium supplementation in hypertensive patients with diuretic-induced hypokalemia. N Engl J Med 1985; 312 (12): 746-9.

66.Leung A.A., Nerenberg K., Daskalopoulou S.S. et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016 May; 32 (5): 569-88.

67. Whelton P. K., Carey R. M., Aronow W.S., et al. 2017 ACC / AHA / AAPA / ABC / ACPM / AGS / APhA / ASH / ASPC / NMA / PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol 2018; 71: e127-e248.

68. Averin EE Effect of torasemide on left ventricular myocardial hypertrophy. Heart failure journal. 2012. T. 13.No. 3.S. 158-161.

69. Averin EE, Lopatin Yu.M., Delarue VV Rehabilitation of cardiac surgery patients in Russia: medical, social, psychological and legal aspects.Heart failure journal. 2012. T. 13.No. 1.P. 40-45.

70. Kompaniets O. G., Averin E.E. Priorities for choosing diuretics in the treatment of hypertension: evidence-based medicine, recommendation documents and real clinical practice. Systemic hypertension. 2013. T. 10. No. 1. S. 62-65.

71. Baryshnikova G.A., Averin E.E. Aldosterone in arterial hypertension: new therapeutic options. Consilium Medicum. 2013.Vol. 15.No. 10.P. 18-23.

72. Baryshnikova GA, Averin EE The use of diuretics in arterial hypertension: the advantages of torasemide. Effective pharmacotherapy. 2013. No. 33. S. 24-32.

73. Averin EE Safety of torasemide in the complex therapy of chronic heart failure: results of a randomized crossover study.Medical advice. 2016. No. 13. S. 81-84.

74. Averin E.E. Safety of multimodality therapy for chronic heart failure: results of a randomized, crossover study Bastion. International Journal of Heart and Vascular Diseases. 2016.Vol. 4.No. 11.P. 40-46.

Analysis No. AN39ISE, Electrolytes (sodium, potassium, chlorine) for dogs and cats: indicators, norm


Sodium is an essential cation in the body’s extracellular fluid.Sodium absorption occurs in the small intestine through active transport mechanisms. In hypotension, sodium can be almost completely absorbed in the large intestine. Sodium is freely filtered by the kidneys, and almost all of the filtered sodium is reabsorbed. In the initial section of the proximal convoluted tubule of the kidney, sodium is reabsorbed together with glucose, phosphate, amino acids and bicarbonate, while sodium reabsorption in the distal section occurs together with chlorine. Sodium is also actively reabsorbed in the thick ascending part of Henle’s loop.

Sodium’s function in the body is to maintain normal blood pressure, blood volume, and muscle and nerve function. Plasma sodium concentration is within a narrow range. The balance of this cation in the blood depends on the consumption of sodium in food and water and its excretion in the urine. Only a small amount of sodium is lost in faeces and sweat, but in some diseases or physiological conditions, depending on the species of the animal, these excretion routes may become more significant.

The regulation of sodium content in the blood is inextricably linked with the regulation of the body’s water balance. Water makes up about 60% of body weight, about a third of it is in the intracellular fluid and one third in the extracellular fluid. About one quarter of the extracellular fluid is found in the vasculature, while three quarters are present in the interstitium. The water balance between different fluid spaces depends on osmotic pressure, and sodium, along with its associated anions, is the main determinant of extracellular osmolarity.The potassium-sodium pump ensures the stability of the ion gradient relative to the inner and outer surfaces of the cell membrane, but sodium can freely pass through the walls of blood vessels along the concentration gradient, balancing the concentration difference between the interstitial and vascular spaces. Serum sodium concentration does not necessarily reflect the amount of sodium in the body, as it reflects the amount of sodium in relation to the total amount of water in the body.If the total body water content is very high (hypoosmolarity state) or very low (hyperosmolarity state), then the measured serum sodium concentration may be within the normal range, even if the total body cation content is disturbed. Receptors in the vessel walls determine changes in osmolarity and blood pressure, resulting in changes in the reabsorption or excretion of sodium and water by the kidneys. An increase in plasma osmolarity of only 1-2% will be captured by osmoreceptors in the hypothalamus, which will lead to the secretion of vasopressin (antidiuretic hormone) from the posterior lobe of the pituitary gland.On the other hand, a 10% decrease in blood volume perceived by receptors results in the release of vasopressin independent of osmolarity. Vasopressin enhances the reabsorption of water in the collecting tubules of the kidneys, thereby replenishing the amount of fluid in the vascular bed. With an increase in blood pressure or an increase in blood volume, impulses from baroreceptors located in the atria and vessels enter the hypothalamus and inhibit the release of vasopressin. At the same time, sodium reabsorption in the distal nephron decreases.The cells of the juxtaglomerular apparatus of the kidney are essentially baroreceptors that respond to low blood pressure. These cells activate the renin-angiotesin-aldosterone system (RAAS) by secreting renin. Renin breaks down angiotensinogen to angiotensin I, which is then converted to angiotensinogen II by the angiotensin converting enzyme (ACE). Angiotensin II causes the release of aldosterone from the adrenal glands, increases the secretion of vasopressin, and also stimulates the centers of thirst.Aldosterone acts on the collecting ducts of the renal cortex to increase sodium reabsorption. Sodium reabsorption in combination with either potassium secretion (another very important function of aldosterone) or chlorine reabsorption serves to maintain electroneutrality.

When assessing serum sodium concentration, the total body water content of the animal should be taken into account. An increase in serum sodium concentration is possible due to an increase in sodium content, a decrease in the amount of water, or as a result of a combination of indicators.Conversely, a decrease in serum sodium concentration is possible due to a decrease in sodium content, an increase in the amount of water, or as a result of a combination of these factors.

Hypernatremia is most commonly associated with an imbalance in body water. This can occur due to a decrease in water intake or when it is lost in excess of the loss of electrolytes (for example, with the development of central or nephrogenic diabetes insipidus). Reduced water consumption may be due to lack of access to water, impaired response to thirst, or physical inability to drink.Loss of water can occur through the skin or through respiration, as well as through the kidneys or the gastrointestinal tract. In many cases, water loss is accompanied by a loss of electrolytes, for example, as occurs with vomiting, diarrhea (osmotic diarrhea) or increased urine output. These animals develop hypovolemia. With absolute loss of water or insufficient water intake, the total sodium content in the body remains normal, and water from the intracellular space enters the intercellular space, maintaining the plasma volume (isovolumic hypernatremia).Excess sodium intake is a rare cause of hypernatremia, and concurrent water restriction or renal inability to concentrate urine is also common. A decrease in sodium excretion can also lead to an excess of cation in the body, which is possible in rare cases of hyperaldosteronism. These animals develop hypervolemia. If an excess of sodium is present in the extracellular fluid, then water from the cells will pass into the extracellular space, and the cells become dehydrated.

Hyponatremia can develop either as a result of sodium loss in excess of water loss or an increase in body water. Hyponatremia is associated with hypoosmolarity, except in cases of pseudohyponatremia or cases of translocation hyponatremia, in which a decrease in blood sodium concentration occurs due to an increase in the content of other osmotically active substances. In pseudohyponatremia, a decrease in sodium concentration occurs as a result of an increase in lipids or proteins and is not accompanied by a true decrease in blood osmolarity.

Translocation hyponatremia develops due to the presence of other substances in the blood that cause hyperosmolarity (for example, glucose), which do not pass well through cell membranes. Osmotically active substances in the blood will “pull” water from the intracellular space, contributing to the dehydration of cells. In this case, the concentration of sodium in the blood decreases due to dilution. Translocation hyponatremia will not be caused by substances that readily penetrate cell membranes (eg, urea).

Hypoosmolar hyponatremia is caused by too much water or too little sodium in the blood. An increased water content in the blood is observed in cases of impaired renal excretion of free water or dilute urine, or if water intake exceeds the maximum renal excretory capacity. Excessive water intake is rare, but can occur with psychogenic polydipsia. With excess water intake, the osmolarity of urine and plasma will be low.
Decreased renal excretion of free water in response to hypovolemia can lead to an increase in total body water. It occurs as a result of the accumulation of fluid in body cavities, which may be associated with congestive heart failure, liver cirrhosis, or nephrotic syndrome. The release of vasopressin in response to developing hypovolemia leads to an increase in water reabsorption. Impaired renal water excretion resulting from the development of renal failure can also lead to hypervolemic hyponatremia.
Hypovolemia is usually accompanied by sodium loss from the body. Sodium loss rarely occurs without water loss. For the development of hyponatremia, there must be a loss of hypertonic fluid (excretion of sodium more than water), or a loss of isotonic or hypotonic fluid, which leads to a decrease in the volume of extracellular fluid, which stimulates thirst and water retention by the kidneys, thereby “diluting” the rest of the body fluids.

Hypovolemic, hypoosmolar hyponatremia is possible as a result of disorders of the gastrointestinal tract (vomiting, diarrhea), kidney (hypoadrenocorticism, prolonged diuresis) and interstitial space (effusion in the body cavity).Primary hypoadrenocorticism (Addison’s disease) is associated with aldosterone deficiency, which leads to decreased renal sodium reabsorption and potassium retention in the collecting ducts of the renal cortex. It should be borne in mind that in the listed conditions, the animal may not detect a change in the concentration of sodium in the blood, despite the fact that dehydration or hypervolemia is present, if only isotonic fluid has been lost or an equilibrium of concentrations has been achieved. Hypovolemia not only stimulates the release of vasopressin, but also activates the RAAS, which leads to sodium retention in the body.


Potassium is the main intracellular cation that plays an important role in the resting membrane potential of cells. The cells contain about 95–98% of the total potassium in the body, while 60–75% is in myocytes. The potential difference between the inner and outer sides of the membrane, as well as maintaining a high concentration of potassium inside the cell, is achieved due to the operation of the Na / K pump with the participation of ATP molecules. Potassium is absorbed in the stomach and small intestine.In the kidneys, potassium is not reabsorbed, therefore, its content in the body will depend on the intake of potassium with food.

Clinical signs associated with changes in serum potassium concentration are manifested as cardiac and skeletal muscle dysfunction.

Hyperkalemia can have a life-threatening effect on cardiac conduction, so serum potassium is kept within a narrow range. In addition, potassium is essential for the normal function of enzyme systems that control the synthesis of DNA, glycogen and proteins.

The total amount of potassium in the body is a balance between potassium ingested (100%) and excreted by the kidneys (about 90–95%) and through the large intestine (about 5–10%). The concentration of potassium in the extracellular space (serum) also depends on the movement of the cation between the extra- and intracellular spaces. Less than 5% of the total body potassium is found in the extracellular space. Therefore, the serum potassium concentration does not fully reflect the total body potassium content.

Hyperkalemia develops as a result of an increase in the load of potassium, a decrease in its excretion, or the movement of potassium from the intracellular space to the extracellular one. An increase in potassium intake is unlikely to lead to hyperkalemia unless there is a concomitant decrease in renal potassium excretion. An increase in potassium load can be iatrogenic and fatal if fluids containing high potassium concentrations are mistakenly prescribed. The development of renal or postrenal diseases of the urinary tract, leading to a decrease in renal excretion of potassium, becomes a common cause of hyperkalemia.In oliguric and anuric stages of renal failure, the kidneys are unable to remove excess potassium from the body. Hyperkalemia also occurs with postrenal pathologies that interfere with the outflow of urine.

Aldosterone promotes an increase in sodium concentration and a decrease in serum potassium levels by increasing sodium reabsorption and potassium excretion in the collecting ducts of the renal cortex. Decreased secretion of aldosterone (hypoadrenocorticism) is usually accompanied by hyperkalemia and hyponatremia.Renal excretion of potassium decreases (with an increase in its concentration in serum) with a decrease in the rate of fluid flow in the tubules, which may be the result of hypovolemia (gastrointestinal disorders, effusion). Hypovolemia with the development of hyponatremia and hyperkalemia is more pronounced with repeated formation of effusions and drainage of cavities.

Gastrointestinal diseases that are most often associated with hyperkalemia include trichocephalosis with a significant degree of invasion.The movement of potassium between extracellular and intracellular fluid plays an important role in maintaining a constant concentration of potassium in the blood serum. The release of potassium from cells with the development of hyperkalemia can be caused by the entry of hydrogen and chlorine ions into the cells, which occurs during metabolic acidosis. Since insulin plays an important role in the transfer of potassium from the extracellular space to the intracellular one, its deficiency can lead to hyperkalemia. Since potassium is found in high concentrations in cells, extensive tissue or cell damage (tumor lysis syndrome, rhabdomyolysis, or severe trauma) is usually accompanied by the development of hyperkalemia, especially in cases of a simultaneous decrease in renal excretion.

Pseudokalemia develops as a result of a violation of the technique of taking blood, with thrombocytosis, leukocytosis and hemolysis. At the same time, there will be no clinical signs of hyperkalemia and predisposing factors for its development. Platelets contain a large amount of potassium, which is released when they are activated. Clotting of blood, therefore, can lead to an increase in serum potassium concentration, especially if thrombocytosis is present. The potassium reference intervals for serum are slightly higher than those for plasma.Hemolysis leads to the release of potassium from red blood cells. The amount of potassium in red blood cells varies depending on the type of animal and even the breed. Horses, pigs and cattle have a higher content of potassium in red blood cells than cats and dogs, with the exception of Japanese dog breeds (Akita Inu, etc.).

Hypokalemia is one of the most common electrolyte disturbances in critically ill patients, although the ultimate cause of this change cannot always be established.Hypokalemia can be the result of a decrease in dietary potassium intake, an increase in its excretion, loss through the gastrointestinal tract (vomiting, diarrhea), movement of this cation between the intra- and extracellular space, or, more often, a combination of all these causes. Decreased potassium intake can contribute to hypokalemia, but is usually not the cause per se. Hypokalemia can be caused iatrogenic by the administration of solutions with a low potassium content. Hypokalemia associated with chronic renal failure is more common in cats.

Distal renal tubular acidosis, post-obstructive diuresis, diabetic ketoacidosis, and non-potassium-sparing diuretics can all lead to increased potassium excretion and hypokalemia. Aldosterone causes sodium reabsorption (with passive absorption of chlorine) in the distal nephron and potassium secretion. Aldosterone also increases the activity of Na / K-ATPase in the distal convoluted tubule, enhancing potassium secretion in the distal nephron. However, hyperaldosteronism is a rare cause of hypokalemia.A significant movement of potassium from the extracellular space to the intracellular one can also lead to hypokalemia, which occurs as a result of an excess of insulin, glucose infusion, or with the development of metabolic alkalosis. Catecholamines released as a result of pain, sepsis, or trauma can also cause potassium to shift by moving it into the cell.


Chlorine is the main anion of the body’s extracellular fluid and, like sodium, is of great importance in the transport of electrolytes and water.Chlorine also serves as a conjugated anion in acid and base metabolism. To maintain electroneutrality, chlorine either moves in the same direction as the positively charged sodium ions, or exchanges with negatively charged bicarbonate ions.

Chlorine homeostasis is mainly regulated by the kidneys and to a small extent by the gastrointestinal tract. Chlorine ingested with food is absorbed in the jejunum, the distal part of the large intestine, together with sodium, in the ileum.Facilitated transport of chlorine in the ileum and colon is the driving force for sodium and water reabsorption. In the kidneys, about 50-60% of the filtered chlorine is reabsorbed in the proximal tubules. The reabsorption of chlorine under the influence of aldosterone is carried out in the distal parts of the nephron, and with the help of active transport, chlorine is reabsorbed in the thick ascending part of the loop of Henle.

When assessing serum chlorine, it is important to compare the chlorine level with the sodium level and the acid-base state of the animal.If deviations in chlorine concentration are proportional to deviations in sodium concentration, then the principles of change are similar to those considered for hyponatremia or hypernatremia. If the change in chlorine concentration is greater than the change in sodium concentration, the bicarbonate concentration and blood gas analysis should be considered.
Hyperchloremia is usually accompanied by water loss. However, hyperchloremia may be associated with decreased blood bicarbonate levels. Loss of bicarbonate can result from abnormalities in the gastrointestinal tract (diarrhea, hypersalivation in cattle, vomiting of intestinal contents, as in the case of intestinal obstruction).Loss of bicarbonate through the kidney occurs in proximal or distal tubular acidosis. In response to respiratory alkalosis, the mechanism of bicarbonate storage in the kidneys is weakened, which leads to chlorine retention and the development of hyperchloremia.

Hypochloremia. Metabolic alkalosis leads to a greater decrease in the concentration of chlorine in the blood than a decrease in the concentration of sodium. In the process of secretion of hydrochloric acid in the stomach, the content of chlorine in the blood serum decreases, and the amount of bicarbonate increases.These changes are usually reversible when hydrogen and chlorine ions and water are absorbed from the intestine. If gastric contents are lost as a result of vomiting or pyloric obstruction and functional obstruction, serum chlorine concentration will remain low and bicarbonate levels will be elevated. Serum chlorine will decline as bicarbonate levels rise in response to chronic respiratory acidosis.

Thus, summing up the role of chlorine in maintaining the blood buffer system and acid-base balance, we can say that increased serum chlorine is associated with metabolic acidosis, while hypochloremia is associated with metabolic alkalosis.


To obtain more accurate results, the animals should be on a starved diet for at least 12 hours before the study. The sample is stable for a week when stored + 2C … + 8C and remains stable during freezing (-17C … -23C).
Violation of preanalytical analysis can lead to distorted results, for example, with hemolysis of the sample or delayed separation of serum from the red blood cell mass after blood collection.


The study results contain information for physicians only.The diagnosis is made on the basis of a comprehensive assessment of various indicators, additional information and depends on the diagnostic methods.

Measurement units: mmol / l.

Sodium, chlorine

Assessment of dehydration

Isotonic dehydration
Proportional loss of NaCl and water (in some cases with diarrhea and kidney disease). The concentration of [Na] and [Cl] in the blood does not change, there is an increase in hematocrit and total protein content in the blood serum.* The osmolarity of plasma practically does not change, water does not move from the intracellular space to the extracellular one, therefore the volume of the extracellular fluid decreases.
Hypertensive dehydration (extracellular fluid becomes hypertonic)
The loss of water is greater than the loss of NaCl (diabetes insipidus, decreased water consumption or lack of access to it, hyperthermia or rapid breathing, osmotic diuresis, diarrhea).
An increase in the concentration of [Na] and [Cl] in the blood, an increase in hematocrit and the content of total protein in the blood serum.* As a result of an increase in plasma osmolarity, water moves from the intracellular space to the extracellular space to maintain the volume of extracellular fluid. Cellular exicosis develops.
Hypotonic dehydration (hypotension of extracellular fluid)
NaCl loss exceeds water loss (secretory diarrhea, vomiting, effusions, heavy sweating in horses).
A decrease in the concentration of [Na] and [Cl] in the blood, an increase in hematocrit and the content of total protein in the blood serum.* Plasma osmolarity decreases, water moves from the extracellular space to the intracellular one. Edema of cells develops (intracellular hyperhydration), exacerbating the lack of fluid in the extracellular space.

  • Total serum protein and / or hematocrit may not increase if there is concurrent protein loss and / or anemia.

Reference values:

Dogs: 142-155 mmol / L.
Cats: 142-158 mmol / L.
Ferrets: 146-160 mmol / L.

Level Up:

Pseudohypernatremia (dehydration, use of anticoagulants containing sodium).
Lack of access to water, hypodipsia.
Diabetes insipidus.
Hyperthermia, fever.
Loss of hypotonic fluid (hypovolemia).
Osmotic diuresis.
Diuretic use.
Chronic renal failure (CRF).
Non-oliguric acute renal failure.
Post-obstructive diuresis.
Disorders of the gastrointestinal tract (vomiting, diarrhea, obstruction of the small intestine).
Thermal burns.
The introduction of hypertonic solutions.

Decrease Level:

Pseudohyponatremia (severe hyperproteinemia, hyperlipemia).
Translocation hyponatremia.
Decreased renal excretion of water (for various reasons).
Increased water intake, exceeding the excretory capacity of the kidneys.

Dogs: 4-5.7 mmol / L.
Cats: 4-5.5 mmol / L.
Ferrets: 4.5–6.4 mmol / L – albinos; 4.3–5.3 mmol / L – dark.

Level Up:

Pseudohyperkalemia (hemolysis, thrombocytosis, leukocytosis, pregnancy in dogs, phosphofructokinase deficiency in dogs).
Increased dietary potassium intake, iatrogenic cause.
Decreased urinary potassium excretion (impaired urine outflow, anuric or oliguric stage of renal failure, effusions, gastrointestinal disorders, hypoadrenocorticism, repeated drainage of effusions, hyporeninemic hypoaldosteronism).
Diabetic ketoacidosis.
Extensive tissue necrosis (rhabdomyolysis, tumor disintegration syndrome, trauma).
Metabolic acidosis.

Decrease Level:

Pseudohypokalemia (severe lipemia).
Decreased intake of potassium from food, iatrogenic cause.
Increased loss through the gastrointestinal tract (vomiting, diarrhea).
Increased renal loss (CRF in cats, post-obstructive diuresis, diabetes mellitus, prescription of (non-potassium-sparing) diuretics, hyperadrenocorticism, hypomagnesemia, hyperthyroidism in cats, distal tubular acidosis, proximal tubular acidosis after bicarbonate treatment, primary hyperactive hyperaemia).
Translocation hypokalemia (administration of insulin or glucose, metabolic alkalosis, hypokalemic periodic paralysis of pregnant cats, action of catecholamines).

Dogs: 98-118 mmol / L.
Cats: 108-125 mmol / L.

Level Up:

Pseudohyperchloremia (pronounced chyle, the effect of certain drugs).
Excess of chlorine consumption over excretion.
Diabetes insipidus.
Action of corticosteroids.
Renal tubular acidosis.
Chronic respiratory alkalosis.
Renal failure

Decrease Level:

Pseudohypochloremia (hyperproteinemia, chylosis).
Chronic respiratory acidosis.
Polyuric stage of renal failure.
The development of edema, burns.
Loss through the GI tract.
Congestive heart failure.
Introduction of sodium bicarbonate.
Loop or thiazide diuretics.

Eosinophils: what does the increase in the level of “cleaner” cells in the blood indicate


Eosinophils: what does the increase in the level of “cleaner” cells in the blood indicate

Eosinophils: what the increase in the level of “cleaner” cells in the blood indicates – RIA Novosti, 09.02.2021

Eosinophils: what does the increase in the level of “cleaner” cells in the blood indicate?

Eosinophils are a type of white blood cell, the growth or decrease of which can signal various diseases. How and when to check their number – RIA Novosti, 09.02.2021

2021-02-09T18: 03

2021-02-09T18: 03

2021-02-09T18: 03




health – society

/ html / head / meta [@ name = ‘og: title’] / @ content

/ html / head / meta [@ name = ‘og: description’] / @ content

https: // cdn24.img.ria.ru/images/07e5/02/09/1596715479_0:192:1024:768_1920x0_80_0_0_cf04966cc8d618b83733978c9945d529.jpg

MOSCOW, Feb 9 – RIA Novosti. Eosinophils are a type of white blood cell, the increase or decrease in the number of which can signal various diseases. How and when to check their number – in the material of RIA Novosti. In medicine, eosinophils are one of the types of white blood cells – leukocytes. They form in the bone marrow and from there into the bloodstream. An increase in their number is observed in parasitic and allergic diseases, and a number of other conditions that require a full examination and treatment.Eosinophils are often referred to as scavenger cells. They are considered the most susceptible to parasitic infections and pathological bacteria. Eosinophilia is not an independent disease, but it can be a sign of a number of pathologies. To diagnose it, you need to contact a therapist, and in the case of a child – to a pediatrician, who, after questioning and examination, will be able to refer you to an appointment with a narrow-profile specialist. He, in turn, will prescribe the delivery of biomaterials (blood, mucus from the nose, sputum) for analysis.Only a laboratory study can reveal eosinophilia, that is, an absolute or relative increase in the number of eosinophils. Blood test for eosinophils: indications, decoding In allergology, counting eosinophils is not always necessary and informative, since their number increases in various conditions. For example, if there are parasites in the body (giardiasis, ascariasis, opisthorchiasis), tumors, collagenoses, tuberculosis. The simplest way to determine the number of eosinophils is a complete blood count. The decoding of the blood test for eosinophils should be carried out by the attending physician, and, according to the conclusions, should be prescribed treatment.Normal cell level in the analysis In adults, the norm of eosinophils in the blood is 0.4×109 / l. The norm in children is slightly higher – up to 0.7×109 / l. However, relative to the content of other immune cells, the normal number of eosinophils in adults and children ranges from 1-5%. Normally, the content in a nasal smear is less than 10%. In the sputum of a healthy person, eosinophils are rare. With pathologies, they can reach a large number – up to 50-90% of all leukocytes. to combat alien elements.The cause can be autoimmune, allergic or infectious diseases (asthma, ascariasis, various types of oncology, and others). Reasons for the lowered indicator When eosinophils in an adult are lowered to 0.02 * 109 / l or less, this means that he develops absolute eosinopenia, that is, a condition in which the number of eosinophil cells in the blood is below normal. If the number of eosinophils themselves in an adult did not change, but their share in the leukocyte formula decreased to 0-0.5%, then this is a sign of the development of relative eosinopenia.The reasons why the number of eosinophils decreased or equal to 0 may be the following: Preparation for the analysis In order to determine the reliable number of eosinophils in the blood, you should know that a complete blood count requires some preparation. First, the biomaterial should be taken in the morning: after waking up the number of eosinophils in a healthy person is normal, while in the evening and at night it usually increases, and during the day it can change. Secondly, blood should be taken on an empty stomach, since food provokes physiological leukocytosis in a person, that is, an increase in the level of leukocytes in the blood, which will also affect the results of the study.Thirdly, a couple of days before the test, you should give up sweet foods and alcohol. If the patient is suspected of having an allergy, then the study should be done immediately after the onset of symptoms and before the person starts taking antihistamines. Also, with a frequently occurring, probably allergic, rhinitis, a smear test for eosinophils from the nose is prescribed. Before the process of collecting mucus, you must not blow your nose thoroughly and for a long time (but it is also not recommended to accumulate mucus in the nose). Do not bury nasal drops in your nose.They will make the smear taken uninformative, and a general sputum test is often done. You also need to prepare for it. Biomaterial is taken in the morning, since the largest amount of sputum accumulates in the respiratory tract during the night. You need to go to the test immediately after the onset of the first symptoms, on an empty stomach, and without taking any medications.



https: // ria.ru / 20210204 / zerno-1595910268.html

RIA Novosti

[email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abd-ab1og. -p1ai / awards /


RIA Novosti

[email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abdlkab1og.xn-- p1ai / awards /



https: // ria.ru / docs / about / copyright.html

https: //xn--c1acbl2abdlkab1og.xn--p1ai/

RIA Novosti

[email protected]

7 495 645-6601

FSUE MIA ” Russia today ”

https: //xn--c1acbl2abdlkab1og.xn--p1ai/awards/

https://cdn21.img.ria.ru/images/07e5/02/09/1596715479_0 0:1024:768_1920x0_80_0_b07381ed6 jpg

RIA Novosti

[email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: // xn – c1acbl2abdlkab1og.xn – p1ai / awards /

RIA Novosti

[email protected]

7 495 645-6601

FSUE MIA “Russia Today”

https: //xn--c1acbl2abdlkab1og.xn--p1ai / awards /

society, medicine, blood, health – society

MOSCOW, Feb 9 – RIA Novosti. Eosinophils are a type of white blood cell, the increase or decrease in the number of which can signal various diseases. How and when to check their number – in the material of RIA Novosti.

In medicine, eosinophils are one of the types of white blood cells – leukocytes. They form in the bone marrow and from there into the bloodstream. An increase in their number is observed in parasitic and allergic diseases, and a number of other conditions that require a full examination and treatment. Eosinophils are often referred to as scavenger cells. They are considered the most susceptible to parasitic infections and pathological bacteria.

Eosinophilia is not an independent disease, but it can be a sign of a number of pathologies.To diagnose it, you need to contact a therapist, and in the case of a child – to a pediatrician, who, after questioning and examination, will be able to refer you to an appointment with a narrow-profile specialist. He, in turn, will prescribe the delivery of biomaterials (blood, mucus from the nose, sputum) for analysis.

Only laboratory research can reveal eosinophilia, that is, an absolute or relative increase in the number of eosinophils.

Blood test for eosinophils: indications, decoding

In allergology, counting eosinophils is not always necessary and informative, since their number increases under various conditions.For example, in the presence of parasites in the body (giardiasis, ascariasis, opisthorchiasis), tumors, collagenoses, tuberculosis.

– Currently, baseline blood eosinophil levels are most commonly used as a biomarker to predict the clinical efficacy of biologics for the treatment of severe bronchial asthma. Calculation of the absolute number of eosinophils in the peripheral blood can indicate the eosinophilic phenotype of severe bronchial asthma, which helps us choose the right treatment for this pathology, ” said Angela Mirzaeva, an allergist-immunologist, a member of the European Academy of Allergists and Clinical Immunologists and the Russian Association of Allergists and Clinical Immunologists.

The simplest way to determine the number of eosinophils is a complete blood count.

– In the results of a general blood test, it is important to look not at the percentage of eosinophils, but in absolute terms. It happens that due to thickening of the blood, the percentage of eosinophils is increased. But when converted to absolute units, we see the norm. The formula for calculating the absolute number of eosinophils in the peripheral blood: (the number of leukocytes * 10 to the 9th degree) * the number of eosinophils in% * 10, – the expert noted.

Deciphering the blood test for eosinophils should be carried out by the attending physician, and, according to the conclusions, should be prescribed treatment.

February 4, 08:00 Science Five ways to strengthen the lungs before and after covid

Normal cell count in the analysis

In adults, the norm of eosinophils in the blood is 0.4×109 / l. The norm in children is slightly higher – up to 0.7×109 / l. However, relative to the content of other immune cells, the normal number of eosinophils in adults and children ranges from 1-5%.

Normally, the content in a nasal swab is less than 10%.

Eosinophils are rare in the sputum of a healthy person.With pathologies, they can reach a large number – up to 50-90% of all leukocytes.

The reasons for the increased rate

Experts distinguish three degrees of severity of eosinophilia:

  • mild – the concentration in the blood increased to 10%;

  • moderate – up to 15%;

  • severe or severe – more than 15%.

If the patient has increased eosinophils, this indicates the presence of any pathology, due to which the body has mobilized its protective resources to fight foreign elements.

The cause may be autoimmune, allergic or infectious diseases (asthma, ascariasis, various types of oncology and others).

February 3, 07:33 Spread of coronavirus Immunologist dispelled harmful myths about vaccination

Reasons for the lowered rate

When eosinophils in an adult are lowered to 0.02 * 109 / L or less, this means that he develops absolute eosinopenia, that is a condition in which the number of eosinophil cells in the blood is below normal.

If the number of eosinophils themselves in an adult has not changed, but their share in the leukocyte formula has decreased to 0-0.5%, then this is a sign of the development of relative eosinopenia.

The reasons why the number of eosinophils decreased or equal to 0 may be the following:

  • severe infectious diseases with purulent processes;

  • pancreatitis;

  • intoxication of the body with heavy metals;

  • gallstone disease;

  • the initial stage of the development of myocardial infarction;

  • diseases of the thyroid gland;

  • leukemia and others.

– Allergists, in turn, do not pay attention to the decrease in numbers. Sometimes eosinophils migrate into tissues during an allergic acute reaction, because there may be few of them in the blood. Thus, for an allergist, this indicator does not have a great clinical significance, – emphasized Angela Mirzaeva.

Preparation for analysis

In order to determine the reliable number of eosinophils in the blood, you should know that a complete blood count requires some preparation.

First, the biomaterial should be taken in the morning: after waking up, the number of eosinophils in a healthy person is normal, while in the evening and at night it usually increases, and during the day it can change.

February 4, 02:30 Science Scientists have found out which cereal products increase the risk of death Secondly, blood should be taken on an empty stomach, since food provokes physiological leukocytosis in a person, that is, an increase in the level of leukocytes in the blood, which will also affect the results of the study.

Thirdly, a couple of days before taking the test, you should give up sweet food and alcohol.

If a patient is suspected of having an allergy, testing should be done immediately after the onset of symptoms and before the person starts taking antihistamines.

Also, with a frequently occurring, probably allergic, rhinitis, a smear test for eosinophils from the nose is prescribed. Before the process of collecting mucus, you must not blow your nose thoroughly and for a long time (but it is also not recommended to accumulate mucus in the nose).Do not bury nasal drops in your nose. They will make the taken smear uninformative.

In addition, general sputum analysis is often done. You also need to prepare for it.

The sampling of biomaterial is carried out in the morning, since the largest amount of sputum accumulates in the respiratory tract during the night. You need to go to the test immediately after the onset of the first symptoms, on an empty stomach, and without taking any medications.

Blood glucose level | Medtronic Diabetes Russia

Norms of blood glucose

Blood glucose is measured in millimoles (mmol / L) per liter.The measurement is carried out using a blood glucose meter and a test strip. The recommended range for blood sugar levels for patients with diabetes is shown in table 1 below.

Fasting blood sugar Blood sugar after meals (after 90 minutes)
No diabetes 4.0-5.9 mmol / L
(72-106 mg / dL)
Up to 7.8 mmol / L
(140 mg / dl)
Type 1 diabetes 5-7 mmol / L (90-126 mg / dL) About 5-9 mmol / L (90-162 mg / dL)
Type 2 diabetes 4-7 mmol / L (90-126 mg / dL) About 5-8.5 mmol / L (90-153 mg / dL)

Blood sugar levels generally fluctuate throughout the day.However, if a healthy body can handle the excess sugar on its own, diabetes requires outside help. To take the right and timely measures, you need to constantly monitor your blood sugar levels.

What Factors Affect Blood Sugar Levels?

The blood sugar level changes under the influence of various factors. Among them:

  • Food consumption
  • Skipping meals
  • Physical activity
  • Stress
  • Disease
  • Alcohol consumption
  • Taking medicines
  • Changing the usual way of life
  • Pregnancy

As you can see, many different elements of daily life can affect blood sugar levels.This is why blood sugar control should be done on a regular basis.

When should you measure your blood sugar?

  • Before meals
  • 2 hours after eating
  • Bedtime
  • Before exercise
  • Before drinking
  • In case of feeling unwell

Hypoglycemia and hyperglycemia: what to do?

The two most common short-term complications of diabetes are a drop in blood sugar below the recommended target range, or, conversely, an increase in it.If your blood sugar is too high, the condition is called hyperglycemia. The condition of low blood sugar is called hypoglycemia (or simply “hypo”).

Both hyper- and hypoglycemia can ultimately lead to the development of short-term and long-term complications. Thus, persistently high blood sugar levels can lead to serious complications in the long term. This is why it is critical to monitor blood sugar levels and take timely measures necessary to keep blood sugar levels within the recommended range.The system of continuous glucose monitoring can become a faithful assistant in this, the main purpose of which is to make everyday life with diabetes easier.

How is sugar in a blood test indicated

A real pandemic of diabetes mellitus is currently developing in the world. And the sooner the correct diagnosis is made, the more chances you have to live a fulfilling life.

We remind you that on our portal you can find Dr. Fedorov’s answers to questions about how to correctly decipher indicators in general urine and blood tests, biochemical blood tests, blood tests for lipid profiles, urinary sediment analysis.And also you can find out what some changes in the electrocardiogram mean.

This time, Dr. Fedorov answers questions about blood sugar levels.

1. What is the most common blood sugar test?

The most frequent blood sugar test that each of us has taken at least once in our lives is the fasting glucose level in a biochemical blood test. Usually, the analysis is taken in the morning, after sleep, and it is not recommended to use anything other than plain water.The glucose level can be determined in capillary (then the analysis is taken from a finger) or venous blood.

Depending on the sampling method, the upper limit of the blood sugar norm also differs:

  • for capillary blood is 5.5 mmol / l,
  • for venous blood – 6.1 mmol / l.

Criteria for diabetes mellitus are the detection, against the background of complete health, of an increase in blood sugar levels of more than 7.0 mmol / L on an empty stomach or more than 11.1 mmol / L after a meal. “You have high blood sugar,” then the doctors say.If the glucose level ranges from 6.1 to 7 mmol / l, then we are talking about a violation of glucose tolerance (or prediabetes). This is a condition that is still possible to reverse, and for a more accurate diagnosis, additional tests will be required.

2. Should I take a glucose tolerance test?

One of these tests is the glucose tolerance test. To do this, the patient is taken a blood glucose test, and then offered to drink a sweet solution, the glucose content of which is 75 grams.After 2 hours, a standard venous blood sample is taken to determine the glucose level.

  • If the indicator is in the range of 7.8 mmol / l – 11.1 mmol / l, we are talking about a violation of glucose tolerance, even despite a normal fasting sugar level.
  • If it exceeds 11.1 mmol / l, then with a high degree of probability the patient has diabetes mellitus.

In both cases, he is referred to an endocrinologist to correct his lifestyle, nutrition, or the selection of antihyperglycemic therapy.In recent years, the need for a glucose tolerance test has decreased, since a new, informative indicator has appeared in the arsenal of doctors – glycated hemoglobin.

3. What is glycated hemoglobin and why is it considered the “gold standard” for diagnosing diabetes mellitus?

Glycated hemoglobin (HbA1C) is another important blood sugar test. This is a universal indicator, if we omit the details, we can say that it provides information on the average concentration of blood sugar over the last 3 months.The analysis is more convenient than other tests for diabetes: it can be taken throughout the day, and not necessarily on an empty stomach, the indicator does not increase in the presence of an acute or chronic infection and after suffering stress, which is typical for a standard blood sugar test.

  • The normal level of glycated hemoglobin ranges from 4-5.6%.
  • An HbA1C level of 5.7 to 6.4% indicates a high risk of developing diabetes. In this case, a change in lifestyle is required – weight loss, daily physical activity, limiting the consumption of rapidly digestible carbohydrates.
  • A figure above 6.5% indicates high blood sugar in the last 120 days – we are talking about diabetes.

In addition to the primary diagnosis of impaired glucose tolerance and diabetes mellitus, the indicator is actively used to assess the effectiveness of glucose-lowering therapy.

4. What does the urine glucose test tell about?

  • Normally, sugar in the urine is absent or excreted in the urine in a minimal amount (less than 0.8 mmol / l), since all glucose is reabsorbed from the primary urine in the renal tubules.
  • Glucose enters the urine only when its concentration in the blood exceeds 10 mmol / l.

Mild glucosuria may occur during pregnancy. In addition to various types of diabetes (mellitus, renal, steroid), glucose in the urine can appear in myocardial infarction and ischemic cerebral stroke, polytrauma, prolonged compression syndrome and massive burns. Most of these conditions are related to resuscitation and do not involve routine testing on an outpatient basis.

5. The doctor ordered a fructosamine test. What kind of research is this?

This substance is a combination of plasma proteins with glucose, it gives the doctor information about the level of glycemia for the last 2-3 weeks.

  • Blood is taken for analysis after an 8-hour fast and the normal rate is 319 mmol / L.

This analysis is considered a “safety net” for glycated hemoglobin in cases where its information content is reduced, for example, in case of anemia.And also in cases when it is necessary to assess the fresh dynamics of blood sugar levels in recent weeks – during pregnancy in diabetic women, as well as a recent change in the diabetes treatment regimen.

Read also:

13 indicators. We decipher the biochemical blood test

10 indicators. We decipher the analysis of urinary sediment

14 indicators. We decipher the general blood test

11 indicators. We decipher the general analysis of urine

7 indicators.We decipher the blood test for lipid profile

Online consultations of leading doctors and research in laboratories in Russia

90,000 Gestational diabetes mellitus (patient memo)

Gestational diabetes mellitus (patient memo)

Gestational diabetes mellitus (GDM) is a one-time increase in blood sugar above normal for the first time during pregnancy.

The norm of blood sugar in pregnant women in the morning on an empty stomach (before meals) <5.1 mmol / l, and after glucose loading during the glucose tolerance test at 24-28 weeks of pregnancy: after 1 hour <10.0 mmol / l, after 2 hours <8.5 mmol / l.Glucose loading should not be performed if the blood sugar level in the morning on an empty stomach was already ≥ 5.1 mmol / L.

Such an increase in blood sugar (glucose) is extremely minimal, does not affect the woman’s well-being in any way, but during pregnancy can lead to very serious consequences for both the expectant mother and her baby. If GDM is not detected in a timely manner or the expectant mother does not take any action to treat it, then the risk of early aging of the placenta and, as a consequence, delayed fetal development, premature birth, as well as polyhydramnios, increased blood pressure, preeclampsia, the formation of a large fetus and the need for in cesarean section, traumatization of a woman and a child during childbirth, hypoglycemia and respiratory failure in a newborn.The most formidable complication of untreated GDM is perinatal fetal death. Therefore, the modern health organization around the world recommends a mandatory examination of ALL pregnant women for the earliest detection of GDM and its timely treatment.

If you have been diagnosed with GDM, then e is not a reason to despair. Without delay, you need to take all measures to keep your blood sugar within the normal range for the rest of your pregnancy. Since the increase in blood sugar in GDM is very insignificant and subjectively not felt, it is necessary to begin to conduct regular self-monitoring of blood sugar using a portable device – a glucometer (during pregnancy, only glucometers calibrated for blood plasma are used – see.Instructions for the device).

Norms of blood sugar for pregnant women : 3.3-5.0 mmol / l in the morning before meals, 1 hour after meals – less than 7.0 mmol / l. It is necessary to record each sugar value in the Self-Test Diary with the date, time and a detailed description of the food intake after which you measured the sugar. You should take this diary with you every time to an appointment with an obstetrician-gynecologist and endocrinologist.

Treatment of GDM during pregnancy:

  1. Diet – the most important in the treatment of GDM (http: // www.niiomm.ru/joomla-stuff/category-blog/32-rekomendatsii-po-pitaniyu-beremennykh-stradayushchikh-sakharnym-diabetom):
  • Digestible carbohydrates are completely excluded from the diet: sugar, jam, honey, all juices, ice cream, pastries, cakes, bakery products made from white high-grade flour; rich pastries (rolls, buns, pies),
  • Any sweeteners , for example, fructose-based products (sold in stores under the brand name “diabetic”) – prohibited for pregnant women and breastfeeding,
  • If you are overweight, then in your diet you need to limit all fats and completely exclude: sausages, sausages, sausages, bacon, margarine, mayonnaise,
  • Never go hungry! Meals should be evenly distributed over 4 to 6 meals throughout the day; breaks between meals should not be more than 3-4 hours.
  1. Physical activity . If there are no contraindications, then moderate physical activity for at least 30 minutes daily is very useful, for example, walking, swimming in the pool.

Avoid exercise that causes high blood pressure and uterine hypertonicity.

  1. Self-check diary , in which you write:
  • blood sugar in the morning before meals, 1 hour after each meal during the day and before bedtime – daily,
  • all meals (detailed) – daily,
  • ketonuria (ketones or acetone of urine) in the morning on an empty stomach (there are special test strips for the determination of ketone bodies in urine – for example, “Uriket”, “Ketofan”) – daily,
  • blood pressure (BP should be less than 130/80 mm Hg.Art.) – daily,
  • fetal movements – daily,
  • body weight – weekly.

!!! Attention: if you do not keep a diary, or do not keep it honestly, thereby you are deceiving yourself (and not the doctor) and risking yourself and your baby!

  1. If, despite the measures taken, the blood sugar exceeds the recommended values, then insulin treatment should be started (for this you will be referred for a consultation to the endocrinologist ).You should be aware that addiction to insulin does not develop, and after childbirth, insulin is canceled in the vast majority of cases. Insulin in adequate doses does not harm either the child or the mother, it is prescribed to maintain the full health of both the mother and the baby.


Gestational diabetes alone is NOT an indication for caesarean section and premature birth. The term and method of childbirth is determined by the obstetrician-gynecologist.

GDM after childbirth:

  • dieting within 1.5 months after childbirth,
  • insulin therapy is canceled (if any),
  • blood sugar control in the first three days (blood sugar norm after childbirth : fasting 3.3 – 5.5 mmol / l, 2 hours after eating up to 7.8 mmol / l),
  • 6-12 weeks after childbirth – consultation of an endocrinologist for diagnostic tests to clarify the state of carbohydrate metabolism,
  • women who have undergone GDM are at high risk of developing GDM in the next pregnancies and type 2 diabetes mellitus in the future, so a woman who has undergone GDM needs:

– follow a diet aimed at reducing body weight with its excess,

– expand physical activity,

– plan subsequent pregnancies,

  • children from mothers with GDM have an increased risk of obesity and type 2 diabetes mellitus throughout their lives, therefore they are recommended to have a balanced diet and sufficient physical activity, observation of an endocrinologist.

Good luck to you! Health and well-being to you and your baby!

Download Word document:

Blood test for immunity | A-Media Family Clinic, St. Petersburg

Most infectious diseases pass into the chronic stage due to reduced immunity, that is, when the defenses cannot provide full protection of the human body from external and internal irritating factors.To determine the state of your immune system, you need to make an immunogram (test for immunity).

Today there are about 10 types of immunograms , and they all determine different indicators. The choice of a specific analysis should be made by a doctor, since, choosing on your own, you can make a mistake and not get the desired result, which will lead to a waste of money and time. The most common is a blood test for immunity. It provides complete information on the state of cellular and humoral immunity.

When is a blood test for immunity necessary?

Adults and children are recommended to be tested for immunity in the case of:

  • frequent ARVI and other viral infections
  • persistent thrush
  • pustular rashes
  • allergic diseases
  • autoimmune pathologies
  • recurrent herpesitis

This type of immune testing will help to identify whether the above conditions are caused by a weakening of the immune system, and will also make it possible to take the necessary therapeutic and preventive measures in time.

What does the analysis consist of?

An immunity test is required for people with suspected abnormalities in the immune system. This procedure is a study of several components of immunity:

  • humoral
  • cellular
  • nonspecific.

The doctor independently decides which tests for immunity need to be done, taking into account the complexity of the situation, medical history and the results of studies already carried out.

Preparation for blood test for immunity

1.The procedure is carried out exclusively on an empty stomach – the last meal should be at least 8 hours before the planned time for the analysis.

2. It is recommended to exclude taking any medications in 2 weeks. In case of constant medication intake, for example, in case of hypertension or diabetes mellitus, it is imperative to notify the doctor.

3. It is not recommended to eat spicy and fatty foods 2-3 days before the procedure.

4.It is forbidden to drink alcohol the day before the study and smoke half an hour before blood sampling.

5. Examination should not be carried out during an acute infectious disease or exacerbation of a chronic one.

Reliable results of the immunity test can only be ensured by strict adherence to all of the above recommendations.

Analysis results

The capabilities of modern immunodiagnostics will allow any of you to know about the state of your immune system and, if necessary, take the necessary measures in time.