HC and Medrol

[Lethal Lee]

HI Deb & Debs Sis!!!

Why the pharmacy gave out the RX in the manufacturer's bottle?...well...who knows.....and just why it is that the manufact. labeled the bottle as 1500mg is beyond me. Gee whiz...converting mg to mEq is very simple math.(providing that the person doing the math would understand that the conversion equation depends upon the ionic properties and atomic weight of the chemical in question)..one would HOPE that the drug manufact. would KNOW how to do that!! Sheesh!

Well I dont understand the conversions didnt do anything but basic lower High School chemistry & some decades ago at that!
I got the conversion I mentioned in previous post from another poster whose Doc is her Husband and rxes her Potassium. She told me 20mEq is ~780mg Potassium. I looked up on internet & found info that seemed to support that was correct.

However just now I looked up Klor-Con M20 I found this.......

www.drugs.com/pro/klor-con-m.html
Each Klor-Con® M20 tablet provides 1500 mg of Potassium chloride equivalent to 20 mEq of Potassium.
Take each dose with meals and with a full glass of water or other liquid.

I guess we go with the manufacturers conversion & assume 1 tab = 1500mg Potassium? So certainly stick with ONLY 1 tab Klor-con for now.

Its kinda an awkward amount for a single tab as ideally Potassium should be taken at least twice daily. Even the slow release tabs supposedly only last around 4 hours. However I cannot confirm that is correct for this product. Certainly it is for Slow-K which I take.

I would suggest when next you see the Doc to ask for RX Klor-con M10 instead. That is 750mg tabs so you could take 1 tab twice a day 1 in am 1 in pm for better coverage.

here is link to manufacturers info (pdf)
www.upsher-smith.com/PDFs/kor_con_PI_030107.pdf
www.upsher-smith.com/PDFs/Klor-con_prod_line.pdf

Tried 1/4 yesterday afternoon and by last night when I took salt and med felt like my right kidney might explode. Ouch.

As for reaction to taking 1/4 tab of Florinef with Salt late in avo maybe it was because you had same amount of Salt during the day & raised Florinef too? By not reducing Salt perhaps just went too high in Sodium?

Just keep an eye on BP & HR. We are feeling our way here.

Re The Ciggies. I am glad to read that you have reduced from 1 1/2 packs to 1 pack. But golly gee girl you sure do like abusing the old Adrenals

Good news that Alcohol is no longer the vice of choice too. No doubt he old Liver is grateful. Lets face it we want that Liver in top shape to process the HC, Thyroid meds, Ativan, Florinef & more. Got to keep it "athlete fit" now!!!

Dont me too hard on yourself. We all have our "crutches" and do our best to find ways of coping with what life throws at us. Sometimes our choices arent the best...but we live & learn (hopefully) from our mistakes.

Even Debsu owner of RTH website hasnt been able to give up the ciggies either...not sure how many she smokes but still!!!!

Let me know how you get on.

[dseezs]

Hey Lee,
Just got off the phone w/Dr. office. Asked to have Sod/Pot run again Mon. The nurse said I didn't need to because my levels were fine. I asked to come in to talk to Dr. because I had bumped dose up to 2 daily. She then said that she would talk to the Dr and call me back.
I haven't bumped it up but figured I could use the bloodwork anyway to see what's going on. They are in the habit of not calling me back anyway so I'll have to wait and see what happens.
I don't feel to bad so far today. My B/P still has me stumped tho!
Random 10:35 AM 124/81-89
11:05 AM Sitting 108/74-81
Standing115/84-101
doing some house stuff Random 12:27 PM 128/88-99
12:42 PM ate at 12:30 took meds and salt cig 140/94-96
1:03 PM random 124/82-96 1:16PM had cig again 133/93-96 got up doing stuff around house random 113/81-84
2PM sitting 111/79-76
standing 103/78-93
got back up and doing more stuff around house called Dr. office 139/96-105 cig
Am I answering my own Q's here?
I smoke more in the early evenings! My HC dose is lower and so are my thyroid meds. Does that make any sense? I know I usually don't feel the need for the Ativan until around 7-8PM. So after I take it sometimes the B/P gets better but sometimes not. Usually by the time 10PM bedtime rolls around and I take my last dose for the night I can feel the HC/salt/thyroid kick in about 1/2 later and I'm relaxed enough and feel sleepy enough that I go to sleep no problem.
Maybe it's all in my head.
Going in circles w/this again. Time to stop or I'll be second guessing everything again.

Update:
Now 6 PM here. sitting 111/75-90, standing 105/73-102.
Aver. Temps from Mar 7 til now: 99-99added 15mg thyroid,-99-99.1-99.1-99.1-99.1.
Dr. office never bothered to call back, so I don't know if I should just show up again Mon or not. Sheesh Ugh!!!!!!
Only took 1 RX Potass. today.
Your thoughts
Thanks
Deb

[Lethal Lee]

Hi Deb,

Bp is rising on standing 11 am but drops at 2pm.

Looks like you are going to have to split dose the Florinef & perhaps change Salt supping to take less in am & greater in avo & evening? So have 1/4 teasp in am make midday/early afternoon 1/2 teasp & another 1/2 teasp early evening?
You could experiment with that & check BP's to see if that helps keep BP rising on standing for more of the day?

Likely that you will need split dosing Potassium too. I dont mean cutting the tabs though

Regarding "random BPs" be aware what we are looking for is RESTING BP. That means NO eating, smoking, caffeine, meds etc etc for 30 mins before taking BP. Must be "at rest" for at least 15 mins then take BP stand up & take again.

Everyones BP changes with activity, after eating, after meds, after cigarette , even if hungry (low blood sugar) etc. So the fact its higher after doing any of these is perfectly normal.

I would wait on testing electrolytes until you have been on the same dose of Florinef, Salt & Potassium for at least a week. Unless you start feeling a lot worse & need Labs to see what is what.

Dont forget to ask Doc for rx Potassium at LOWER strength tabs. Tell her its helping but you need to take more than once a day & 750mg tabs would be better than 1500mg tabs.

[dseezs]

Hey ya Lee,
I'ordered myself some blood work. My question is: I got my period today. Would it be silly to check my electrolytes 3 days into it? Or wouldn't it make any difference now? Wed will be 1 week since doing anything with Florinef, salt or Potassium.
My temps dropped big time today.
Mar 8 thru now
99-99-99.1-99.1-99.1-99.1-99-98.9-98.6 today.
Also found out thru the pharmacist that Potass. tabs are NOT 1500mg. 20mEq 780.
B/P's
124/87-84
117/84-102

114/76-84
99/76-102

120/83-79
109/75-97
Didn't feel warm before at 99=99.1 but boy I do now!
Whatcha think?
Thanks
Deb

[Lethal Lee]

Hi Deb,

found out thru the pharmacist that Potass. tabs are NOT 1500mg, the 20mEq = 780
Great that you cleared that up!!!
Thats also what I was told previously too.
Here a link that confirms what Pharmacist said....

hkpp.org/qla/measurement.html
1mEq Potassium (K) = 39mg
10mEq tab = 10x39 = 390 mg Potassium
20mEq tab = 20x39 = 780 mg Potassium

1 mEq Chloride (Cl−) = 35.5 mg
10mEq tab = 10x35.5 = 355mg Chloride
20mEq tab = 20x35.5 = 710 mg Chloride

So combined Klor-con would contain....
10mEq tab 390mg K+355mg Cl=745mg Potassium Chloride
20mEq tab 780mg K+710mg Cl=1490mg Potassium Chloride

I think the confusion (on the manufacturers part) is that a 20 mEq tab would contain Potassium Chloride ~1500mg? So they are "correct" saying its 1500mg but its not ALL Potassium!!! They should make their info much clearer than they currently do. No wonder the Docs & the patients get confused!!!

Anyway the important thing is you definitely need to start taking 2 x 20 mEq tabs 1 in am & another in pm. Then see after a week or so if that needs adjusting up more. You wont need a different rx Potassium script so thats good too.

I ordered myself some blood work. My question is: I got my period today. Would it be silly to check my electrolytes 3 days into it? Or wouldn't it make any difference now? Wed will be 1 week since doing anything with Florinef, salt or Potassium
I would wait at least a few days (week at the most) after being on 2 of the rx Potassium tabs a day. Likely you will be finished with period by then although it doesnt really matter a lot. It would matter if testing Aldo, Renin etc prior to any Florinef. But now on Florinef your Aldo would be suppressed so NO doesnt matter which cycle day you test electrolytes.

My temps dropped big time today.
Mar 8 thru now
99 - 99 - 99.1 - 99.1 - 99.1 - 99.1 - 99 - 98.9 - 98.6 today.

Actually I think these are pretty good! Very steady and all but one has less than 0.2 degree variation from day to day. Means we are on the right track & Adrenals seem to be coping pretty well at the moment. Todays drop is only 0.3 so NOT a big drop. Maybe body didnt like the fact took LESS Potassium than really wanted/needed (due to confusion re mEq==>mg) so have been on 1 tab instead of 2 past few days & all in a.m. instead of spread out?

B/P's
124/87-84
117/84-102

114/76-84
99/76-102

120/83-79
109/75-97

Resting BPs & HR all look good.
Not so good that they are still all droping.
HR on standing is going up too but not super high so thats good too.

Didn't feel warm before at 99=99.1 but boy I do now!Whatcha think?
I think we still havent got the POtassium/Sodium right as yet!
Mainly cos of the Potassium dose confusion (thankyou Klor-con!!!).
So lets get you on 2 tabs of rx Potasium a day give it a few days & see what that does for BPs, temps & symptoms.

[dseezs]

Hey Ya Lee,
Been awhile. How's it goin?
I'm not horrible. Definitely felt worse that's for sure.
I'm sorry but I didn't take your advice about taking more RX Potass. I really wanted to know where I was at so I kept everything the same and went ahead and had the blood draw. I got results today:
Fasting
Glucose, Serum 87 (65-99)
Sodium, Serum 138 (135-145)
Potassium, Serum 4.7 (3.5-5.2)
Chloride, Serum 106 (97-108)
Calcium, Serum 9.2 (8.5-10.6)
Carbon Dioxide, Total 25 (20-32)
Magnesium, Serum 2.5 (1.6-2.6)
Day 13 30 HC
Day 6 1 RX Potassium AM
Day 8 1 Tab Florinef AM
Day 7 salt 1/2-1/4-1/4-1/4
Day 34 1800 Calcium
Day 34 750 Magnesium
Day 4 105 Thyroid (4x) 30-30-30-15
Had Vit D tested but results not in yet.
Temps Mar 16-23
16-98.6 Period
17-98.5
18-98.6
19-98.7
20-98.7
21-98.7
22-98.3 dropped 3000 Vit D
23-98.7
B/P-HR Today
11 AM 120/85-82
116/85-91

2PM 122/81-75
118/84-90

5:30 PM 125/83-88
112/77-100
I haven't changed anything except for dropping the Vit D. I was up to 5000 daily for a little over a month and I guess I'd rather be safe than sorry. Waiting on the test results.
So now that I have the sod. and potass. results how should I proceed? And should I have it checked (sod.&potass.) again after a week or so after a change?
I have an appt. with Dr on Wed to talk about meds. I really need her to help me get by those nurses of hers for bloodwork. They keep telling me everything's fine! UGH! I thought maybe I should get an RX for some Armour also so I can keep the thyroid I have for backup. Does 3 Grains sound right?
Still smoking unfortunately. Still taking ativan at 7PM nightly. Not feeling as bad as I was, but not GREAT either. You know how that goes. 1 step forward, 2 steps back sometimes.
Thanks for your help
Hope all is well for everyone
Deb

[yippy]

Deb,
DO NOT increase your K+.
I shall be callin ya....or....I'll get off of my butt and drive the whole 2 miles across town to your house.

Hugs and kisses,
THE Yippinator *insert evil laugh here*

[Lethal Lee]

Labs Results
Fasting Glucose.....87 (65-99) *good
Sodium................138 (135-145) *far too low
Potassium............4.7 (3.5-5.2) *good
Chloride..............106 (97-108) *good
Calcium................9.2 (8.5-10.6) *good
Carbon Dioxide.....25 (20-32) *good
Magnesium..........2.5 (1.6-2.6) *excellent
Vit D tested but results not in yet.

Meds & supps
Day 13 30 HC
Day 6 1 RX 780mg Potassium AM
Day 8 1 Tab Florinef AM
Day 7 Salt 1/2-1/4-1/4-1/4
Day 34 1800 Calcium
Day 34 750 Magnesium
Day 4 105 Thyroid (4x) 30-30-30-15

Temps
Mar 16-98.6 *Period
Mar 17-98.5
Mar 18-98.6
Mar 19-98.7
Mar 20-98.7
Mar 21-98.7
Mar 22-98.3 *dropped 3000 Vit D
Mar 23-98.7

Comments:Daily av temps look pretty good too with the exception being the day you dropped Vit D.
So Adrenals are looking pretty stable which is good.

B/P-HR Today
11 AM
sitting........120/85-82
standing....116/85-91
2PM
sitting........122/81-75
standing....118/84-90
5:30 PM
sitting........125/83-88
standing....112/77-100

Comments:Your BPs still consistently dropping on standing so still need some tweaking here. Resting BP's & HR for am & early avo are pretty optimal. However by late avo the HR is climbing. Standing BP's are too low & drop instead of rising. The biggest drop being late avo. The HR in late avo when standing is getting too high as well.

I haven't changed anything except for dropping the Vit D. I was up to 5000 daily for a little over a month and I guess I'd rather be safe than sorry. Waiting on the test results.

Personally I wouldnt have stopped the Vit D. I need 2000 IU daily just to maintain my levels. It takes a LOT of Vit D for many months before any possibility of toxicity. Have the Vit D results turned up yet?

So now that I have the Sodium and Potassium results how should I proceed? And should I have it checked (Sod & Potass) again after a week or so after a change?

Well obviously the Potassium looks pretty good. That is assuming the tests were done ~8am fasting before any meds & supps?

If so I would not take any more Potassium just keep on the 1 rx tab in am for the time being. I see the Magnesium result is pretty good as well. Maybe the Magnesium supping & rising cellular levels are helping with the Potassium too. The Rx Potassium certainly seems to be benefitting you.

Sodium is obviously far too low still. I think you are going to have to increase Florinef some to get that up. If it was me I would try adding some Florinef to the late afternoons say 1/4 tab & also drop one of the 1/4 teasp doses of Sea Salt altogether & maybe combine the other 1/4x2 doses?

So have 1 tab Florinef & 1/2 tab Sea Salt in am. Then another 1/4 tab Florinef & 1/2 teasp Sea Salt late avo/early evening. See what that does to BP, HR levels & symptoms.

I would also suggest going ahead with another 1/4 grain Thyroid med raise. Today will be 7 days since last raise wont it?

I have an appt. with Dr on Wed to talk about meds. I really need her to help me get by those nurses of hers for bloodwork. They keep telling me everything's fine! UGH! I thought maybe I should get an RX for some Armour also so I can keep the thyroid I have for backup. Does 3 Grains sound right?

Well 3 grains is the minimum we see that works. Average is 3-5 grains. So would be good if Doc was willing to rx for up to 3 grains at this point leaving you room to keep increasing gradually. Once at 3 grains STTM suggests slowing raises right down to 1/4 grain every 6 weeks (and only if needed),

Still smoking unfortunately. Still taking Ativan at 7PM nightly. Not feeling as bad as I was, but not GREAT either. You know how that goes. 1 step forward, 2 steps back sometimes.
Well likely you are still Hypo as you are not even at 2 grains yet. At least as you say you are feeling better than you were, vitals & Labs are improving too. Not to mention no recent trips to ER needed either!!!! So hey thats ALL good!!!!