Check potassium at regular intervals. If low K+ thought due to indapamide:

• Mild 3.0 - 3.4 <div class="navybox"> <p style="color:green;"><b>Mild (3.0 - 3.4 mmol/l)</b></p> <p><b>When to repeat</b></p> <ul> <li>Compare with previous results. If no change in medication, may be one-off. <b>Change in K+ &lt; 0.5 mmol/L can be just standard lab variation from sample to sample (i.e. “lab error”)</b></li> <li>Continue indapamide and Repeat U&Es routinely (e.g. 4 weeks) then reassess</li> </ul> <p><b>Management</b></p> <ul> <li>If potassium still newly low on repeat and timeline fits with indapamide, can usually continue indapamide. Encourage bananas and tomatoes. Recheck U&Es periodically</li> <li>If due to D&V, use sick day rules: temporarily stop indapamide and restart when better</li> <li>If unrelated to indapamide and is chronic, assess for reversible causes including check magnesium. Low magnesium will make the hypokalaemia resistant to treatment. Correct any magnesium deficiency** which may sometimes correct potassium. If on digoxin, give potassium supplements and aim for K+ ≥ 4.5 long term since lower K+ levels increase the risk of digitoxicity (even at normal serum digoxin levels)</li> <li>If no reversible causes and no concerning underlying cause, advise dietary supplementation (e.g. bananas, tomatoes, avocados, potatoes)</li> <li>Recheck U&Es periodically</li> </ul> <div class="redbutton" style="font-size:12px; font-weight:normal; width: -webkit-fill-available; text-align:left; background-color:#1f4395;"> <p><b>**How to correct low magnesium</b> <br>Oral Supplementation: </p> <ol> <li>First Line: Magnesium aspartate dehydrate – Magnaspartate®. 1-2 sachets daily (= 10-20mmol Mg) for 3 days</li> <li>Second Line: Magnesium glycerophosphate – YourMag®. 2 x 4mmol tablet three times a day (= 24mmol Mg) for 3 days</li> </ol> <p>Recheck Magnesium blood levels after 1-2 weeks. Repeat 3 day course if still low.</p> </div> </div> – recheck K+ in 4 weeks. If still low but mild, continue indapamide.
• Moderate 2.5 - 2.9 <div class="navybox"> <p style="color:orange;"><b>Moderate (2.5 - 2.9 mmol/l)</b></p> <p><b>When to repeat</b></p> <ul> <li>Compare with previous results - if new change, repeat U&Es within 24 hours.</li> <li>If persistent on recheck and due to starting indapamide / thiazide, switch to ARB instead (e.g. losartan 50mg OD [25mg in elderly]).</li> <li>If due to D&V, use sick day rules: temporarily stop indapamide and restart when better</li> <li>If no reversible causes, advise dietary supplementation (e.g bananas, tomatoes, avocados, potatoes) AND oral supplements (e.g. SandoK one TDS).</li> <li>Recheck U&Es in 1 week</li> </ul> <p><b>Management</b></p> </div> – recheck K+ in 24 hours. If still moderately low, switch to losartan.
• Severe < 2.5 <div class="navybox"> <p style="color:red;"><b>Severe ( &lt; 2.5 mmol/l)</b></p> <p><b>When to repeat</b></p> <ul> <li>Admit</li> </ul> <p><b>Management</b></p> <ul> <li>Admit</li> </ul> </div> – Admit