“What causes hypokalemia?” and other questions that may have entered your mind while watching Survivor Philippines

Hi guys!

I didn’t expect much med-related questions would be asked of me when I first started my blog series.

I was afraid I might bore you, but since I have been asked questions personally by people I came across with, I thought I should address them in this blog.

Some of it have been queries or comments my sister and some of my friends have picked up from other people or from comments in forums or message boards.

As I cannot answer all of them in one blog, we’ll have to do this in increments. I hope these would clarify things!

1) Do they have their toiletries with them? Aren’t you bothered as a doctor that the castaways will not be observing proper hygiene?

There are no shampoos, no conditioners, no soaps, no toothbrushes or toothpaste, no deoderant... you get the picture.

How could a doctor allow these? It’s simple as this: those are the rules of the game.

Sure, they would be prone to sickness and infection. But that’s what they signed up for. I signed up for this as well, so I would have to accept that. The possibility of sickness and infection was what the Medical Team has prepared for and have been praying won’t happen.

2) Are they fit and can resist infections 100%?

Yes and no.

Yes, because they were deemed fit and cleared to undergo 39 days without food while undergoing rigorous activities.

Their hearts and lungs were checked thoroughly by board-certified specialists and have been allowed to participate. Had they not been given this clearance, they would be disqualified.

If you have an existing problem (e.g. asthma and you haven’t had attacks in recent years) but the specialist has allowed you, then you are still qualified.

All castaways were given vaccinations. But it is not a guarantee that they can go through 39 days without any incident. There would be no doctor that will guarantee that because doctors aren’t psychics.

Moreover, we can’t prevent animal stings, burns, or insect bites. Given these circumstances, it really was up to the Castaways to make that final decision to go through it or withdraw and continue on with their normal lives. They were not forced to accept the challenge of being Castaways.

3) When you first attended to John when he had that medical scare, why did you have to ask him if he was ok when he was clearly not ok?

It’s the internationally recognized/standard question you ask a victim or patient in that situation.

What you want to know first is if he is responsive or unconscious. How he responds is next to note. Is he grunting? Are his answers giving you clues that he’s confused or drowsy? Is he coherent and are his answers appropriate to your questions?

If he is, he will usually immediately tell you what’s wrong. So, as dorky as the question sounds, it’s how he responds that is more important.

You can use this information. At any time you find yourself in a similar situation (e.g., with a seemingly unconscious person on the floor), for example. You can ask the same thing: “Hey, are you ok?” Or you can always follow-up with questions like “Can you hear me? Can you see me? Can you talk?”

4) Why don’t you give them anything for their insect bites?

As doctors, we are dictated by our profession to address all of a patient’s medical concerns. However, in this instance, we cannot address all of them.

The rule Survivor Philippines MDs keep is this: KEEP THEM HEALTHY, BUT NOT NECESSARILY COMFORTABLE.

Dr. Adrian Cohen, the former Medical Director for Survivor (US) suggested this.

So this means, if we see that a Castaway needs antibiotics or stitches, we will give it to them.

But if a castaway complains of pain, we usually hold that pain reliever first. If they complain of (a minor) sunburn, they would have to care for it themselves.

Initially, we have provided them with a first aid kit, as you may have seen in an earlier episode. However, once the supply was out, they were not replenished.

They have to utilise what they have in their surroundings as this was what it meant to survive, and this was what was expected of them in the game.

As for the bug bites, there were no synthetic anti-repellants for Castaways. Again, it is part of being survivors to be creative to find ways to prevent or treat this. But we do keep a close eye if their wounds develop into more serious infections and we have attended to the few who have developed them.

5) What causes hypokalemia?

Perhaps the most obvious cause is a low-potassium diet. In some cases, however, a person still suffers from hypokalemia even without excessive potassium loss. This is rare.

A more common cause is excessive loss of potassium, often associated with heavy fluid losses that "flush" potassium out of the body. This is a typical consequence of vomiting, diarrhea, excessive perspiration, or losses associated with surgical procedures. (1)

A third general cause of hypokalemia is prolonged fasting and starvation (2) and this is the most probable reason why something like this could have happened to John.

But how was it possible that the other Castaways did not go through with this and it was someone as fit as John that was the casualty?

In most people, after three weeks of fasting, blood potassium levels will decline and result in severe hypokalemia. However, in some persons, potassium may be naturally maintained at a normal level even after 100 days of fasting.

In addition, there are studies where it was found out that the most rapid fall in potassium occurred when the carbon dioxide in the body has decreased below normal. This has happened to patients under general anesthesia and, to a lesser extent, people who are hyperventilating (3). This was discussed previously as a probable explanation for what happened to John.

So, add the amount of physical exertion John has for challenges and for camp life + his huge muscle mass + perspiration + hyperventilation where he throws off carbon dioxide + fasting and starvation = what happened to John and not to the other Castaways.

That’s it for now! If you have comments, suggestions, or questions that pertain to the medical aspect of Survivor Philippines or the castaways, please leave a message on the comments section and I will do my best to address them as soon as I can.

Next time: Metabolism of Starvation Made Simple

References:

1 Hypokalemia - Wikipedia

2 Hypokalemia - Health at Oz

3 Indian Medlars Center