Week 2: Potassium Disorder (Dr. Le)

what is the level range for potassium

3.5-5.0

what percent of potassium contained with the ICF

98%

•The sodium-potassium adenosine triphosphatase (Na+­K+­ATPase) pump located in the cell membrane is responsible what

compartmentalization of potassium

intracellular potassium cncentration is aprox what

130-145

•Both hypo- and hyperkalemia can lead to life-threatening arrhythmias (t/f)

true

defined as serum potassium less than 3.5 is what

hypokalemia

persistent hypokalemia linked to increased mortality to what

HF, CKD, DM

K+ shift for hypokalemia is what

alkalosis, insulin, B2 agonists

K+ deficit in hypokalemia

poor intake, renal/gi issues

renal losses is what

diuretics

gi losses is what

diarrhea

vomiting

in hypokalemia does the EKG changes?

• T wave flatten or inversion

• U wave elevation

• ST depression or flattening

  • prolonged QT

Often asymptomatic, N/V, muscle weakness is what symptoms

mild hypokalemia

Cramping, weakness, malaise, and myalgias, paralysis, EKG changes, cardiac arrhythmias, death is symptoms of what

moderate/severe hypokalemia

management of hypokalemia depends on what

degree and rapidity of hypokalemia

treat underlying causes for hypokalemia

metabolic alkalosis

magnesium deficiency

medications

clinical syndrome

hydrodialysis

if the K+ <3 mEq what needs to be done

always treat

• oral preferred if asymptomatic

• IV if severe symptoms or unable to tolerate PO

what are the potassium oral replacement for hypokalemia

• potassium chloride

• potassium bicarbonate

• potassium citrate

• potassium glyconate

what is the most common potassium used

potassium chloride

what are the side effects for Potassium replacement oral

Gi side effects: N/v/d, flatulence

if the potassium dose >40mEq, what should be done

divide into smaller doses, split dose twice a day

what are the phosphate oral replacement used for

hypokalemia

how much potassium is contained within ICF

98%

normal range or potassium

3.5-5.0

hypo and hyper kalmia can lead

neuromuslcar and cardiac issues

persistent hypokalemia linked to increase mortality like what

HF

CKD

DM

mechanism of potassium

K+ shift

K+ deficit

alkolosis, insulin, B2 agonists is what mechanism of potassium

K+ shift

poor intake, Renal/GI losses is what mechanism in potassium

K+ deficit

you can stop B2 agonist but cant stop insulin

true

increase the excretion of potassium

diuretics

how to manage hypokalemia

therapy depends on the degree and rapidity of hypokalemia

when the K+ level is 3.5-4 what needs to be done

encourage dietary potassium intake

if K+ is < 3 what needs to be done

oral if asymptomatic

what is the most common of potassium formulations

potassium chloride

what are the 4 type of salt forms for potassium

chloride, bicarbonate, citrate, gluconate

which potassium cause alkalizing effect

potassium bicarbonate

what is the first option for hypokalemia symptomatic

potassium oral replacement

is potassium dose dependent

yes

when not recommend potassium acetate

in alkalosis

usual dose to prevent hypokalemia is what

20 mEq/day

usual dose to treat hypokalemia is what

40-100 mEq/dose

micro encapsulated products have better GI tolerance and no bitter smell or aftertaste

true

if a patients potassium level is 2.9 mEq and you administer him 60 mEq of KCl, what is the expected increase in his K level

3.5

if a patients K level is 2.9 mEq/L how much KCl would you need to administer to raise his K level to 3.7 mEq/L

80

for every ~10 mEq of K+ administer what happens to serum K+

increase by 0.1 mEq/L

•For every ~10 mEq of K⁺ administered à serum K⁺will increase by 0.1 mEq/L

true

If a patient's K is 3.3 mEq/L and you give him KCL 40 mEq. What do you expect his K to increase to? 

3.7

what is peripheral line for IV max rate

10 mEq/hr

what is the central line for IV max rate

20 mEq/hr

If your patient only has a PIV, and the your KCl IVPB is 20 mEq/100mL bag, the nurse ask how fast to program the pump in mL/hr?

50mL/hr

Never give potassium as an IV push, what will happen

cause cardiac arrest

Phlebitis, injection site pain, extravasation are adverse effect

IV potassium

standard infusion for IV potassium

infuse > 10 mEq/hr → EKG monitoring

if cardiac arrest imminent, may give 10 mEq IV over 5 mins

• can repeat once if necessary

emergency use of IV potassium

aldosterone antagonists drugs

spironolactone

eplerenone

ENaC inhibitor drugs

Amiloride

Traimterene

caution in patient with renal dysfunction, what should happen to dose

reduce the dose by 50%

What results should you look for in this hypokalemia patients

A. EKG

B. SCr

C. Mg

D. Na+

A, B, C

Dr. Darcie asks for recommendation replace potassium goal to 3.6 mEq/L, patient only has a pIV line in ED. How much potassium should she order, how to administer it

40 mEq PO

if dose is 80 mEq, 10 mEq/hr, how many hours

8 hours

what defines as hyperkalemia

greater than 5.0

Chronic hyperakalemia management are what

dietary

diuretics

cation exchangers

dialysis

symptomatic for hyperkalemia

protect the heart

promote intracellular movement of potassium

enhance excretion from body

remove any offending agents

how to protect the heart in symptomatic hyperkalemia

IV calcium

what is the management for hyperkalemia (C BIG K DROP)

Calcium

Bicarbonate, Beta 2 agonist

insulin

Glucose

Potassium binder

diuretics, dialysis

what are the options for IV calcium

calcium chloride or calcium gluconate

calcium chloride is 3x more calcium than gluconate

true

which calcium is preferred for hyperkalemia

calcium gluconate

what is the adminstration for IV calcium

1g IV bolus over 5-10 mins

what is the first line for intracellular shift of potassium

insulin + dextrose

emergency dialysis can be considered in patient with acute kidney injury with persistent EKG changes or refractory

true

monitoring for hyperkalemia

continuous ECG

Serum K+

blood glucose monitoring

sodium bicarbonate therapy

medication review

•critical electrolyte disorder, often caused by kidney dysfunction. Early recognition and treatment are vital is what

hyperkalemia

mild cases what agent to use in hyperkalemia

resins or diretics

for severe case with EKG changes what do you do in hyperkalemia

give IV calcium