Potassium Imbalances

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59 Terms

1
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what is potassium necessary for?

  • resting membrane potential of nerve and muscle cells

  • regulates intracellular osmolality

  • promotes cellular growth

  • maintenance of cardiac rhythm

  • acid-base balance

2
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what are common sources of potassium?

fruits and vegatables, salt substitutes, potassium medications, stored blood

3
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What causes a shift of potassium out of cells?

  • Acidosis

  • Tissue catabolism (fever, crush injury, sepsis, burns)

  • Tumor lysis syndrome

  • Intense exercise

4
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What causes failure to eliminate potassium?

  • Renal disease

  • Adrenal insufficiency

  • Medications: ACE inhibitors, ARBs, NSAIDs, heparin, potassium-sparing diuretics

5
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what causes potassium loss?

vomiting, diarrhea, BG suctioning

diuretics, hyperaldosteronism, magnesium depletion

diaphoresis

6
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what causes a shift of potassium into cells?

  • alkalosis

  • increase epinephrine

  • increase insulin

7
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what causes lack of potassium intake?

  • Low potassium diet

  • Starvation

  • NPO without potassium replacement

8
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What are symptoms of hyperkalemia?

  • Abdominal cramping, diarrhea, vomiting

  • Muscle weakness, loss of tone

  • Fatigue, irritability, confusion

  • Paresthesias, decreased reflexes

  • Irregular pulse

  • Tetany

9
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What are symptoms of hypokalemia?

  • Muscle weakness, cramps

  • Leg cramps, flabby muscles

  • Fatigue, constipation, paralytic ileus

  • Shallow respirations

  • Hyperglycemia

  • Irregular, weak pulse

10
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What ECG changes occur with hyperkalemia?

  • Tall, peaked T waves

  • Widened QRS

  • Loss of P wave

  • Prolonged PR interval

  • Ventricular fibrillation or standstill

11
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What ECG changes occur with hypokalemia?

  • Flattened T wave, presence of U wave

  • ST depression

  • Prolonged QRS

  • Peaked P wave

  • Ventricular dysrhythmias

  • Heart block (1st and 2nd degree)

12
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How does hyperkalemia affect the ECF/ICF ratio and cell excitability?

It increases potassium in the ECF, altering the ECF/ICF ratio, leading to increased cell excitability and disrupted nerve and muscle impulse transmission

13
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what is the most clinically significant effect of hyperkalemia?

changes in cardiac conduction

14
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what is the initial ECG finding in hyperkalemia

tall, peaked T wave

15
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what happens to cardiac conduction as potassium levels increase?

  • decreased cardiac depolarization (heart contracts easily)

16
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What neuromuscular symptoms may occur with hyperkalemia?

  • Fatigue, confusion, tetany

  • Muscle cramps and paresthesias

  • Loss of muscle tone, weakness, paralysis

17
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What can result from paralysis of respiratory muscles in hyperkalemia?

respiratory arrest

18
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what GI symptoms are associated with hyperkalemia?

  • Abdominal cramping

  • Vomiting

  • Diarrhea

19
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What are the four main treatment strategies for hyperkalemia?

  • Stop potassium intake

  • Increase potassium excretion

  • Force potassium into cells

  • Stabilize cardiac membranes

20
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What is the first step in managing hyperkalemia?

stop all oral and IV potassium intake

21
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What medications and methods are used to increase potassium excretion?

  • Loop or thiazide diuretics

  • Dialysis

  • Sodium polystyrene sulfonate (Kayexalate)

  • Patiromer (Veltassa)

  • Sodium zirconium cyclosilicate (ZS-9, Lokelma)

22
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How does Kayexalate work?

binds to potassium in the bowel and removes about 1 mEq of potassium per gram and releases 1-2 mEq of Na

23
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When is patiromer (Veltassa) preferred?

For chronic hyperkalemia due to chronic renal failure; takes up to 7 hours to begin working, 2 days for max effect

24
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What is the mechanism of ZS-9 (Lokelma)?

Traps potassium in the GI tract to promote fecal excretion; max effect in 2–3 hours.

25
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What treatments shift potassium from ECF into cells?

  • IV regular insulin and dextrose

  • Beta-adrenergic agonist (albuterol)

  • IV sodium bicarbonate

26
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why is dextrose given with insulin in hyperkalemia?

To prevent hypoglycemia while insulin shifts potassium into cells.

27
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What IV drugs are used to stabilize the heart in hyperkalemia?

  • IV calcium chloride

  • IV calcium gluconate

28
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Do calcium preparations lower potassium levels?

No. They protect the heart by stabilizing cell membranes but do not lower potassium

29
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Why is continuous ECG monitoring used in hyperkalemia?

To detect dysrhythmias and monitor the effectiveness of therapy.

30
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What should be monitored when giving IV calcium?

Blood pressure—rapid administration may cause hypotension

31
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What should be monitored when giving insulin for hyperkalemia?

Blood glucose—monitor for hypoglycemia and give glucose as needed.

32
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What are the three general causes of hypokalemia?

  • Increased potassium loss

  • Shift of potassium from ECF to ICF

  • Decreased dietary intake (rare)

33
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What are common GI causes of potassium loss in hypokalemia?

  • diarrhea

  • Laxative misuse

  • Vomiting

  • Ileostomy drainage

34
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What are common renal causes of potassium loss?

  • Increased urinary output

  • Use of loop or potassium-depleting diuretics

  • Low magnesium levels

35
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How does low magnesium contribute to hypokalemia?

It stimulates renin and aldosterone release, which leads to potassium excretion by the kidneys

36
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How does alkalosis contribute to hypokalemia?

Hydrogen ions move out of cells into ECF, and potassium moves into cells to maintain electrical neutrality, lowering ECF potassium.

37
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What ECG changes are seen with hypokalemia?

  • Flattened T wave

  • Depressed ST segment

  • U wave present

  • Peaked P waves

  • Prolonged QRS complex

38
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What cardiac rhythm complications may occur due to hypokalemia?

  • Heart block

  • Ventricular dysrhythmias (potentially lethal)

39
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How does hypokalemia affect skeletal muscles?

  • Muscle weakness

  • Paresthesias

  • Severe hypokalemia may cause paralysis, especially in the extremities.

40
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What is a dangerous complication of muscle paralysis in hypokalemia?

Respiratory muscle involvement, which may lead to shallow respirations and respiratory arrest.

41
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How does hypokalemia affect smooth muscle and the GI tract?

It can cause decreased GI motility, resulting in constipation and potentially paralytic ileus.

42
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How does hypokalemia affect insulin and glucose metabolism?

It impairs insulin secretion, which can lead to glucose intolerance and hyperglycemia.

43
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What are the two main treatment strategies for managing hypokalemia?

  • Potassium chloride (KCl) supplements (oral or IV)

  • Increased dietary intake of potassium-rich foods

44
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What is typically sufficient to correct mild hypokalemia?

Increasing potassium-rich food intake

45
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Why must IV KCl always be diluted?

To prevent vein irritation, cardiac complications, and tissue damage.

46
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How should IV KCl bags be handled before infusion?

Invert IV bags several times to ensure even potassium distribution.

47
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What should you never do when administering IV KCl?

  • Never give IV KCl as a push or bolus.

  • Never add KCl to a hanging IV bag

48
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What is the maximum recommended IV KCl infusion rate for non-critical care patients?

10 mEq/hour

49
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What conditions must be met to exceed 10 mEq/hr when administering IV KCl?

  • Critical care setting

  • Continuous ECG monitoring

  • Central line access

50
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What device must always be used when infusing IV KCl?

Infusion pump

51
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How often should IV sites be assessed during IV KCl infusion?

At least hourly

52
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Why is it important to monitor IV sites during KCl infusion?

To detect phlebitis and infiltration, which can lead to necrosis and tissue sloughing

53
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Name 5 fruits that are high in potassium.

  • Apricot (raw, medium)

  • Avocado (¼ whole)

  • Banana (¼ whole)

  • Cantaloupe

  • Dried fruits

54
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Name 5 more potassium-rich fruits.

  • Grapefruit juice

  • Honeydew

  • Orange (medium)

  • Orange juice

  • Prunes, Raisins

55
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Name 5 vegetables that are high in potassium

  • Baked beans

  • Butternut squash

  • Refried beans

  • Black beans

  • Broccoli (cooked)

56
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Name 5 more potassium-rich vegetables.

  • Carrots (raw)

  • Greens (except kale)

  • Mushrooms (canned)

  • Potatoes (white and sweet)

  • Spinach (cooked)

57
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Name 2 more potassium-rich vegetable products.

  • Tomatoes or tomato products

  • Vegetable juices

58
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Name at least 5 other foods high in potassium.

  • Bran or bran products

  • Chocolate (1.5–2 oz)

  • Granola

  • Milk (all types, 1 cup)

  • Nutrition supplements (under medical guidance)

59
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Name 5 more high-potassium items.

  • Nuts and seeds (1 oz)

  • Peanut butter (2 Tbsp)

  • Salt substitutes / Lite Salt

  • Salt-free broth

  • Yogurt