Hypokalemia

potassium below ___ indicates hypokalemia

3.5 mEq/L

what is the critical potassium value (medical emergency)?

a potassium less than 2.5 mEq/L, due to risk of lethal dysrhythmias

what body systems does potassium heavily affect?

heart rhythm, skeletal and smooth muscle contraction, nerve impulses, normal GI function

hypokalemia overall pattern

low and slow across systems

GI losses that cause hypokalemia

• excessive diarrhea, vomiting

• GI suction

• excessive stimulant laxative use

what meditations can cause hypokalemia?

• stimulant laxatives if you use too much

• loop diuretics (like furosemide/Lasix)

other causes of hypokalemia

• poor potassium intake or starvation

• corticosteroid therapy

• cushing’s syndrome

• insulin excess

• potassium loss in sweat

• alcoholism

energy level in hypokalemic patients

lethargic

• loss of energy and decreased responsiveness

how does hypokalemia impact respirations?

low, shallow respirations

• due skeletal muscle weakness

cardiac risk in hypokalemia

high risk for lethal dysrhythmias

• patient needs continuous cardiac monitoring

why does hypokalemia cause dysrhythmias

disrupts cardiac electrical conduction and repolarization

why does hypokalemia cause lots of urine?

kidneys have trouble concentrating urine when potassium is low

muscle findings in hypokalemia

• leg cramps

• limp muscles with decreased strength

• decreased DTRs

deep tendon reflexes are ____ in hypokalemia

decreased

how does hypokalemia impact blood pressure?

it lowers blood pressure with orthostatic drops

how does hypokalemia impact respirations?

it makes them slow, and shallow because of weak muscles

GI motility in hypokalemia

decreased peristalsis → paralyzed ilium (part of small intestine) → constipation → abdominal distention

why does hypokalemia cause abdominal distention?

decreased GI smooth muscle activity and peristalsis, making you constipated

FIRST nurse action for patient with hypokalemia

• place on cardiac monitor

• obtain a 12-lead EKG as prescribed

ongoing monitoring priorities in hypokalemia

• monitor respirations/vital signs

• assess level of consciousness and safety

• monitor I&O and urine output (will be higher)

• assess bowel sounds and abdominal distention

ways to increase potassium

• diet

• oral supplements

• IV replacement as prescribed

examples of high-potassium foods

• bananas

• citrus fruits (tomatoes, orange juice)

• peas, beans

• melons (mangos, cantaloupe, honeydew)

• avocados

• spinach;

• potatoes; raisins; dairy products

what do we always do when safely giving potassium via IV?

• DILUTE and INFUSE SLOWLY

• NEVER give via IV PUSH or bolus

what form of potassium do we NEVER administer?

IV push/bolus

• giving potassium too fast will kill them

who mixes potassium IV solutions?

pharmacists, not nurses

what to monitor IV sites for during potassium infusion

• infiltration

• extravasation

• burning (slow the rate)

what do we do if burning happens while giving potassium via IV?

slow the rate

what should we educate hypokalemic patients about?

review diuretic and laxative use to prevent excessive potassium loss

• laxatives can cause constipation in the long run

due to lethargy and muscle weakness, hypokalemic patients can be at ____

risk for falls

when to initiate telemetry in hypokalemic patients?

• chest symptoms (palpitations)

• any EKG changes given dysrhythmia risk

what is the nurse’s responsibility before giving potassium replacement?

verify the latest lab value yourself

• question any replacement order if current potassium is elevated