HYPOKALEMIA VS HYPERKALEMIA

potassium

EXCRETION: normally excreted

FUNCTION:

• 98% of potassium are in the cells. Low levels in blood

• Cardiac

• Neuromuscular

• Glycogen deposition in muscle and liver cells

*IMPORTANT POTASSIUM REGULATORS

• sodium-potassium pump

• insulin

• ADH: aldosterone or vasopressin

potassium MAINLY comes from where?

diet

hyperkalemia causes

• KEY: RENAL FAILURE (CAN’T EXCRETE k+) or high potassium intake

• Low aldosterone (adrenal issue)

• shift from cell to plasma

salt subsitutes

hyperkalemia

• why: salt substitutes are just substituted with potassium

acidosis

hyperkalemia

• why: potassium is positively charged. To compensate for acidosis, the cell tries to get rid of positively charged ions inside the cell and that includes potassium (since all of it is inside the cell)

rapid IV potassium infusion

hyperkalemia

potassium containing drugs (potassium pencillin)

hyperkalemia

intense exercise

hyperkalemia

• why: pushes potassium out of cell into the blood (since all of potassium resided in the cell)

EARLY/MILD hyperkalemia

peaked T waves

SEVERE hyperkalemia ECG

• loss of P waves

• long PR

• depressed ST

• wide QRS

paresthesia or numbness/tingling

MILD hyperkalemia

paralysis

SEVERE hyperkalemia

respiratory or cardiac arrest

VERY SEVERE hyperkalemia

abdominal cramping, vomiting, diarrhea

hyperkalemia

• why: hyperactivity (nerve impulses) of GI smooth muscles

hyperkalemia treatment: FIRST (stop potassium intake)

stop diet or IV potassium

hyperkalemia treatment: SECOND (potassium excretion)

• loop or thiazide diuretics

• kayexalate

• hemodialysis → IF RENAL FIALURE

hyperkalemia treatment: THIRD (potassium back into cell)

insulin with glucose/dextrose

hyperkalemia d/t metabolic acidosis

sodium bicarbonate

hyperkalemia treatment: FOURTH (cardiac)

IV calcium chloride/gluconate

• why: does not LOWER potassium but treats the cardiotoxicity (dysthymias) from hyperkalemia

mild hyperkalemia w. kidney function

• stop potassium intake (diet or IV)

• increase fluids (pee out potassium)

• loop or thiazide diuretics

severe hyperkalemia or symptomatic hyperkalemia

• insulin w. glucose

• acidosis: sodium bicarbonate (opens up cell for potassium and bicarbonate)

dangerous dysrhythmias

IV calcium IMMEDIATELY

insulin considerations

check glucose

• why: because giving insulin can lead to hypoglycemia

IV calcium consideration

check BP

• why: giving calcium rapidly can cause hypotension

hypokalemia causes

• KEY: loss of potassium (urine)

• shift from plasma to cell

diarrhea or vomiting

hypokalemia

ileostomy drainage

hypokalemia

increased urine output or diuretics

hypokalemia

• why: potassium is mainly excreted by kidneys

dialysis

hypokalemia

diaphoresis (sweat)

hypokalemia

NG suction

hypokalemia

starvation

hypokalemia

low magnesium levels

hypokalemia

• why: low magnesium levels stimulate renin + aldosterone release → potassium is excreted

insulin

hypokalemia

• REMEMBER: insulin is a treatment for hyperkalemia, but it can cause hypokalemia

alkalosis

hypokalemia

• REMEMBR:

  • Acidosis = hyperkalemia (why: because during acidosis, the blood is trying to get rid of the acid by exchanging hydrogen with potassium. potassium enters blood)

  • Alkalosis = hypokalemia (why: because during alkalosis, the blood is trying to get compensate for the lost acid, by exchanging hydrogen with potassium, from the cell. potassium enters cell)

sodium retention

hypokalemia (sodium ↑ = potassium ↓)

low blood volume

hypokalemia

• why: low blood volume causes sodium retention as a compensatory response, thus when sodium is retained, potassium is loss

hypokalemia ECG

• U wave

• flat T

• peaked P

• depressed ST

• wide QRS

paralysis

SEVERE hypokalemia

• REMEBER: paralysis may occur with hyperkalemia. Trick: look at serum levels

SOB or respiratory arrest

SEVERE hypokalemia

• why: paralyzed muscles

paralytic ileus or constipation

hypokalemia

hyperglycemia

hypokalemia

• why: hypokalemia impairs insulin production

oral or IV potassium chloride (KCL)

when blood labs indicate hyperkalemia

potassium-rich foods

for mild hyperkalemia

IV potassium chloride considerations

• dilute IV potassium solution

• invert (turn upside down) solution

• DO NOT HANG potassium to hanging bag (prevent bolus dose)

• Infusion Rate: 10 mEq/hr

critical care, continuous ECG monitoring, w. central line access

*may exceed 10 mEq/hr

correct rate of IV potassium chloride

use infusion pump

assess IV sites for phlebitis & infiltration

during IV potassium chloride

• why: potassium chloride is irritating to the vein

infiltration sign

sloughing & necrosis

critically ill

continuous ECG monitoring

at risk for hypokalemia

• continuous ECG monitoring

• serum potassium levels monitoring

on digoxin therapy

monitor for digoxin toxicity signs/symptoms (anorexia, n/v, vision issues: blind spots, halo, decreases acuity)