POTASSIUM IMBALANCES

True

• Hypokalemia may also occur in patients with normal potassium stores.

  • In alkalosis (high blood pH), serum potassium temporarily shifts into the cells.

Inside cells

ECF

• 98% of the body's potassium is _____s. The remaining 2% is in the____and is important for:

• Nueromuscular function

• Cardiac function

Alkalosis

Normal body stores in hypokalemia occurs with?

Intracellular Potassium Shift

• Insulin Therapy

• Alkalosis

• Beta 2 andregenic agonist

• Refeeding syndrome

Renal Potassium Wasting

• Loop/ thiazide diuretics

• Primary hyperaldosteronism

• HYpomagnesemia

Extrarenal Potassium wasting

• Vomiting, NG suction, Diarrhea, Laxative,

Pathophysiology of Hypokalemia

Hypokalemia

albuterol and epinephrine can cause

Hypokalemia

Corticosteroids

Penicillin

Ampothericin B

Hypokalemia

Villous adenoma can cause

• Primary : adrenal adenomas

• Secondary: (RAAS stimulation) cirrhosis, nephrotic syndrome, heart failure, Malignant hypertension

Types of hyperaldosteronism

Diabetic Ketoacidosis

Insulin is used to treat

Debilated older adults

alcoholism

Anorexia nervosa

Bulimia

At risk patient for hypokalemia

Weak muscles

Slow gut

Irritable heart

Remember hypokalemia

insulin rates adjusted

manage alkalosis

Rebound Hyperkalemia can occur after

<2.5

• lethal ventricular arrythmias

Red flag in Hypokalemia

magnesium

Mandatory co electrolyte

• Hypokalemia is refractoty to k+ rif ______ is low

10 mEw/ hr

20 mEq/ hr

maximum peripheral infusion of Potassium

maximum central infeusion

Potassium 140 mEq/L

major intracellular cation

Hypokalemia

Cushing Syndrome can cause

1. Shalloww flat inverted T waces

2. St depression

3. Prominent U wave

Hypokalemia

• Early change:

• Intermediate Change:

• hallmark change: Severe change:

ABC

Cardiac monitoring

Assess Renal Function No Pee No K

Primary interventions for Hypokalemia

Cardiac monitoring

Patient in hypokalemia should be in a continuous

At least 30 ml/ Hour or (0.5 mL/kg/hr)

Hypokalemia minimum urine output

10-40 mEq / 1000 mL 0.9 Nacl

Potassium must be diluted in an IV bag using

magnesium

_______ maintains the Na+/ k+ atpase pump and inhibits the renal ROMK channel

Hypokalemia

At risk for paralytic ileus

With meals or full glass of water

how to take oral potassium

Potatoes

Oranges

Tomatoes

avocadoes

Spinach
Strawberry

Island Fish

Umbrella mushroom. Beans/ lentils

melon / cantaloupe milk bananas

POTASSIUM (high in potassium)

Hypokalemia

Digitalist toxicity occurs in ________

• even if digoxin is at normal levels

0.5-2.0 ng/mL

Normal digoxin level

Visual disturbances (yello-green halos, Blurred vision), NV anorexia Bradycardia, dysrhythmias

Digoxin toxicity signs

Check Serum K+ and heart rate (apical pulse for 1 min) before administering digoxin

Nursing action to prevent Digoxin toxicity

Furosemide (lasix)

Bumetanide

Hydrochlorthiaze

Examples of K+ wasting diuretics

Potassium supplements

K+ wasting diuretics require

Spironolactone

eplerenone

triamterene

Examples of Potassium sparing Diuretics

24 hour potassium excretion test

Urine potassium - creatinine ration

Serium magnesium

Additional studies

ABG, Urine Chloride, Urine Sodium, Renin, Aldosterone

Assessment + Diagnostic Finding for Hypokalemia

40-60 Meq/day if no loss

50-100 mEq/day of at risk for hypokalemia

Normal Potassium intake

50-60

Salt substitute contain _____ mEq/day

Potassium Chloride Kcl

Potassium acetate

Potassium phosphate

Potassium IV

Foods

medications

Fluid balance

Lab and cardiac monitoring

Nursing Management for Hypokalemia

Oral potassium

IV Potassium

How to correct Hypokalemia

• Lower lean body mass

• Higher total body K+

• less k+ requirement

Older adults be cautious in giving Oral potassium because of?

Oral potassium

• abdominal pain, distension, GI bleeding

_______ can cause bowel lesion

assess for: _______,____,_____

Dysphagia

swallowing difficulty

Poor GI motility

Consider liquid potassium if patient is

potassium

Do not mix with Dextrose

Hyperkalemia

A rare imbalance if the person has normal renal function

• meaning cause siya g pagkasira ng kidney

potassium

Cardiac Arrest is primary associated with ______

Hyperkalemia

initially causes membrane depolarization

followed by Na channel deactivation

Decreased Renal Excretion

• AKI, CKD

• Medications: ACE inhibitors, ARBs, potassium Sparindiuretics, Nsaids

• Hypoaldostenism (Addison)

Potassium Release/ Shift

• Tumor lysis syndrome, Rhabdomyolysis, burns, trauma

• Acidosis

• Hyperosmolarity (hyperglycemia)

Excessive potassium intake

Pathophysiology of Hyperkalemia

Hyperkalemia

Hypoaldostenism (addisons) (kyperkalemia or HYpokalemia?)

KCL

heparin

ace inhibitors

NSAIDs

Beta blockers

Cyclosporine

Tacrolimus

Potassium Sparing diuretics

Medications that can cause Hyperkalemia

Pseudohyperkalemia

False hyperkalemia

Peak T waves

Flat p waves

Widened QRS

Prolonged PR interval

ECG for Hyperkalemia

Tall narrow, symmetrical T waves

Short QT inteval

Earlt ECG fingdings ib hyperkalemia

Sine wave pattern

• QRS merge with T wave

• Ventricular fibrilation or asystole

ECG in Severe Hyperkalemia

>6 mEq/L of potassium

When should a 12 lead ECG be used?

Serum potassium and ECG

ABG

Renal Function

Glucose, sodium, bicarb, calcium

Assessment and diagnostic Findings for Hyperkalemia

Vein without IV

Repeat serum potassium is done from a

Orally / enema

• requires normal bowel function

Cation exchange resin is adminstered?

Sodium polystyreme Sulfonate SPS

Patiromer Sorbitex Calcium PSC

Enumarate the Cation Exchange Resins

Sodium Polyesterene Sulfonate

Binds with k+ and excreted in Feces

Patiromer sorbitex calcium

Exhange calcium for K+ at lower intestine

1. IV Calcium Gluconate (1st)

2. Sodium Bicarbonate

3. Insulin Dextrose

4. Loop Diuretics

5. Beta 2 Agonists

6. Dialysis and Renal Replacement

Medications for Hyperkalemia

IV calcium Gluconate

Stablished the heart, does not lower K+

Severe metabolic Acidosis

• alakalinize plasma

• shift potassium to cell

• furnish sodium to antagonize effect of potassium

when is Sodium Bicarbonate use?

Sodium Bicarbonate

Canot be used as a single therapy due to inconsisten potassium lowering effect

insulin

Temporarily shifts K+ to cell

10 units soluble insulin + 25 grams glucose

How many dose of insulin is given

Albuterol

Can cause

• Tachycardia and Chest Discomfort

Beta 2 agonist

• Salbutamol/ Albuterol (Nebulization)

Adjunct to insulin glucose

Dialysis and renal replacement

If hyperkalemia is not Transient and is Refractory ____ is needed

HYperkalemia

Deadliest electroylte imbalance

Peak t waves

Prolonged PR interval, Flat P waves

QRS complex

Sine wave pattern & asystole

HYPERKALEMIA

early change:

Intemmediate change

Avanced Change

Critical Severe change

Sine wave pattern

Pre-terminal rhythm

2-6 HOURS

Shifting potassium in hyperkalemia only lsT FOR

• Insulin + D5W

• Sodium Bicarbonate

• Inhaled Beta 2 agonist

medications that shift potassium to cells

• loop diuretics

• Cation exchange resins

• Hemodialysis

Mediations that eliminate potassium from the body (definitive Treatment)

Cation exchange resins

Diarrhea is expected when using

Absent bowel sounds, or paralyrtic ileus

Do not use Cation exchange resing when

Dialysis

Fastest most difinitive method for Hyperkalemia