Electrolytes (K+)

Question 1

Potassium normal range

Answer 1

-3.5 - 5 mEq/L

Question 2

Potassium

Answer 2

-primary intracellular cation
-cell metabolism
-glycogen and protein synthesis
-resting potential

Question 3

hypo/hyperkalemia usually associated with

Answer 3

-potentially fatal cardiac arrhythmias

Question 4

factors affecting potassium

Answer 4

-Na/K ATPase pump
-insulin
-glucagon
-catecholamines
-aldosterone
-kidneys
-aterial pH/acid-base status

Question 5

Hypokalemia causes

Answer 5

-diuretic loss (K-wasting)
-B-agonists (albuterol)
-NG drainage
-metabolic alkalosis
-diarrhea
-***Mg depletion (impairs K reabsorption, cofactor for Na/K ATPase)

Question 6

Hypokalemia sx

Answer 6

-nonspecific, can vary
-weakness
-N/V
-change in cardiac function/arrhythmias
-cramping
-impaired muscle contraction
-cardiac pt at higher risk

Question 7

Goals of therapy hypokalemia

Answer 7

-prevent/treat
-normalize serum K
-identify cause
-prevent overcorrection

Question 8

Hypokalemia Treatment at 3.5-4 mEq/L

Answer 8

-no therapy needed
-goal in ICU is over 4 so might need to treat

Question 9

Hypokalemia Treatment at 3-3.4 mEq/L

Answer 9

-debatable
-PO potassium for pt with cardiac conditions

Question 10

Hypokalemia Treatment at <3 mEq/L

Answer 10

-ALWAYS treat
-PO route preferred in asymptomatic
-IV for symptomatic pt that CANNOT take PO
-should attempt to correct Mg2+ deficit

Question 11

Potassium Dosage forms*

Answer 11

-liquid
-powder
-tabs

Question 12

When to admin K+ in IV

Answer 12

-severe case (K<2.5-3)
-symptomatic (ECG changes/muscle spasms)
-unable to tolerate PO

Question 13

IV K+ warnings

Answer 13

-thrombophlebitis and pain at infusion site
-higher risk of overcorrection
-arrhythmia or cardiac arrest if given too quickly!!

Question 14

IV K+ admin

Answer 14

-10-20 mEq / 100mL D5W
-infusion rate w/o cardiac monitoring: 10mEq/h!
-rate w/ monitoring: 20 or 40-60 mEq/h if emergent w severe hypokalemia (during cardiac arrest)

Question 15

Hyperkalemia

Answer 15

-K+ >5.5 mEq/L
-mild: 5.5-6
-mod: 6-6.9
-severe: 7

Question 16

Hyperkalemia presentation

Answer 16

-cardiac arrhythmias
-peaked T wave
-slow AP
-VF of asystole

Question 17

Goals of Hyperkalemia therapy

Answer 17

-antagonize adverse cardiac effects
-reverse any sx
-return the serum K+ to NL
-correct underlying cause

Question 18

Goal of therapy for SEVERE HYPERkalemia

Answer 18

1. antagonize membrane actions (C)
2. decrease ECF K+ (A BIG)
3. Remove K+ from the body (K DROP)

C A BIG K DROP

Question 19

C A BIG K DROP

Answer 19

1. antagonize membrane actions
   -C
2. Decrease ECF K
   -Albuterol
   -Bicarb
   -Insulin + Glucose
3. Remove K+ from body
   -Kayexalate/Lokelma
   -Diuretics (furosemide)
   -Renal unit for dialysis of patient

Question 20

Antagonizes membrane actions

Answer 20

Calcium

Question 21

Decreases ECF K+

Answer 21

-Albuterol
-Bicarb
-Insulin + Glucose

Question 22

Removes K+ from body

Answer 22

-Kayexalate/Lokelma
-Diuretics (furosemide)
-Renal unit for dialysis Of Patient

Question 23

ACute tx options?

Answer 23

?slide 141

Question 24

Lokelma vs Kayexalate

Answer 24

?

Question 25

Chronic Hyperkalemia treatment

Answer 25

-Patiromer (Valtassa)

Question 26

Patiromer (Valtassa)

Answer 26

-binds K in GI tract to decrease absorption
-8.4g PO qd (suspension)
-serum K+ decreases 7 hours after dose upto 48 hours

Question 27

Patiromer side effects

Answer 27

-hypomagnesemia
-constipation
-diarrhea
-nausea
-ab discomfort
-flatuelence