Fluid and Electrolyte Cases Part 2

Question 1

If urine potassium is less than 20 mEq/L =

Answer 1

Extrarenal losses like GI losses via laxatives or diarrhea

Question 2

If urine potassium is greater than 20 mEq/L =

Answer 2

Renal losses via drugs or renal tubular acidosis or vomiting

Question 3

Most common causes of hypokalemia

Answer 3

Drug induced
Diarrhea
Vomiting

Question 4

Drugs that cause intracellular shift of potassium

Answer 4

Albuteral
Bicarbonate
Insulin

Question 5

Drugs that cause enhanced renal excretion of potassium

Answer 5

Diuretics
High-dose PCN
AG
Amp B

Question 6

Drugs that cause enhanced fecal elimination of potassium

Answer 6

Sodium polystyrene sulfonate

Question 7

Foods high is potassium

Answer 7

Dried figs, molasses, dried fruit, nuts, bran cereals

Question 8

Diuretic or diarrhea induced hypokalemia treatment

Answer 8

Potassium chloride

Question 9

Decreased phosphorous + hypokalemia

Answer 9

Potassium phosphate

Question 10

Metabolic acidosis + hypokalemia

Answer 10

Potassium bicarbonate

Question 11

IV Treatment considerations

Answer 11

Only in symptomatic, severe cases and pt unable to tolerate PO
MIX WITH NaCl!!!!

Question 12

Peripheral vein max rate of infusion of K

Answer 12

10 mEq/hr

Question 13

Central line max rate of infusion of K

Answer 13

40 mEq/hr

Question 14

Too high of a rate of infusion =

Answer 14

Arrhthmia, hyperkalemia, phlebitis

Question 15

Other treatment considerations

Answer 15

Correct Mg deficiency (PO>IV)

Stop other drugs that increase K (triamterene, amiloride, spironolactone, ACEi/ARBs)

Question 16

Hyperkalemia symptoms

Answer 16

Muscle weakness

EKG changes with concentrations > 6.5 mEq/L

Question 17

Hyperkalemia Treatment Plan

Answer 17

Calcium IV bolus over 2-3 minutes to stabilize the cardiac membrane (Ca gluconate most common)
Insulin therapy to shift potassium intracellularly or albuterol or sodium bicarbonate
Remove potassium from body via sodium polysterene or dialysis

Question 18

Insulin therapy does what?

Answer 18

Stimulate Na-K ATPase pump

10 units with 50 mL of D50 and can give dextrose if normoglycemic or hypoglycemic

Question 19

Albuterol does what?

Answer 19

Stimulate Na-K ATPase pump
Additive effect to insulin
10-20 mg/mL per dose

Question 20

Sodium bicarbonate does what?

Answer 20

Increases blood pH

NOT very effective

Question 21

Sodium polysterene does what?

Answer 21

Exchanges potassium for sodium in the gut and you poop it out
With sorbitol to prevent constipation

Question 22

Abnormal EKG =

Answer 22

Admister calcium gluconate
Continue EKG monitoring
Check blood glucose

Question 23

Hyperglycemic =

Answer 23

Give insulin
Follow blood sugar
Consider albuterol
Consider bicabonate if acidotic
Give exchange resin or dialysis
Follow K level every 2 hours until less than 5.5

Question 24

Not Hyperglycemic =

Answer 24

Give insulin & glucose
Consider albuterol
Consider bicabonate if acidotic
Give exchange resin or dialysis
Follow K level every 2 hours until less than 5.5