Fluid and Electrolyte Cases Part 2 Flashcards
If urine potassium is less than 20 mEq/L =
Extrarenal losses like GI losses via laxatives or diarrhea
If urine potassium is greater than 20 mEq/L =
Renal losses via drugs or renal tubular acidosis or vomiting
Most common causes of hypokalemia
Drug induced
Diarrhea
Vomiting
Drugs that cause intracellular shift of potassium
Albuteral
Bicarbonate
Insulin
Drugs that cause enhanced renal excretion of potassium
Diuretics
High-dose PCN
AG
Amp B
Drugs that cause enhanced fecal elimination of potassium
Sodium polystyrene sulfonate
Foods high is potassium
Dried figs, molasses, dried fruit, nuts, bran cereals
Diuretic or diarrhea induced hypokalemia treatment
Potassium chloride
Decreased phosphorous + hypokalemia
Potassium phosphate
Metabolic acidosis + hypokalemia
Potassium bicarbonate
IV Treatment considerations
Only in symptomatic, severe cases and pt unable to tolerate PO
MIX WITH NaCl!!!!
Peripheral vein max rate of infusion of K
10 mEq/hr
Central line max rate of infusion of K
40 mEq/hr
Too high of a rate of infusion =
Arrhthmia, hyperkalemia, phlebitis
Other treatment considerations
Correct Mg deficiency (PO>IV)
Stop other drugs that increase K (triamterene, amiloride, spironolactone, ACEi/ARBs)
Hyperkalemia symptoms
Muscle weakness
EKG changes with concentrations > 6.5 mEq/L
Hyperkalemia Treatment Plan
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
Insulin therapy does what?
Stimulate Na-K ATPase pump
10 units with 50 mL of D50 and can give dextrose if normoglycemic or hypoglycemic
Albuterol does what?
Stimulate Na-K ATPase pump
Additive effect to insulin
10-20 mg/mL per dose
Sodium bicarbonate does what?
Increases blood pH
NOT very effective
Sodium polysterene does what?
Exchanges potassium for sodium in the gut and you poop it out
With sorbitol to prevent constipation
Abnormal EKG =
Admister calcium gluconate
Continue EKG monitoring
Check blood glucose
Hyperglycemic =
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
Not Hyperglycemic =
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
