Hypokalemia

Question 1

What is the normal range for potassium

Answer 1

3.5-5.1

Question 2

What is considered hypokalemic

Answer 2

<2.5

Question 3

What is hypokalemia on a cellular level

Answer 3

Large amounts of potassium have congregated in the cell and there is very little left in the blood

Question 4

What is potassium responsible for

Answer 4

Nerve impulse conduction, muscle contraction

Question 5

Causes of hypokalemia

Answer 5

“Body is trying to DITCH K+”
Drugs 
Inadequate intake K+
Too much water intake
Cushing’s syndrome (too much aldosterone secretion)
Heavy fluid loss

Other: alkalosis, hyperinsulinism (too much insulin in the blood)

Question 6

Types of drugs that could cause hypokalemia

Answer 6

Laxatives (potassium is lost in stool)
Diuretics (wastes potassium, large amount of potassium being lost due to frequent urination)
Corticosteroids

Question 7

Reasons for inadequate K+ intake

Answer 7

NPO (long time)
Anorexia
Nausea (can’t eat/keep anything down)

Question 8

Reasons for heavy fluid loss influencing hypokalemia

Answer 8

NG suction (GI secretions rich in electrolytes, can suck out too much)
Vomiting
Diarrhea
Wound drainage (wound vac)
Sweating

Question 9

S&S of hypokalemia

Answer 9

Everything is slow + low

• weak pulse (irregular, thready)
• orthostatic hypotension
• decreased bowel sounds + reflexes
• flaccid paralysis, confusion, weakness
• shallow respirations + diminished breath sounds (due to weak muscle contraction)

Question 10

EKG changes in hypokalemia

Answer 10

Depressed ST segment
Flat or inverted T wave
Prominent U wave

Question 11

Seven L’s of how someone would present

Answer 11

Lethargic
Low, shallow respirations
Lethal cardiac changes
Loss of urine
Leg cramps
Limp muscles
Low BP + HR

Question 12

Hypokalemia interventions

Answer 12

• watch heart rhythm, respiratory status, GI + renal status (urine output), BUN and creatinine, put on cardiac monitor
• watch magnesium levels
• watch glucose, calcium, and sodium (plays in cell transport)
• levels 2.5-3.5, doctor will order oral supplement of potassium, pills or powder with food
• levels <2.5, doctor will order nurse to start infusion
• hold diuretics that waste K+ and digoxin until you talk to doctor
• doctors will sometimes switch pt to a K+ sparing diuretic

Question 13

Why do you need to watch magnesium in hypokalemia

Answer 13

Levels tend to trend the same way, if mag level is too low, will be harder to make potassium go back up

Question 14

How can’t you give K+ in hypokalemia

Answer 14

IV push
Subcutaneous
IM injection

Will kill pt

Question 15

Things to watch when giving K+

Answer 15

• follow bag instruction IV, no more than 20 mEq/hr typically
• if pt is receiving at least 10 mEq/hr or more you want to put them on cardiac monitor
• watch for phlebitis or infiltration, potassium is hard on the veins

Question 16

Examples of K+ sparing diuretics

Answer 16

Amiloride
Trianterene
Eplerenone
Spironolactone

Question 17

Potassium rich foods

Answer 17

Potatoes and pork
Orange
Tomatoes
Avocados
Strawberries
Spinach
fIsh
mUshrooms
Musk melons > cantaloupe

Carrots
Raisins
Bananas