Hypokalemia/Hyperkalemia

Question 1

What are the 4 main causes of hypokalemia

Answer 1

Inadequate intake
Increase excretion
Intracellular shift (from extracellular to intra)
Pseudo hypokalemia- abnormal WCC (AML)

Question 2

List the symptoms of hypokalemia (5)

Answer 2

Muscle weakness, cramping, tremor
Intestinal obstruction - constipation
Hypotension
Resp depression
Arrhythmias

Question 3

Effects of hypokalemia in the heart

Answer 3

VTach and VFib

Question 4

What are the ECG changes in hypokalemia (5)

Answer 4

Small p wave
PR interval slightly elongated
ST depression
Small T wave
Prominent U wave

Question 5

Investigations in a patient with hypokalemia symptoms

Answer 5

Beside ECG
Bloods: blood gas, CEU
Urinary K+

Question 6

How to manage hypokalemia

Answer 6

1. Stabilise ABCs
2. Stop ,Meds worsening hypokalemia
3. Look for underlying cause of hypokalemia

Question 7

What foods are a source of potassium (5)

Answer 7

Banana
Dried fruits
Nuts
Avocado
Broccoli
Spinach
Orange juice

Question 8

How would you treat hypokalemia

Answer 8

Oral potassium chloride (KCL) ,potassium phosphate, potassium bicarbonate, K-citrate

Dosage 40-100mmol/day for treating and 20mmol/day for prevention

Question 9

Outline the causes of hyperkalemia (5)

Answer 9

Increased intake
Reduced excretion- CKD
Acidosis
Drug induced -NSAIDs, K sparing diuretics, digoxin, ACE inhibitors
Cell death
Massive blood transfusion
Measurement error

Question 10

Outline the symptoms of hyperkalemia

Answer 10

Muscle cramps, parastgesia and weakness or flaccid paralysis
Palpitations
Generalised fatigue and malaise
Nausea, vomiting and diarrhoea

Question 11

What physical exam findings are seen in hyperkalemia

Answer 11

Bradycardia
Arrhythmias with frequent premature ventricular contractions
Decreased tendon reflexes and increased power

Question 12

How would you diagnose hyperkalemia

Answer 12

ECG- talk t waves with a narrow base (frequent in V2-V4
Widened QRS (5.5-6.5 mEq/dl K+)
Absent p waves (6.6-7.5 mEq/dl K+)

Confirm with K+ serum level

Question 13

Management of hyperkalemia

Answer 13

A,B,C
Stop K fluids or drugs

Membrane stabilisation:
10% calcium chloride or glauconate initially 10mL

Shift K into cells:
insulin or dextrose 50ml of 50%
Salbutamol nebulisation
HCO3 50-100mL of 8.4% over 30min

Increase K elimination:
Diuretics Lasix 1-2mg/kg IV
Dialysis
K+ binders (Kayexalate 30mg PO)

Treat underlying cause