Paulson - Potassium

Question 1

hyperkalemia definition

Answer 1

K+ > 5.0

Question 2

hyperkalemia refers to high __ K+

Answer 2

serum

Question 3

what organ regulates K+ levels

Answer 3

kidney

Question 4

nl K+

Answer 4

3.5-5.0

Question 5

4 causes of hyperkalemia

Answer 5

increased intake

decreased excretion

shift from intracellular to extracellular

pseudohyperkalemia

Question 6

increased intake of K+ (2)

Answer 6

supplements

IV

Question 7

mc cause of pseudohyperkalemia

Answer 7

mechanical trauma → venipuncture → hemolysis and K+ leakage from cell

Question 8

what do you think when you see pseudohyperkalemia

Answer 8

hemolysis

Question 9

causes of decreased excretion of K+ (3)

Answer 9

arf/ckd

hypovolemia/volume depletion

hypoaldosteronism (adrenal insufficiency)

Question 10

4 causes of hypovolemia

Answer 10

dehydration

chf

cirrhosis

low flow to kidneys

Question 11

what causes intracellular to extracellular shifts (3)

Answer 11

any breakdown of cells

acidosis

insulin deficiency of resistance

Question 12

causes of cell breakdown (4)

Answer 12

trauma

rhabdo

tumor lysis syndrome

pseudohyperkalemia

Question 13

how does insulin affect K+

Answer 13

K+ follows insulin into cells → deficiency causes accumulation in serum → hyperkalemia

Question 14

meds that cause hyperkalemia

Answer 14

ACEIs

ARBs

NSAIDs

spironolactone

beta blockers

digitalis

succinylcholine

bactrim

K+ supplements

Question 15

how does hyperkalemia affect the heart

Answer 15

membrane excitability → depressed fxn → cardiotoxicity

Question 16

mc presentation of hyperkalemia

Answer 16

asymptomatic

Question 17

possible sx of hyperkalemia

Answer 17

n/v

palpitations

lethargy

confusion

paresthesias

muscle weakness

paralysis

arrhythmias

death

Question 18

labs for hyperkalemia dx

Answer 18

check and recheck K+

BMP

EKG

+/- ABG

Question 19

classic/mc EKG finding for hyperkalemia

Answer 19

peaked T waves

Question 20

what level are peaked T waves seen in hyperkalemia

Answer 20

5.5-6.5 → early finding

Question 21

other EKG findings of hyperkalemia (early → late) (3)

Answer 21

flattened p wave w. prolonged PR interval or absent P wave

wide QRS

sine wave pattern

Question 22

latest ekg finding of hyperkalemia

Answer 22

sine wave pattern

Question 23

what level is sine wave pattern seen in hyperkalemia

Answer 23

K+ > 8.0

Question 24

emergent signs of hyperkalemia

Answer 24

clinical sx → esp muscle weakness or paralysis, arrhythmias

K+ > 6.5

K+ > 5.5 PLUS significant renal impairment PLUS ongoing tissue breakdown OR ongoing K+ absorption OR acidosis

Question 25

tx for hyperkalemia (5)

Answer 25

IV calcium glconate continous cardiac monitoring drive K+ back into cell remove K+ from the body stop K+ supplements/drugs

Question 26

when is calcium gloconate used for hyperkalemia

Answer 26

severe (\>6.5) PLUS EKG changes

Question 27

options to drive K+ back into cell

Answer 27

**insulin PLUS glucose** SABA → albuterol IV sodium bicarb

Question 28

how do you remove K+ from the body (3)

Answer 28

GI cation exchanger diuretics → Lasix + saline hemodialysis

Question 29

how do GI cation exchangers work

Answer 29

bind K+ in GI tract in exchange for other cations → excreted in feces

Question 30

examples of GI cation exchangers

Answer 30

sodium polystyerene solfonate (Kayexalate) patiromer (Veltassa)

Question 31

when is hd indicated for hyperkalemia

Answer 31

severe renal impairment

Question 32

hypokalemia definition

Answer 32

K+ \< 3.5

Question 33

causes of hypokalemia (6)

Answer 33

increased loss movement of K+ from blood → intracellular hypomagnesemia renal tubular acidosis meds very low kcal diets

Question 34

K+ losses often concurrent w. __ losses

Answer 34

Mg → diuretics vomiting

Question 35

what meds cause hypokalemia

Answer 35

diuretics (minus K+ sparing - spironolactone) amphotericin B antipsychotics barium/chloroqine intoxication

Question 36

what common antipsychotics cause hypokalemia

Answer 36

risperdal seroquel

Question 37

sx of hypokalemia

Answer 37

muscle fatigue/weakness cramps, rhabdo, myoglobinuria resp muscle weakness/failure ileus, constipation, n/v

Question 38

where does K+ muscle fatigue/weakness start

Answer 38

LE → ascending

Question 39

dx for hypokalemia

Answer 39

bmp Mg → separate test EKG

Question 40

ekg findings for hypokalemia

Answer 40

**flattened/inverted T wave** **U wave in V4-V6** ST depression prolonged qt → qu interval arrhythmia

Question 41

ex ekg of K+ 1.7

Answer 41

Question 42

emergent indications for hypokalemia

Answer 42

cardiac manifestations K+ \< 2.5

Question 43

tx for emergent hypokalemia

Answer 43

IV K+

Question 44

s.e of IV K+ (2)

Answer 44

pain phlebitis

Question 45

tx for non emergent hypoklaemia

Answer 45

oral KCl

Question 46

tx for hypokalemia + hypomagnesemia

Answer 46

replete both