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PTx 2 > Potassium > Flashcards

Potassium Flashcards

1
Q

What is the most abundant intracellular cation?

A

Potassium

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2
Q

What is the daily requirement of K+ needed to maintain a normal serum concentration?

A

40-80 mEq

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3
Q

What is the normal range for potassium?

A

3.5-5

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4
Q

How is potassium excreted?

A

90% renal excretion

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5
Q

True or false. The potassium level is affected by acid-base disorders. Why or why not?

A

True. Because of the H-K exchange (when H+ increases, K+ is pulled from the cell and into the blood stream and when H+ decreases K+ is pulled into the cell)

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6
Q

Acidosis can cause _______kalemia.

A

HYPERkalemia

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7
Q

Alkalosis can cause _______kalemia

A

hypokalemia

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8
Q

What are 3 hormones that can affect potassium balance?

A

insulin
catecholamines
aldosterone

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9
Q

How does insulin affect potassium?

A

When insulin is secreted, K+ is pulled INTO the cells and serum K+ levels decrease

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10
Q

How is hypokalemia classified?

A

K+ < 3.5 mEq/L

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11
Q

What is mild hypokalemia?

A

K+ between 3.1-3.4

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12
Q

What is moderate hypokalemia?

A

K+ between 2.5-3.0

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13
Q

What is severe hypokalemia?

A

K+ < 2.5

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14
Q

What are some causes of hypokalemia?

A
  1. poor dietary intake
  2. large renal or GI loss (diuretics, especially Loops)
  3. Intracellular shift (alkalosis, insulin admin, glucose admin, beta agonists)
  4. Low Magnesium
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15
Q

Why can low magnesium cause low potassium?

A

Mg2+ is the cofactor for the exchange of K+ in the body so if Mg2+ is low, K+ won’t be able to stay stored intracellularly and will be renally excreted more rapidly.

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16
Q

What are types of drugs that can cause hypokalemia?

A

Drugs that cause a transcellular shift
Drugs that enhance renal excretion of K+
Drugs that enhance fecal elimination of K+

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17
Q

What are some examples of drugs that can cause a transcellular shift of K+ resulting in hypokalemia?

A
  • B2-receptor agonists (albuterol)
  • Tocolytic agents (ritodrine, nylidrin)
  • Theophylline
  • Caffeine
  • Insulin overdose
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18
Q

What are some examples of drugs that can enhance renal excretion of K+?

A
  • Diuretics
  • High dose penicillins
  • Mineralcorticoids
  • Aminoglycosides
  • Amphotericin B
  • Cisplatin
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19
Q

What are some examples of drugs that can enhance fecal excretion of K+?

A

Laxatives (sugar is also a laxative)
• sodium polystyrene sulfonate
• phenolphthalein
• sorbitol

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20
Q

What is the clinical presentation of moderate hypokalemia?

A

Cramps
Muscle weakness
Malaise

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21
Q

What is the clinical presentation of sever hypokalemia?

A 
EKG changes
• flattened T waves
• ST segment depression
• PR prolongation
Bradycardia
Heart block
Arrhythmias: atrial flutter, PVCs, V fib
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22
Q

What drug do you need to watch or monitor if a patient has hypokalemia?

A

Hypokalemia can cause DIGOXIN toxicity
(b/c K+ and Dig share the same receptor and if K+ is low, more dig binds to the receptor which increases its activity and can cause toxicity)

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23
Q

What are some non-drug therapies that you can do to treat hypokalemia?

A
  1. dietary replacement of K+
  2. D’C the offending agent
  3. Correct the underlying cause
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24
Q

What electrolyte may you need to correct if K+ is low and not increasing even with treatment?

A

Magnesium

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25
Q

If the K+ < 3.5, a 1 mEq/L drop is equal to a loss of ____ mEq

A

200 mEq

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26
Q

If the K+ < 3, a 1 mEq/L drop is equal to a loss of ____ mEq

A

200-400 mEq

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27
Q

What equation helps you know how many mEq of K+ need to be replaced?

A

(4 - K+serum) x 100

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28
Q

How do you treat mild to moderate hypokalemia?

A

with ORAL preps

29
Q

If a pt is on diuretic and has low K, how many mEq/day are needed to replace their K+?

A

40-100 mEq/day

30
Q

Which of the following disintegrates better in GI tract and has fewer erosions?
A. Wax-matrix ER tablets
B. Controlled-release micro encapsulated tablets
C. Potassium chloride elixer

A

B

31
Q

Which of the following is inexpensive, has poor compliance, poor taste and immediate effect?
A. Controlled-release micro encapsulated tablets
B. Potassium chloride elixir
C. Wax-matrix ER tablets
D. Potassium chloride effervescent tablets for solution

A

B. potassium chloride elixir

32
Q

Which of the following is more expensive but convenient for people who have trouble swallowing?
A. Controlled-release micro encapsulated tablets
B. Potassium chloride elixir
C. Wax-matrix ER tablets
D. Potassium chloride effervescent tablets for solution

A

D. Potassium chloride effervescent tablets for solution

33
Q

Which of the following has fewer erosions than wax-matrix tablets?
A. Controlled-release microencapsulated tablets
B. Potassium chloride elixir
C. Encapsulated CR microencapsulated particles
D. Wax-matrix ER tablets

A

C. Encapsulated CR microencapsulated particles

34
Q

If a patient has acidosis and hypokalemia, what are the treatment options?

A 
potassium acetate (IV)
potassium bicarb (IV or PO)
35
Q

If a patient has alkalosis and hypokalemia, what are the treatment options?

A

potassium chloride (IV or PO)

36
Q

If a patient has low phosphorus and hypokalemia, what are the treatment options?

A

potassium phosphate (IV or PO)

37
Q

How do you treat severe hypokalemia?

A

with IV potassium in a SALINE prep

38
Q

Why do you not give K+ in a D5W solution?

A

D5W has sugar in it and sugar increases insulin release and pulls more K+ inside the cells and out of the blood stream which worsens the hypokalemia

39
Q

What is the max concentration for K+ in an IV bag?

A

80 mEq/L

40
Q

What is the max rate you can run IV K+ at in a peripheral line?

A

10 mEq/h

41
Q

What is the max rate you can run IV K+ at in a central line?

A

40 mEq/h

42
Q

Why do we care about max rate of admin?

A

it can be damaging or irritating to peripheral veins

43
Q

How is hyperkalemia classified?

A

K+ > 5 mEq/L

44
Q

How is mild hyperkalemia classified?

A

K+: 5.1 - 5.9

45
Q

How is moderate hyperkalemia classified?

A

K+: 6-6.9

46
Q

How is severe hyperkalemia classified?

A

K+ > 7 mEq/L

47
Q

What are some causes of HYPERkalemia?

A 
increased intake
• dietary potassium (salt substitutes)
• drug-induced
pseudohyperkalemia
• lab error
• hemolysis of the sample
48
Q

What are some drugs that can cause HYPERkalemia?

A 
IV fluids
K-sparing diuretics
ACEI/ARBs
NSAIDs
Heparin
Bactrim
49
Q

What is the clinical presentation of HYPERkalemia?

A 
Muscle weakness
Paresthesias 
Hypotension
EKG changes 
• peak T waves with level > 6 mEq/L
• widened PR interval 
• widened QRS complex 
Arrhythmias
Acidosis
50
Q

What are some treatment goals for HYPERkalemia?

A
  1. antagonize adverse cardiac effects
  2. reverse symptoms present
  3. return serum K+ to normal
  4. return total body stores to normal
  5. identify underlying cause and correct
51
Q

What are some non-drug treatments for HYPERkalemia?

A

D’C the offending agent

Hemodialysis if nothing else works

52
Q

If the pt has HYPERkalemia with EKG changes what meds do you give them first?

A

Calcium Gluconate 1 g IV in D5W over 5-10 minutes to stabilize the heart and prevent arrhythmias

53
Q

What is the onset and duration of action for calcium gluconate?

A

1-2 min/30 min

54
Q

What do you need to look out for when giving a patient Calcium gluconate?

A

iatrogenic hypercalcemia (make sure to check for ionized calcium with the equation from the total calcium lab)

55
Q

What is the equation to find out ionized calcium?

A

…

56
Q

What does iatrogenic mean?

A

“we (the healthcare providers) did it to the patient”

57
Q

What is ionized Ca2+?

A

the free number of Ca2+ in the bloodstream NOT bound to albumin

58
Q

Why do you give regular insulin to combat hyperkalemia?

A

it is a temporary fix that shifts K+ INTO the cell and out of the plasma

59
Q

How many units do you give of regular insulin to treat hyperkalemia?

A

5-10 units IV bolus
*usually 10 units are given
(if the patient has metabolic acidosis, they may need an insulin infusion) Why?

60
Q

Why do you give dextrose IV push or infusion with regular insulin?

A

The dextrose stimulates insulin secretion and helps offset hypoglycemia caused by the insulin given.

61
Q

What percentage of dextrose do you give with insulin?

A

10-50%

62
Q

What is the onset and duration of action for the insulin/dextrose combo?

A

onset: 30 min
duration: 2-6 h

63
Q

Why do you give albuterol for hyperkalemia?

A

to shift K+ into the cell

64
Q

What is the dose for albuterol given for hyperkalemia?

A

10-20 mg nebulized over 10 min

65
Q

What are the side effects of albuterol?

A

tachycardia, jittery, irritable

66
Q

What should you monitor when a patient is given albuterol?

A

monitor HR

67
Q

What is the problem with giving albuterol for hyperkalemia?

A

it doesn’t have a predictable response and many people have a poor response to it

68
Q

What is the dose of Na bicarbonate used for hyperkalemia?

A

50-100 mEq IV over 2-5 min

PTx 2 (6 decks)

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