Potassium

Question 1

Complication of hypokalemia

Answer 1

Fatal arrhythmia

Question 2

When K>3, 10 mEq KCl changes the measured K by:

Answer 2

0.1

only in the case where the K>3.

Question 3

What is the max speed at which K can be replaced in a peripheral IV?

Answer 3

10 mEq/hr *if K>3

Question 4

When K 2.5-3, how many mEq of KCl does it take to move measured K 0.1?

Answer 4

15 mEq KCl to move K 0.1

Question 5

When K 2.0-2.5, how many mEq of KCl does it take to move measured K 0.1?

Answer 5

20 mEq KCl to move K 0.1

Question 6

What is the best way to replace K?

Answer 6

PO

40 mEq intervals

Question 7

Take home about K

Answer 7

Replace K as soon as you see it dropping

Question 8

What is critical hypokalemia?

Answer 8

Arrhythmia already there –> go straight to dialysis (for any electrolyte abnormality)

Question 9

Step 1 in hyperkalemia

Answer 9

EKG

Question 10

Peaked Ts mean

Answer 10

Mild to moderate Hyperkalemia

Question 11

Stretched T waves mean

Answer 11

Moderate Hyperkalemia

Question 12

EKG complication of severe hyperkalemia?

Answer 12

T wave stretches out, EKG eventually looks like a sine wave –> may be too late

Question 13

What are the three phases of hyperkalemia correction?

Answer 13

1. Stabilize cardiac membrane
2. Temporize K (shift K into cells)
3. Eliminate K

Question 14

What is the action in the stabilization of the cardiac membrane in the tx of hyperK?

Answer 14

IV CCl

Question 15

What are the actions in the temporization of serum K in the tx of hyperK?

Answer 15

Option 1: Give D50 –> insulin pushes K into cells
Option 2: Give NaC03-
Option 3: Beta agonists ie albuterol (less used)

Question 16

What are the two routes of elimination of K?

Answer 16

Pee and poop

Question 17

What are the actions in the temporization of K in the tx of hyperK?

Answer 17

Option 1: for functioning kidneys, use furosemide

Option 2: Kayexalate

Question 18

What is the first step in the treatment of DKA/HHS?

Answer 18

Assess K+

Treat volume depletion

Question 19

In the treatment of DKA/HHS, what is the next step if the K is >5.2?

Answer 19

Begin insulin infusion

Question 20

In the treatment of DKA/HHS, what is the next step if the K is 3.3-5.2?

Answer 20

Begin insulin

Infuse K with volume resuscitation

Question 21

In the treatment of DKA/HHS, what is the next step if the K is <3.3?

Answer 21

Hold insulin

Infuse K with volume resuscitation

Question 22

What is initial management in a patient with hyperkalemia and evidence of ECG changes?

Answer 22

Calcium gluconate should be given intravenously for any evidence of ECG changes due to hyperkalemia. It prevents dysrhythmias and can reverse ECG changes.