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Phar 503 > Potassium Disorder > Flashcards

Potassium Disorder Flashcards

1
Q

What are the physiological functions of potassium

A

Cell metabolism, glycogen and protien synthesis, electrical action potential

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2
Q

What is the distribution of total body K+, how much intracellular, how is it distributed intracellularly, extracellular

A

50 mEq/kg, 98% (150 mEq/L), 75% skeletal muscle/25% liver and blood cells, 2% (4mEq/L) extracellular

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3
Q

What are mechanisms that cause hypokalemia

A

Stimulation of NA/K ATPase pump, intracellular shift of K+, metabolic alkalosis

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4
Q

What are mechanisms that cause hyperkalemia

A

inhibition of Na/K ATPase pump, release of K+ from cells, metabolic acidosis

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5
Q

What are conditions that would cause stimulation of Na/K ATPase pump (drive K+ in)

A

Excess insulin, Beta 2 adrenergic agonist, alpha 1 antagonist, aldosterone

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6
Q

What are conditions that would inhibit Na/K ATPase pump (slow K+ in)

A

Lack of insulin, Beta 2 adrenergic antagonist, alpha 1 agonist, digoxin toxicity

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7
Q

What are conditions that would cause a release of K+ from cells

A

injury/trauma, exercise, catabolism, hyperosmolarity

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8
Q

T/F: Anabolism causes an intracellular shift of potassium

A

True

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9
Q

What are determing factors for the degree of how much potassium leaves the body

A

a very high potassium concentration, presence of aldosterone, delivery of sodium water into the kidney

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10
Q

Why does metabolic acidosis cause hyperkalemia

A

In order to compensate for high H+ the hydrogen ions are pushed in and K+ is pushed out in order to keep the electrostatic balance

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11
Q

Why does metabolic alkalosis cause hypokalemia

A

In order to compensate for low H+ the hydrogen ions are pushed out and K+ is pushed in in order to keep the electrostatic balance

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12
Q

What is the inverse relationship between ph and K+

A

every increase in ph of .1 leads to a decrease of 0.6 mEq/L

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13
Q

What is the normal range for K+

A

3.5-4 mEq/L

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14
Q

What range is considered hypokalemia

A

less than 3.5 mEq/L

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15
Q

Which patients are more likely to suffer complications from hypokalemia

A

congestive heart failure, left ventricualr hypertrophy, cardiac ischemia

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16
Q

What are outcomes of uncorrected hypokalemia

A

Essential hypertension, ischemic and hemorrhagic stroke, arrhythmias, death

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17
Q

What are the causes of hypoalkemia

A

insufficient dietary intake, metabolic alkalosis, periodic paralysis, hyperaldosteronism, diuretics/osmotic diuersis,hypomagnesia

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18
Q

What are medications that may cause intracellular shift of K+ causing hypokalemia

A

Beta 2 adrenergic agonists (albuterol), phosphodiesterace inhibitors (theophylline, caffeine), insulin, barium or verapamil overdose

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19
Q

How do diuretics cause hypoalkemia

A

Na+ reabsorption is hindered causing a large amount to be in the kidney, the body will then activate the Na/K ATPase in the collecting duct causing K+ to be secreted out into the urine

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20
Q

What are the signs of hypoalkemia

A

muscle weaknes (more lower than upper), constipation. EKG changes, arrhythmias, ascending paralysis

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21
Q

In EKG readings what wave changes due to hypokalemia and how is it changed

A

T wave, inversion

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22
Q

How does hypoalkemia increase the risk for hypertension

A

low release of sodium in the urine, low direct vasodilation, high sensitivity to norepinephrine or angiotensin 2

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23
Q

How does hypoalkemia increase the risk for stroke

A

higher blood pressure, higher free O2 free radicals and higher arterial thrombosis

24
Q

T/F: An increase in K+ intake can cause a lower stroke rate in pateints and decrease blood pressure

A

True

25
Q

What is the goal range for patients who have hypokalemia

A

greater than or equal to 4 mEq/L

26
Q

What are the primary ways to treat hypoalkemia

A

treat the underlying cause, treat hypomagnesia, avoid drugs that drop K+

27
Q

Around what range should the patient have a moderate to sever symptoms of hypoalkemia

A

3.0- 2.7 mEq/L, less than 2.7 mEq/L

28
Q

In patients who have hypokalemia what is the method to estimate the potassium defecit

A

If the K+ is greater than or equal to 3.0 mEq/L; each 0.1 mEq/L lower in the K+ level represents a 10 mEq deficit, If the K+ is less than 3.0 mEq/L, each 0.1 mEq/L represents a 20 mEq deficit

29
Q

Which food has the highest potassium content

A

dried figs molasses, nuts avocados ban cereals lima beans

30
Q

T/F: Dietary changes cause an immediate change in K+

A

False: these changes happen over days

31
Q

What is the oral potassium supplement dosing that aides in hypokalemia

A

divide the dose into no more than 40mEq doses at a time every 3-4 hours to avoid Gi ADR

32
Q

What potassium oral supplement is used most often for hypoalkemia, What is the dosage strength,why

A

KCl controlled release, 10 mEq, less likely to cause GI irritation

33
Q

What are the parenteral main routes for Potassium supplements

A

IVPB or continuous infusion, must be at a rate and mixed

34
Q

T/F: Potassium can be administered IM, IVP or SC

A

False: Potassium can NEVER be administered IM, IVP, or SC

35
Q

What is the rate of administration for potassium supplementation through peripheral access or non cardiac monitoring, maximum concentration for continuous flowing IV fluids and IV piggyback

A

10 mEq/hr, 40-60mEq/1000ml and 40meq/250 ml

36
Q

What is the rate of administration for potassium supplementation through central access with cardiac monitoring, what is the maximum concentration

A

20 mEq/hr but up to 40-100 mEq/hr in rare life threatening cases 40mEq/100ml

37
Q

What is the range that diagnosis as hyeralkemia, what is susceptible population of patients

A

greater than 5 mEq/L, acute and chronic renal disease

38
Q

Causes of pseduo-hyperalkemia

A

hemolysis, thrombocytosis, leukocytosis, erythrocytosis

39
Q

What are the causes of hyperkalemia

A

dietary source, medications (penicillin), extracellular shift of K+

40
Q

T/F: Hyperosmolarity from hyperglycemia can cause hyperkalemia

A

True

41
Q

Which medications cause impaired K+ excretion leading to hyperkalemia

A

spironolactone, eplerenone, trimethoprim, NSAIDS, tacrolimus cyclosporine, amiloride

42
Q

What are symptoms of cardiac hyperkalemia

A

slower ventricular conduction, decreased duration of action potential, depolarizes the cell membrane, EKG changes, arrhythmia (AV block,cardiac arrest)

43
Q

In EKG readings what wave changes due to hyperkalemia and how is it changed

A

T- wave, Tall peaked

44
Q

What are the primary treatments for hyperkalemia

A

treat the underlying cause, asses for pseudohyperkalemia

45
Q

In severe hyperkalemia what are the objectives to reach for a patient

A

membrane stabilization (restore the normal gradient with the resting membrane potential), intracellular shifting ( stimulate Na/K ATPase, increase serum pH), elimination (increase delivery of Na+ and urine flow rate)

46
Q

What drug will stabilize the membrane, what is checked after treatment

A

Calcium IV for 30-60 mins, EKG

47
Q

What are the neuromuscular symptoms of hyperkalemia

A

muscle twitching, cramping, flaccid paralysis, paraesthesias

48
Q

What is the prophylactic dose for potassium if diuretics are needed

A

10-20 mEq per day and titrate as needed

49
Q

Around what range should a patient have moderate to severe hyperkalemia symptoms

A

6.5-8, greater than 8

50
Q

What drug will be used to stabilize the intracellular shift of hyperkalemia, what is the dose, what is a risk

A

insulin 10 units IV +/- 50 ml of D5W, hypoglycemia

51
Q

In order to treat hyperkalemia when is insulin given with D5W

A

When the patients glucose is less than 200

52
Q

T/F: Insulin given for hyperkalemia should be taken from 1 to 2 hours

A

False: Insulin should be IV for 4-6 hours

53
Q

What drug will be used for hyperkalemia caused by metabolic acidosis

A

NaHCO3

54
Q

What are the 3 medications/methods used for elimination in hyperkalemia

A

sodium polystyrene sulfonate, furosemide, dialysis

55
Q

What are the two distribution routes for sodium polystyrene sulfonate, what are the doses for each

A

PO: 15-30 grams in 70% sorbitol every 4-6 hours, Rectal: 30-60 grams per rectum every 4 to 6 hours

56
Q

T/F: Sodium polystyrene must be eliminated from the body no matter what the route is

A

True

Phar 503 (25 decks)

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