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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

25
What is the goal range for patients who have hypokalemia
greater than or equal to 4 mEq/L
26
What are the primary ways to treat hypoalkemia
treat the underlying cause, treat hypomagnesia, avoid drugs that drop K+
27
Around what range should the patient have a moderate to sever symptoms of hypoalkemia
3.0- 2.7 mEq/L, less than 2.7 mEq/L
28
In patients who have hypokalemia what is the method to estimate the potassium defecit
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
Which food has the highest potassium content
dried figs molasses, nuts avocados ban cereals lima beans
30
T/F: Dietary changes cause an immediate change in K+
False: these changes happen over days
31
What is the oral potassium supplement dosing that aides in hypokalemia
divide the dose into no more than 40mEq doses at a time every 3-4 hours to avoid Gi ADR
32
What potassium oral supplement is used most often for hypoalkemia, What is the dosage strength,why
KCl controlled release, 10 mEq, less likely to cause GI irritation
33
What are the parenteral main routes for Potassium supplements
IVPB or continuous infusion, must be at a rate and mixed
34
T/F: Potassium can be administered IM, IVP or SC
False: Potassium can NEVER be administered IM, IVP, or SC
35
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
10 mEq/hr, 40-60mEq/1000ml and 40meq/250 ml
36
What is the rate of administration for potassium supplementation through central access with cardiac monitoring, what is the maximum concentration
20 mEq/hr but up to 40-100 mEq/hr in rare life threatening cases 40mEq/100ml
37
What is the range that diagnosis as hyeralkemia, what is susceptible population of patients
greater than 5 mEq/L, acute and chronic renal disease
38
Causes of pseduo-hyperalkemia
hemolysis, thrombocytosis, leukocytosis, erythrocytosis
39
What are the causes of hyperkalemia
dietary source, medications (penicillin), extracellular shift of K+
40
T/F: Hyperosmolarity from hyperglycemia can cause hyperkalemia
True
41
Which medications cause impaired K+ excretion leading to hyperkalemia
spironolactone, eplerenone, trimethoprim, NSAIDS, tacrolimus cyclosporine, amiloride
42
What are symptoms of cardiac hyperkalemia
slower ventricular conduction, decreased duration of action potential, depolarizes the cell membrane, EKG changes, arrhythmia (AV block,cardiac arrest)
43
In EKG readings what wave changes due to hyperkalemia and how is it changed
T- wave, Tall peaked
44
What are the primary treatments for hyperkalemia
treat the underlying cause, asses for pseudohyperkalemia
45
In severe hyperkalemia what are the objectives to reach for a patient
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
What drug will stabilize the membrane, what is checked after treatment
Calcium IV for 30-60 mins, EKG
47
What are the neuromuscular symptoms of hyperkalemia
muscle twitching, cramping, flaccid paralysis, paraesthesias
48
What is the prophylactic dose for potassium if diuretics are needed
10-20 mEq per day and titrate as needed
49
Around what range should a patient have moderate to severe hyperkalemia symptoms
6.5-8, greater than 8
50
What drug will be used to stabilize the intracellular shift of hyperkalemia, what is the dose, what is a risk
insulin 10 units IV +/- 50 ml of D5W, hypoglycemia
51
In order to treat hyperkalemia when is insulin given with D5W
When the patients glucose is less than 200
52
T/F: Insulin given for hyperkalemia should be taken from 1 to 2 hours
False: Insulin should be IV for 4-6 hours
53
What drug will be used for hyperkalemia caused by metabolic acidosis
NaHCO3
54
What are the 3 medications/methods used for elimination in hyperkalemia
sodium polystyrene sulfonate, furosemide, dialysis
55
What are the two distribution routes for sodium polystyrene sulfonate, what are the doses for each
PO: 15-30 grams in 70% sorbitol every 4-6 hours, Rectal: 30-60 grams per rectum every 4 to 6 hours
56
T/F: Sodium polystyrene must be eliminated from the body no matter what the route is
True

Phar 503 (25 decks)

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