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Medical > Potassium Disorders: Hypokalemia and Hyperkalemia > Flashcards

Potassium Disorders: Hypokalemia and Hyperkalemia Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the indications for urgent treatment of potassium disorders ?

A
  • Severe or symptomatic hypokalemia or hyperkalemia.
  • Abrupt changes in potassium levels.
  • Electrocardiography changes.
  • The presence of certain co-morbid conditions.
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2
Q

What is the definition of hypokalemia ?

A

Serum potassium level less than 3.6 mEq per L [3.6 mmol per L].

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3
Q

What is the definition of hyperkalemia ?

A

Serum potassium level more than 5 mEq per L [5 mmol per L].

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4
Q

Name the medications that causes Hypokalemia?

A
  • Diuretics.
  • Laxatives and enemas.
  • Corticosteroids.
  • Insulin overdose
  • Beta2 sympathomimetics
  • Decongestants
  • Xanthines
  • Amphotericin B
  • Verapamil intoxication
  • Chloroquine (Aralen) intoxication
  • Barium intoxication
  • Cesium intoxication
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5
Q

What are the Warning signs of hypokalemia ?

A 
1- Changes on electrocardiography,.
2- Severe hypokalemia (less than 2.5 mEq per L [2.5 mmol per L]).
3- Rapid-onset hypokalemia.
4- Underlying heart disease
5- Cirrhosis.
6- Weakness or palpitations.
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6
Q

What should you focus on, when examining a patient with hypokalemia ?

A

Identifying cardiac arrhythmias and neurologic manifestations which range from generalized weakness to ascending paralysis.

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7
Q

What is the first ECG manifestation of hypokalemia?

A

Decreased T-wave amplitude.

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8
Q

What are the ECG and types of arrhythmia occur in hypokalemic patients.

A
  • Decreased T-wave amplitude.
  • ST-interval depression.
  • T-wave inversions.
  • PR-interval prolongation.
  • U waves. Arrhythmias.
  • Sinus bradycardia,
  • Ventricular tachycardia or fibrillation.
  • Torsade de pointes.
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9
Q

What are the indications for IV KCl rather than oral?

A
  1. Severe hypokalemia.
  2. Hypokalemic ECG changes.
  3. Physical signs or symptoms of hypokalemia.
  4. Patients who are unable to tolerate the oral form.
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10
Q

Why potassium should not be given in dextrose-containing solutions?

A

Because dextrose-stimulated insulin secretion can exacerbate hypokalemia.

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11
Q

What is the definition of mild - moderate and severe Hypokalemia?

A
  • Mild: 2.9 - 3.4 mEq/L
  • Moderate: 2.5-3.0 mEq/L
  • Severe: Less than 2.5 mEq/L.
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12
Q

What is the dose of KCL in mild to moderate hypokalemia?

A
  • Capsules or tablets: 40-100 mEq PO qDay in divided doses; single dose not to exceed 25 mEq to minimize GI discomfort.
  • Oral solution: 40-100 mEq PO qDay in 2 to 5 divided doses; limit single doses to 40 mEq/dose; not to exceed 200 mEq/24hr.

Aternatively, 10-20 mEq PO BID/QID (20-80 mEq/day)

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13
Q

What is the dose of KCL in severe hypokalemia?

A
  • 40 mEq PO TID/QID
    OR
  • 20 mEq PO BID/TID in addition to IV potassium administration with careful monitoring; doses >40 mEq are typically not well tolerated orally, resulting in GI irritation and nausea
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14
Q

What is the dose of KCL in Hypokalemia Prophylaxis ?

A

20-40 mEq PO qDay or divided BID

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15
Q

What is the IV infusion dose of KCL in hypokalemia ?

A

≤10 mEq/hr; repeat as needed based on lab values done frequently

  • central line infusion and continuous ECG monitoring recommended for infusions >10 mEq/hr.
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16
Q

10 mEq of potassium chloride increases serum potassium levels by approximately ….. .

A

0.1 mEq/L

17
Q

What is the dose of KCL if K: 2.5-3.5 mEq/L ?

A

10 mEq/hr maximum infusion rate.
40 mEq/L maximum concentration.
not to exceed 200 mEq dose/24hr.

18
Q

What is the dose of KCL if K <2.5 mEq/L or symptomatic hypokalemia (excluding emergency treatment of cardiac arrest) ?

A

40 mEq/hr maximum infusion rate (central line only) in presence of continuous ECG monitoring and frequent lab monitoring.
patients may require up to 400 mEq/24hr

19
Q

What is Gitelman syndrome?

A

It is an autosomal recessive disorder of the kidney, characterized by hypokalemic metabolic alkalosis and low blood pressure.

20
Q

What is the DDx of hypokalemia when urine potassium level is less than 20 mEq/L ?

A
  • Diarrhea and use of laxatives
  • Diet or total parenteral nutrition (TPN) contents
  • The use of insulin, excessive bicarbonate supplements, and episodic weakness.
21
Q

What is the DDx of hypokalemia when urine potassium level is higher than 40 mEq/L ?

A

Consider diuretics.

If diuretic use has been excluded, measure arterial blood gases (ABG) and determine the acid-base balance. Alkalosis suggests one of the following:

  • Vomiting
  • Bartter syndrome
  • Gitelman syndrome
  • Mineralocorticoid excess.
22
Q

Name some fruits and vagetables that contains high potassium.

A

Bananas, tomatoes, oranges, and peaches are high in potassium.

23
Q

How to differentiate between exogenous insulin administration and internal insulin release?

A

By measuring serum insulin and C-peptide tests. An elevated serum insulin level without an appropriately elevated C-peptide level suggests exogenous insulin administration.

24
Q

What is the relationship between Angiotensin-converting enzyme (ACE) inhibitors and potassium ?

A

ACE inhibitors, inhibit renal potassium excretion, which can improve some of the hypokalemia that thiazide and loop diuretics can cause. However, ACE inhibitors can lead to lethal hyperkalemia in patients with renal insufficiency who are taking potassium supplements or potassium-sparing diuretics.

25
Q

Why does potassium is essential to the human body?

A

Potassium is essential for:

  • Transmission of nerve impulses.
  • Contraction of cardiac muscle.
  • Maintenance of intracellular tonicity, skeletal and smooth muscles.
  • Maintenance of normal renal function.
26
Q

How should KCl tablets be taken ?

A

Any of these forms may irritate the stomach and cause vomiting; consequently, they should be taken with food or after meals to minimize gastrointestinal discomfort.

27
Q

How to interpret urine K:Cr ratio in the settings of hypokalemia?

A

Urine K:Cr should be less than 1 in setting of hypokalemia.

  • If <1 consider GI loss
  • If >1 consider a renal loss
28
Q

What are the types of infusion given in hypokalemia correction?
and when to use each one ?

A
  • Potassium Chloride ( In alkalosis).
  • Potassium Bicarbonate ( In acidosis).
  • Potassium Phosphate (low phosphate).
29
Q

What is the formula of hypokalemia correction ?

A

K deficit (in mmol) = (K normal lower limit − K measured) × kg body weight × 0.4.

30
Q

What is the dose of KCl IV replacement if K level is less than 2.5 ?

A
  • 40 Meq KCl in 400 mL of NS over 4 hrs in PIV line.

- 40 Meq KCl in 200 mL of NS over 2 hrs in CVC line.

31
Q

What is the dose of KCl IV replacement if K level: 2.6 -3 ?

A
  • 30 meq KCl in 300 mL of NS over 3 hrs in PIV line.

- 30 meq KCl in 200 mL of NS over 2 hrs in CVC line.

32
Q

What is the dose of KCl IV replacement if K level: 3.1 - 3.5 ?

A
  • 20 meq KCl in 200 mL of NS over 2 hrs in PIV line.

- 20 Meq KCl in 100 mL of NS over 1 hr in CVC line.

33
Q

What is the dose of KCl IV replacement if K level is less than 2.5 and the patient has a Cr level of : > 150 umol/L (1.7 mg/dL)?

A
  • 20 meq KCl in 200 mL of NS over 2 hrs in PIV line.

- 20 meq KCl in 100 mL of NS over 1 hr in CVC line.

34
Q

What is the dose of KCl IV replacement if K level : 2.5 - 3 and the patient has a Cr level of : > 150 umol/L (1.7 mg/dL)?

A
  • 10 meq KCl in 200 mL of NS over 2 hrs in PIV line.

- 10 meq KCl in 100 mL of NS over 1 hr in CVC line.

35
Q

How to give correction of hypomagnesemia in a normal kidney function if Mg level is < 1 mg/dL (< 0.41 mol/L) ?

A

Give 4 g of Magnesium Sulphate in 250 mL of NS over 3 hours.

36
Q

How to give correction of hypomagnesemia in a normal kidney function if Mg level : 1- 1.8 mg/dL (0.41- 0.74 mol/L) ?

A

Give 2 g of Magnesium Sulphate in 100 mL of NS over 2 hours.

37
Q

How to correct hypophosphatemia in a patient with a normal kidney function if phosphate level is < 1 mg/dL (<0.32 mol/L) ?

A

Give 30 mmol (potassium/Sodium) phosphate in 500 NS over 6 hours.

38
Q

How to correct hypophosphatemia in a patient with a normal kidney function if phosphate level is : 1.1 - 2 mg/dL (0.33 - 0.64 mol/L) ?

A

Give 20 mmol (potassium/Sodium) phosphate in 250 NS over 6 hours.

39
Q

How to correct hypophosphatemia in a patient with a normal kidney function if phosphate level is : >2 mg/dL (>0.64 mol/L) ?

A

Oral phosphate replacement can be used e.g 500 mg Tab Q8hrs , or phosphate rich diet.

Medical (6 decks)

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