hypokalemia. definition serum potassium concentration < 3.5 meq/l etiology total body potassium...
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HYPOKALEMIA
Definition•serum potassium concentration < 3.5
mEq/L
Etiology•total body potassium deficit
▫Poor intake▫Excessive renal & GI loss
•serum potassium is shifted into the intracellular compartment
•drug
Drug induce hypo K
Category & Clinical presentation
State Serum K level Clinical presenttation
mild 3-3.5 mEq/L asymptomatic
moderate 2.5-3 mEq/L cramping, weakness, malaise, and myalgias
severe < 2.5 mEq/L ECG changes arrhythmias
ECG changes: ST-segment depression or flattening,T-wave inversion, and U-wave elevation
Treatment
•K supplement 3 salt (Chloride, phosphate, carbonate)
•PO mild to moderate (should be divided into 3-4 doses to minimize the developement of GI side effects)
• IV severe (K < 2.5 mEq/L) exhibiting signs symptoms of
hypokalemia patients unable to tolerate oral
therapy
KCl oral
•10% KCl elixir (20 mEq/15 ml)•Ped KCl 2% (4 mEq/15ml)
10% KCl elixir serum K
60 ml 0.3-0.8
120 ml 0.4-1.6
180 ml 0.6-2.4
KCl IV infusion
•NaCl •D5W advoided•10 to 20 mEq of potassium is diluted in
100 mL 0.9% NaCl•administered through a peripheral vein
over 1 hour•Mutiple dose: can be repeated as needed
until the serum potassium concentration normalizes (equilibium time 30 min)
KCl IV infusion (Conc.)
•Severe K depletion•KCl 300 to 400 mEq/day •dilute 40 to 60 mEq in 1,000 mL 0.45%
NaCl•Rate of infusion: not exceeding 40 mEq/h
•Central intravenous line into a large vein (e.g., superior vena cava)
Alternative therapy
Potassium-sparing diuretics •Spironolactone : 25-mg, 50-mg, and 100-
mg tablets▫Start 25 to 50 mg daily titrated to a
maximum dose of 400 mg/day.▫side effects: hyperkalemia, gynecomastia,
breast tenderness, and impotence
Alternative therapy
•Triamterene: 50-mg and 100-mg capsules▫Start 50 mg twice daily titrated to 100
mg twice daily▫side effects: hyperkalemia, sodium
depletion, and metabolic acidosis•Amiloride: 5-mg tablet
▫Start 5 mg daily; however, 10 mg can be given in those with severe hypokalemia
Alternative therapy
•Generally, concomitant use of potassium supplementation with potassium-sparing diuretics is not necessary.
•There is a significant risk of hyperkalemia during combination therapy, especially in patients with underlying renal insufficiency or diabetes mellitus.
The end