Therapeutics - Electrolytes - K
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What types of drugs can cause Hypokalemia?
- Cellular K redistributing
- Renal potassium wasting and Hypomagnesemia inducing
What drugs can cause hypokalemia?
- insulin (Cellular K redistributing)
- High dose antibiotics and corticosteroids (Renal wasting)
- Cisplatin and Foscament (Mg depleters)
What drugs can cause HYPERkalemia?
- Potassium supplements
(Kelsey can always bring three Nalgene’s per hot destination so take pants)
What medications/treatments are available for Hypokalemia?
- Potassium chloride
- acetate and bicarbonate
What are the EKG symptoms of Hypokalemia?
Flattening of the T wave and Elevation of the U wave
What are the s/s of Hypokalemia?
- EKG (flat T-wave
- incr. U-wave)
- Digoxin toxicity
- increased pH/Bicarb
- N/V paralytic ilius
For every 1 mEq/L fall in K
- what is the corresponding drop in total body deficit?
- ~200 mEq
What type of Potassium would you use if a person has Alkalosis and HYPOkalemia?
What type of Potassium would you use if a person has Acidosis and HYPOkalemia?
- citrate or acetate
How is moderate (2.5-3.5 mEq/L) HYPOkalemia usually treated when no EKG changes are present?
- 40-120 mEq/day (or [4-K] x 100)
How is severe (<2.5 mEq/L) HYPOkalemia usually treated when w/ or w/o EKG changes?
- avoid glucose solution
- correct any Mg deficits
- Max rate : 10 mEq/hr (peripheral) 40 mEq/hr (central)
- Max conc.: 40 mEq/L (peripheral) 80 mEq/L (central)
- cardiac monitoring over 10 mEq/hr
What diseases can cause HYPERkalemia?
- Addison’s disease
- renal failure
- tissue breakdown
- metabolic acidosis
What medications can be used to treat HYPERkalemia?
- sodium bicarbonate
- Sodium polysturene sulfonate (kayexalate)
- Loop/thiazide diuretics
- Hemodialysis and Discontinue K sparing drugs
(Don’t insult Sally because she likes her dress)
What are the s/s of HYPERkalemia?
- Muscle weakness
- GI hypertrophy
- EKG changes
- dec. pH
- de. Cardiac conduction
What are the EKG changes associated with HYPERkalemia?
- Widened QRS complex
- Shortened Q-T segment and Peaked T-wave
What is a normal treatment regimen for HYPERkalemia?
- 1g CaCl infused directly or in 50mL D5W over 15 min
- 50% dextrose IV over 5 min
- 10% dextrose w/ 20 U regular insulin over 1-2h
- Sodium polysturene 15-60g or 10-20 nebulizer albuterol over 10 min
How can you promote ECF to ICF movement of K during HYPERkalemia?
- insulin and sodium bicarbonate
When can you use albuterol for HYPERkalemia?
When is IV calcium indicated for HYPERkalemia?
>7 mEq/L or EKG changes
When is Dextrose/sodium bicarb/insulin recommended for HYPERkalemia?
[K] > 6.0 mEq/L or EKG changes
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