Hypo and HyperK

Card Set Information

Author:
Snooze
ID:
296214
Filename:
Hypo and HyperK
Updated:
2015-02-18 15:34:46
Tags:
disorders
Folders:

Description:
Hypo and HyperK
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user Snooze on FreezingBlue Flashcards. What would you like to do?


  1. K balance b/w IC and EC compartments are maintained by what 3 factors (2 DIRECTLY give reason to tx for imbalance)?
    • 1. Beta-2 adrenergic stimulation (caused by epinephrine) promotes cell uptake of K
    • 2. Insulin promotes cell uptake of K
    • 3. Plasma [K] directly correlates with movement of K in/out of cells
  2. Reduced dietary intake seldom causes hypoK. What are 4 GENERAL causes of hypoK?
    1. Inc'd shift of K INTO cells by certain circumstances

    2. Inc'd GI loss with V/D, intestinal fistula, enteral tube drainage, chronic lax abuse

    3. Inc'd urinary loss with aldosterone excess, diuretic use

    4. HypoMg (commonly asso'd) correct both
  3. HypoK s(x) start to occur at what plasma K level?
    <3mEq/L
  4. What are 3 common s(x)s that occur with hypoK and hyperK?

    What are 2 signs of hypoK that differ from hyperK?
    • 1. Muscle weakness
    • 2. Abnormal cardiac conduction
    • 3. EKG changes

    • HypoK ONLY:
    • 1. Dig toxicity (even if normal serum dig)
    • 2. Rhabdomyolysis (hypoK reduce blood flow to skeletal muscles)
  5. How can one estimate K deficit per 1mEq/L reduction in plasma K?
    200-400mEq K deficit per 1mEq/L reduction in plasma K
  6. What is the preferred formulation of K for hypoK, esp in concurrent metabolic acidosis?
    KCl
  7. Guidelines for administering K in hypoK:
    1. Pt w/o EKG changes or sxs of hypoK can be treated with ____ _____________
    2. Avoid mixing K in _________, which can cause insulin release and K shift
    3. To avoid irritation, NMT ______ of K should be administered through PERIPHERAL vein
    4. Recommended infusion rate of K is _______ and max of _______ which should be through a central venous catheter and monitored with continuous EKG monitor
    1. Pt w/o EKG changes or sxs of hypoK can be treated with oral supplementation (K bicarbonate)

    2. Avoid mixing K in dextrose, which can cause insulin release and K shift

    3. To avoid irritation, NMT 60mEq/L of K should be administered through PERIPHERAL vein

    • 4. Recommended infusion rate of K is 10-20mEq/hr and max of 40mEq/hr which
    • should be through a central venous catheter and monitored with
    • continuous EKG monitor
  8. HypoK tx divided by plasma K level in 4 sections.

    What is preferred tx for plasma K 3-3.5mEq/L w/o signs or sx?
    Oral KCl 60-80mEq/day

    FYI Doses>60mEq should be divided to avoid GI efx
  9. HypoK tx divided by plasma K level in 4 sections.

    What is preferred tx for plasma K 2.5-3 mEq/L  with AND w/o signs or sx?
    W/o sx: Oral KCl 120mEq/day (divide doses >60mEq to avoid GI efx)

    With sx: IV 60-80mEq administered at 10-20mEq/hr

    FYI monitor 2hrs after infusion
  10. HypoK tx divided by plasma K level in 4 sections.

    What is preferred tx for plasma K 2-2.5 mEq/L?
    IV KCl 10-20mEq/hr (consider continuous EKG monitoring)
  11. HypoK tx divided by plasma K level in 4 sections.

    What is preferred tx for plasma K <2 mEq/L?
    IV KCl 20-40mEq/hr with continuous EKG monitoring
  12. Specifically, what 4 occurrences cause an inc shift of K INTO cells causing hypoK?
    • 1. Inc'd pH
    • 2. Hypothermia
    • 3. Insulin or carb load
    • 4. B2 stimulation caused by stress-induced epi or admin of B2 agonist
  13. In contrast to hypoK, inc'd intake of K can cause hyperK. What are 2 GENERAL causes of hyperK?
    • 1. Shift of K from IC to EC compartment
    • 2. Reduced urinary excretion
  14. What are the 6 specific causes of shifting of K from IC to EC, causing hyperK? (HINT: 4 are complete opposite of causes of hypoK)
    • 1. Acidosis (decreased pH)
    • 2. Rewarming after hypothermia (i.e. after cardiac surgery)
    • 3. Insulin deficiency
    • 4. B2 blockade

    • 5. Dig OD
    • 6. Succinylcholine
  15. Specifically, what are the 5 causes of reduced urinary excretion, causing hyperK? (HINT: 2 are drugs)
    • 1. Kidney dsfx
    • 2. Intravascular vol depletion
    • 3. Hypo-aldosteronism
    • 4. K sparing diuretics
    • 5. ACE or ARBs
  16. B/c not all pt with hyperK experience EKG changes and may mainfest as VF, at what plasma K level should emergency tx take place?
    K>6.5mEq/L
  17. What are 4 circumstances that enhance conduction disturbances in hyperK?
    • 1. HypoCa
    • 2. HypoNa
    • 3. Acidosis
    • 4. Rapid elevation in plasma [K]
  18. Asymptomatic treatment of hyperK can be treated with: (drug and dose)
    Na polystyrene sulfonate (Kayexelate) 15g PO q6h prn (mix in 20-100ml H2O)

    FYI do not mix with sorbitol --> intestinal necrosis
  19. What are the 3 s/sx that warrant urgent tx for hyperK?
    • 1. K>6.5mEq/L
    • 2. Severe muscle weakness
    • 3. EKG changes
  20. To prevent hyperK-induced arrythmias in symptomatic hyperK, what should be administered preferably? (drug and dose)

    How much plasma K is reduced in the process?
    Ca gluconate 1g=10ml IV peripherally over 2-10mins, may rpt in 5min if no improvement in EKG

    FYI preferred over CaCl b/c dec risk of tissue necrosis, although elemental Ca level is lower

    Plasma K levels will NOT be reduced, but it does antagonize efx of K in cardiac conduction cells
  21. When using Ca Gluconate to prevent hyperK-induced arrythmias, avoid its use in which types of patients, where there have been reports of sudden death?
    AVOID in digoxin patients b/c hyperCa can precipitate dig tox
  22. In symptomatic hyperK (not emergency), what are the 3 tx options (drug)?
    • 1. Regular insulin w/or w/o dextrose
    • 2. NaHCO3
    • 3. Albuterol
  23. In symptomatic hyperK (not emergency), what is the preferred tx option that is predictable in kidney dz than the other 2 options? (drug n dose)
    Regular insulin 10 units IV PLUS 25-50g 50% dextrose IV push (to prevent hypoglycemia)
  24. In symptomatic hyperK (not emergency), what is the tx option that may be effective in pt w/underlying metabolic acidosis? (drug n dose)
    NaHCO3 50mEq infused slowly over 5 min, may rpt in 30 min if necessary
  25. In symptomatic hyperK (not emergency), what is the tx option that may be used in combination with insulin? Ineffective in 40% of pt as monotherapy. (drug n dose)
    Albuterol 10-20mg nebulized over 10 mins
  26. Following therapy use of symptomatic hyperK, what are 3 options to remove excess K from body? Which one is last resort for severe hyperK or when other measures r ineffective?
    • 1. Diuretics
    • 2. Kayexelate PO (not in emergency b/c onset is 2hrs n unpredictable efficacy)
    • 3. Dialysis (last resort)

What would you like to do?

Home > Flashcards > Print Preview