This document provides an overview and guidelines for assessing and managing hypokalemia. It discusses the goals of maintaining potassium balance, causes and clinical manifestations of hypokalemia, approaches to estimating potassium deficit and choosing treatment methods, and considerations for monitoring and follow up. Real case examples are also presented to demonstrate practical application of the guidelines.
18. HYPOKALEMIA – DRUG INDUCED Phenolphthalein Na polystrene sulfonate Acetazolamide Thiazides Loop diuretics Fludrocortisone Pencillin Aminoglycoside Amphotericin B Cisplatin Epinephrine Pseudoephedrine Salbutomol Theophylline Ritodrine Verapamil Chloroquine Insulin overdose K LOSS IN STOOL RENAL K LOSS TRANSCELLULAR K SHIFT
30. HYPOKALEMIA & TOTAL K DEFICIT Sterns RH, Medicine 60:339-354:1981 500 -750 300-600 150-400 125 -250 TOTAL K deficit (mEq/L,70 kg) <2 2 3 3.5 S.K (mEq/L)
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37. K CONCENTRATION OF IV FLUIDS 4 10 17 20 35 K(mEq/L) RL Iso E Iso G Iso P Iso M IV Fluid
73. Potassium Balance: Critical for Excitable Heart & Nervous Tissues Figure 20-4: Osmolarity changes as fluid flows through the nephron
74. Low Renin Low Aldosterone Cortisol Ectopic ACTH Cushing syndrome Liddle’s Licorice AME DOC 11 hydorxylase D 17 hydorxylase D High Normal Low Lin SH, et al. Am J Med Sci 2003; 325: 153-156.
80. Lin SH et al. Am J Emerg Med 2003 Blood pressure Renin Renin Aldo K + excretion rate and acid - base status ? H H y y p p o o k k a a l l e e m m i i a a & & P P a a r r a a l l y y s s i i s s L L o o w w K K + + e e x x c c r r e e t t i i o o n n a a n n d d n n o o r r m m a a l l a a c c i i d d - - b b a a s s e e SPP Barium poisoni ng FPP Hypernatremic HPP None Family history Hypernatremia High K + excretion and abnormal acid - base Acid - base state ? Clue Hyperthyroidism ? TPP YES NO Metabolic Acidosis NH + 4 excretion (UAG, UOG) Low High Toluene Profound diarrhea RTA Metabolic Alkalosis R enin Normal GS or BS Diuretics Vomiting High Primary mineralocorticoid excess Aldo Aldo Primary Aldo steronism Licorice use AME Ectopic ACTH Liddle syndrome
Notas del editor
Hypokalemia produces distinctive changes in the ST-T complex. The most common pattern seen is ST depressions with prominent U waves and prolonged repolarization . With hypokalemia, the U waves typically become enlarged and may even exceed the height of the T waves . Particularly important in Digitalis patients!
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