Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari, National Chairperson (Ex) Intensive Care Chapter I A P Founder Chairman..... National conference on pediatric critical care Professor of pediatrics ( Hon ) JNMC:Wardha Nagpur : INDIA

1. 1 mL/kg of 3% sodium
chloride raises the serum
sodium by 1.6 mEq.
In and out of
potassium
Dr deopujari

2. In and out of potassium
Is no OUTDOOR
BUISNESS ?

3. Miss
Munira

8. Urinary potassium is for the most part secretory
potassium. Distal potassium secretion is regulated by
the amount of sodium in the the distal and collecting
tubules, and the aldosterone activity. Serum
potassium in itself is an important factor in the
regulation of aldosterone activity.

9. 98 %
2 %

10. 98 % 2 %
Causes
Hyperkalemia
K
+

11. Causes of spurious Hyperkalemia
Fist clenching during blood withdrawal
Hemolysis
High platelet count : more than 1 × 106/mm3
leukocytosis : more than 2 × 106
/mm3
Abnormal potassium permeability of erythrocytes
Infectious mononucleosis
Cold agglutinins

12. Clinical features…………….

13. 138
Hyperkalemia and ECG
The earliest ECG manifestation of Hyperkalemia is
peaked or tented T waves.
Serum potassium and ECG
5.5 to 6.5 peaking of T waves
6.5 to 7.5 QRS widening
7.5 to 8.5 decrease in P wave and increase in PR interval
8.5 and more Sine wave , and V.F,Asystole

14. True Hyperkalemia
Excess K+ intake
Redistribution
Decreased excretion
Renal failure
Oliguria
Hypoaldo.
Nsaids
Ace inhibitors
Acidosis
Diabetes.
Adrenal Ins.
Periodic P.

15. 98 %
2 %

16.  Calcium chloride: 0.2 mL /kg/dose of 10% sol IV over 5
min; not to exceed 5 mL (stop infusion if bradycardia
develops)
Calcium gluconate: 100 mg/kg (1 mL/kg) of 10% sol IV over
5 min; not to exceed 10 mL (stop infusion if bradycardia
develops)
 Soda bi carb …( with acidosis )
 2 ml / kg 25 % dextrose with .1 units /kg insulin .
over 30 minutes (1 U regular insulin/5 g glucose )
 Beta agonists
Hyperkalemia

17. Drug Dose
Onset of
action
Duration
Calcium
gluconate
(10%)
1-2 ml/Kg IV 1-3 min. 20-30 min.
Sodium
bicarbonate
(7.5%)
1-2 ml/Kg IV 5-20 min. 1-2 hours
Insulin -
glucose
0.1 U/Kg of
insulin & 0.5-
1.0 g/Kg of
glucose
20-30 min. 2 hours
Salbutamol
4 i:micro g/Kg
IV over 15-20
minutes5 - 10
mg via
inhalation
30 min. 4-6 hours
potassium exchange resins
Hemodialysis

18. Hypokalemia…

19. Causes…………..

20. Hypokalemia true Distribution
Increased loss Urinary K + Decreased
Hypertension Normal B.P.
Acidosis Alkalosis
Renin
G.I.loss
Biliary ETC.

21. 88
Hypokalemia and ECG..

22. I . V . Kesol should be considered for
 Significant arrhythmia
 Sever muscle weakness
 Severe hypokalemia (< 2.5.0 mEq. / L).
 Digoxin toxicity
 Hepatic encephalopathy
Maximum concentrations of KCl used in
peripheral veins generally should not exceed
4 meq. /100 cc due to the damaging effects on
the veins , at a rate of 1 mEq/kg per hour.

23. If serum [K+
] level does not
appreciably rise by 48 hours,
concomitant magnesium
depletion should be suspected
3 months female weighing 2.3 kg with
persistent diarrhea .
Serum potassium 2.3 and not rising in
spite of good
Potassium replacement.
Cause ?

24. Potassium should be administered slowly,
preferably Orally, at a dosage of 4 to 6
mEq/kg per day.
Human milk contains small amounts of K+ , about (12.8 mEq)
per liter, whereas cow's milk contains almost three times.

25. SERUM K
5
INCREASE POTASSIUM
NORMAL POTASSIUM
DECREASE POTASSIUM
CNANGE IN PH AND POTASSIUM
7.4
TOTAL
BODY
POTA.

26. H
I
O
N
S
K
ACIDOSIS CAUSES
HYPERKALEMIA
ALKALOSIS ……… LOW K
+

27. THANKS