Potassium
Hypokalemia under 3.5 mEq/L
Signs and Symptoms of Hypokalemia
Hypokalemia is low and slow
What is low and slow? Breathing, energy, bowel sounds, brain (confused), blood pressure (orthostatic), reflexes, and pulse (wear and irregular).
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- Premature Ventricular Contractions
- Ventricular Tachycardia
- Torsades
- U wave
- ST Depression
- Shallow or Inverted T wave
- Muscles weakness
- Paralysis
- Leg cramps (painful)
- Shallow breathing
- Monitor respiratory system!
- Told you that every thing is slow
- Decrease bowel sounds
- Constipation
- Nausea and vomiting
- Hyporeflexia
- Decreased DTR’s
- Low
- Weak thready pulse
- Orthostatic hypotension (change position slowly)
Causes of Hypokalemia
- Diuretics (e.g. furosemide)
- Diarrhea/Vomiting
- Poor K+ intake
- Processes/Medications that move potassium inside the cell (hyperinsulinism, alkalosis, & albuterol)
- NG tube to suction (An NG tube to suction may seem benign, but causes electrolyte imbalances!)
- Too much aldosterone. Remember aldosterone increases sodium and decreases potassium.
- Steroids such as prednisone and methylprenisolone (Think of Cushing Syndrome where too much adrenal hormone leads to hypernatremia and hypokalemia).Â
- Acid/Base imbalances (alkalosis)
- Bulimia= Vomiting causes a loss of potassium and H+ ion (from gastric acid). Hypokalemia and alkalosis are friends.
NCLEX Tips
Let's test your understanding
Hyperkalemia > 5.5 mEq/L
Signs and Symptoms of Hyperkalemia
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Murder
Hyperkalemia can kill you
M
- Muscle cramps
- Weakness
U
- Urine Little or no Urine.
- Renal failure!Â
R
- Respiratory Distress
D
- Deadly cardiac Problems
- Decreased Contractility
- Bradycardia & cardiac arrest.
- Hypotension
E
- EKG changes
- Tall Peaked T wave
- Bradycardia
- Cardiac arrest
- Irregular rhythm
R
- Reflex- Hyperreflexia or areflexia (flaccid)
- Muscle weakness
- Numbness and tingling.
Causes of Hyperkalemia MACHINE mnemonic
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- Medications
- ACE inhibitors
- NSAIDs
- Potassium-sparing diuretics (Spironolactone)
- Acidosis
- Metabolic and respiratory acidosis
- Compensatory mechanism in which H+ ions enter cells to reduce acidosis, but K+ ions exit cells⇒ hyperkalemia
- Also in major burns during the first 48 hours, potassium exits the cell and hyperkalemia occurs.
- Cellular Destruction
- Burns, traumatic injury, hemolysis
- In tissue damage K+ exits the cell
- Watch for potassium in burn patients!
- Hypoaldosteronism
- Aldosterone ⇑ Na+ and ⇓ K+
- Is “hypo” or low opposite occurs ⇓Na+ and ⇑K+
- ADDISON’S = hyperkalemia
- Intake- Excessive
- Where is potassium: Salt substitutes
- Fruit (bananas and oranges are big ones)
- Green leafy veggies
- Potatoes
- Tomatoes
- Spinash
- Avocados
- Strawberries
- Melons
- Nephron damage
- Renal failure
- Excretion Impaired
- Again, kidney disease or patients on dialysis
- Monitor potassium in dialysis client
- If a client has high potassium, look at the kidneys
Treatments for Hyperkalemia A BIG DICK
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Albuterol
Bicarbonate
Insulin (drives potassium inside the cell)
Glucose (to counteract the effects of insulin)
DIuretics (potassium wasting diuretics such as furosemide)
DI Dialysis (best treatment if hyperkalemia due to renal failure)
Calcium gluconate (doesn’t lower potassium but reduces the cardiac effects of hyperkalemia). Tricky. Remember that it does not decrease K+, only protects the heart.
- Kayexalate (binds to potassium to get rid of it through the GI tract). Other med similar to kayexalate: Lokelma
- Kayexalate is Sodium polycystyrene sulfonate. Name that you will see on the NCLEX
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