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Hipokalemia and Hyperkalemia

dr. Milanitalia Gadys Rosandy

Mechanisms of Potassium Secretion and
Sodium Reabsorption

Guyton & Hall Medical Fisiology 11th Edition

 Control of Potassium Secretion by
Principal Cells

(1) the activity of the sodium-potassium ATPase pump

(2) the electrochemical gradient for potassium secretion from

the blood to the tubular lumen

(3) the permeability of the luminal membrane for potassium

Guyton & Hall Medical Fisiology 11th Edition

Primary Mechanisms Potassium Intake

Guyton & Hall Medical Fisiology 11th Edition

HIPOKALEMIA
Causes of Hypokalemia
 SIGN AND SYMPTOMPS

 MILD - MODERATE HYPOKALEMIA : Muscular

weakness, fatigue, and muscle cramps

 SEVERE HYPOKALEMIA : Gastrointestinal smooth

muscle involvement may result in constipation or
ileus. Flaccid paralysis, hyporeflexia, hypercapnia,
tetany, and rhabdomyolysis.

Current Medical Diagnosis and Treatment, 2015

 The electrocardiogram (ECG) shows decreased
amplitude and broadening of T waves, prominent U
waves, premature ventricular contractions, and
depressed ST segments.

Current Medical Diagnosis and Treatment, 2015

Management Hypokalemia

Harrisons Internal Medicine, 2015

 Indikasi terapi

 Indikasi terapi
 Indikasi mutlak  hipoK berat < 2 mEq/L
 pasien KAD, pasien digitalisasi, kelemahan otot pernafasan
 Indikasi kuat  hipoK sedang 2-3 mEq/L
 insuf koroner, ensefalopati hepatikum, adanya penggunaan
obat-obatan dgn ES perpindahan K spt insulin
 Indikasi sedang  hipoK ringan (3-3,5 mEq/L)

 RUMUS :
(0,2 – 0,3) x BB x Δ K
Management Mild to Moderate Hipokalemia

 Preparat Kalium oral :

 Diberikan untuk hipokalemi ringan – sedang
 Koreksi lambat :
 KSR 2 – 3 x 1 – 2 tablet (KSR = 600mg )
 Aspar K 3 x 1–3 tab(K L-aspartate 100 mg+Mg L-
aspartat 100 mg)
 Renapar 3 x 1–3 tab (K L-aspartate 300mg+Mg L-
aspartate 100mg)
 Note : jika koreksi dgn KSR selama beberapa hari tidak membaik,
kemungkinan terjadi hipomagnesemia, krn deplesi Mg dapat
menyebabkan peningkatan sekresi K di distal and then
pertimbangkan pemberian Aspar K or Renapar
Management Severe Hipokalemia

 Intravenous potassium is indicated for patients with severe

hypokalemia and for those who cannot take oral
supplementation.

 Via CVC : 40 mEq/L and at rates up to 10 mEq/h.

 Via Periferal : Concentrations of up to 20 mEq/h

 Continuous ECG monitoring is indicated, and the serum

potassium level should be checked every 3–6 hours.

 Avoid glucose-containing fluid to prevent further shifts of

potassium into the cells. Magnesium deficiency should be
corrected, particularly in refractory hypokalemia.
HIPERKALEMIA
Causes of Hyperkalemia

Harrisons Internal Medicine, 2015

 SIGN AND SYMPTOPMS

 Hyperkalemia impairs neuromuscular transmission, causing muscle

weakness, flaccid paralysis, and ileus.

 Electrocardiography is not a sensitive method for detecting

hyperkalemia, since nearly half of patients with a serum potassium
level > 6.5 mEq/L will not manifest ECG changes.

 ECG changes in hyperkalemia include bradycardia, PR interval

prolongation, peaked T waves, QRS widening, and biphasic QRS–T
complexes. Conduction disturbances, such as bundle branch block
and atrioventricular block, may occur. Ventricular fibrillation and
cardiac arrest are terminal events.
 Klasifikasi

 Derajat berat :
 Ringan : 5,5 – 6,0 mEq/L
 Sedang : 6,1 – 7,0 mEq/L
 Berat : > 7 mEq/L

 Koreksi IV hanya jika K > 6 mEq/L

MANAGEMENT
HYPERKALEMIA

Harrisons Internal Medicine, 2015

 Serum potassium level > 5.0 mEq/L (> 5.0 mmol/L).

 ▶ Hyperkalemia may develop in patients taking ACE inhibitors,

angiotensin-receptor blockers, potas- sium-sparing diuretics, or
their combination, even with no or only mild kidney dysfunction.

 ▶ The ECG may show peaked T waves, widened QRS and biphasic
QRS–T complexes, or may be normal despite life-threatening
hyperkalemia.

 ▶ Measurement of plasma potassium level differen- tiates

potassium leak from blood cells in cases of clotting, leukocytosis,
and thrombocytosis from elevated serum potassium.

 ▶ Rule out extracellular potassium shift from the cells in acidosis

and assess renal potassium excretion.
THANK YOU