ALL ABOUT POTASSIUM

*critical care handbook 2013 KKM

*sarawak handbook of emergencies

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 POP QUIZ
You are reviewing a patient in acute cubicle
65/C/Male
Being treated as sepsis secondary to thyphoid fever

Renal profile:
Urea 12.0 mmol/L
Sodium 135 mmol/L
Potassium 2.7 mmol/L
Chloride 103 mmol/L
Creatinine 117 umol/L
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• What are the abnormalities in the renal
profile?
• Why do you think patient is having
hypokalemia?
• What bedside investigation is required?

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Causes of hypokalemia
1. Decreased Potassium Intake
2. Increased Potassium Loss: Defined as
K<
Drugs (______, laxatives, steroids, 3.5mmol/L
aminoglycosides)
Renal causes/Dialysis
Endocrine: Conn’s/Cushings
3. Transcellular shift: _______ /glucose therapy,
salbutamol, theophylline
4. Magnesium depletion

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 Signs & Symptoms
(usually present if K < 2.5)
• Fatigue
• Neuromuscular disturbance: weakness,
hyporeflexia, cramps, rhabdomylysis, paralysis
• GI: constipation, ileus
• ECG changes: small or inverted T wave,
prominent U wave, depressed ST, prolonged PR
• Arrhythmias: 1st or 2nd degree heart block, AF,
VT, CF

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 Correction
• If ________ , replace Mg first
• Reduction of 1mmol/L serum K+ results in
200-400mmol potassium deficit
• Replacement should be guided by K
concentration: recheck level _____ hourly

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 Potassium Replacement
• Slow release K: 1 tab = 8 mmol
• 1g KCl usually dilute in 100cc NS (for
rapid correction over 1h ) -> can be
given up to 3g in cardiac arrhythmias in
divided doses
• Asymptomatic (< 2.5mmol/L without
ECG changes): around 40mmol/L
potassium (= 3g KCl) given over __ hours
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 Pop Quiz
• 48/M/Male
• K/C CKD, DM, HPT
• Admitted following uncontrolled BP
• Noted RP
Urea 20 mmol/L
Na 140 mmol/L
K 6.0 mmol/L
Chloride 110 mmol/L
Creatinine 600 umol/L
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• What immediate investigation will you
order?
• How are you going to tackle this?
• What are the possible causes for this?

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HYPERKALEMIA (K > 5.0)

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 Dr Smith’s ECG Blog

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Symptomatic Hyperkalemia

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 INSULIN COCKTAIL/LYTIC
COCKTAIL
In the prescription:
1. 10ml 10% ___________ slow bolus
over 2-10 minutes followed by
2. 50 gram of D50% IV push then
3. 10 unit of IV ________ or rapid
insulin

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 Additional options to remove
potassium from body
• Loop or thiazide _______ : ineffective in
advance CKD
• Cation exchange resin @ Oral kalimate 15g
3-4 times daily
• DIALYSIS

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