POTASSIUM IMBALANCES: CAUSES AND CLINICAL MANIFESTATIONS

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Causes of hyperkalemia

1. Excess potassium intake
2. Shift of potassium out of cells
3. Failure to eliminate potassium

Causes of shift of potassium out of cells

Acidosis
Tissue catabolism (e.g., fever, sepsis, burns)
Crush injury
Tumor lysis syndrome

Failure to Eliminate Potassium - causes

Renal disease
Potassium-sparing diuretics
Adrenal insufficiency
ACE inhibitors (This group of drugs causes dilation of blood vessels, which results in lower blood pressure.)

Manifestation of hyperkalemia

Irritability
Anxiety
Abdominal cramping, diarrhea
Weakness of lower extremities
Paresthesias
Irregular pulse
Ventricular fibrillation
Ventricular standstill
Cardiac arrest if hyperkalemia sudden or severe

Hypokalemia causes

1. potassium loss
2. Shift of potassium into cells
3. Lack of potassium intake

Potassium loss

GI losses: diarrhea, vomiting, fistulas, NG suction
Renal losses: diuretics, hyperaldosteronism, magnesium depletion
Skin losses: diaphoresis
Dialysis

Shift of Potassium Into Cells

Increased insulin (e.g., IV dextrose load)
Alkalosis
Tissue repair
↑ Epinephrine

Lack of Potassium Intake

Starvation
Diet low in potassium
Failure to include potassium in parenteral fluids if NPO

Manifestations of hypokalemia

Fatigue
Muscle weakness, leg cramps
Nausea, vomiting, paralytic ileus
Soft, flabby muscles
PARESTHESIAS, decreased reflexes
Weak, irregular pulse
Polyuria
Hyperglycemia
Ventricular dysrhythmias (e.g., PVCs)
Bradycardia

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