muscle weakness/cramps, nausea, vomiting, polyuria, EKG changes, cardiac arrhythmias, increased pH and bicarb levels
Signs and symptoms of hypokalemia
GI, renal (high aldosterone, low, Mg), inadequate intake of fluids, alkalosis, medications
What are the causes of hypokalemia?
diuretics, high dose antibiotics, corticosteroids, B2 agonists, insulin, aminoglycosides, amphotericin B, cisplatin, foscarnet
What medications cause K depletion?
diuretics, high dose antibiotics, corticosteroids, B2 agonists, insulin, aminoglycosides, amphotericin B, cisplatin, foscarnet all cause depletion of what electrolyte?
diuretics, high dose antibiotics, and corticosteroids
drugs that cause hypokalemia through renal potassium wasting
aminoglycosides, amphotericin B, cisplatin, foscarnet
drugs that cause hypokalemia secondary to Mg depletion
FALSE (use serum [K] and NOT a predetermined amount)
Potassium repletion should be guided by using a predetermined amount, rather than relying on serum [K]
anything but KCl (citrate, acetate, gluconate, or bicarbonate)
What potassium salt should be used in hypokalemia/acidosis?
KCl (except the effervescent tabs, which use KCl and Kbicarb)
What salt are oral K replacement products using?
acetate, Cl (usually saline solution; never concentrated potassium vials on patient units)
What salt are IV K replacement products using?
oral 40-120mEq daily
For moderate hypokalemia without EKG changes, what repletion strategy is indicated?
IV (replacement - usually 10-20mEq/hr of 40mEq/L conc. - max rate is 40, conc is 80)
For severe hypokalemia ( <2.5mEq/L) with or without EKG changes, what repletion strategy is indicated?
40 (mEq/hr - requires cardiac monitoring, when this fast)
What is the maximum infusion rate of potassium?
muscle weakness, parethesis(pins and needles), GI hypermotility, hypotension, EKG changes, decreased pH, increased potassium
What are the S/S of hyperkalemia?
increased intake, blood transfusions, rapid excessive IV administration, medications
What are the causes of hyperkalemia?
K supplements, K-sparing diuretics, ACE inhibitors, beta blockers, TMP/SMX, NSAIDs, digoxin, prograf, heparin, cyclosporin
What are medications that can cause hyperkalemia?
decreased excretion (renal failure, addison's disease - decreased ADH production), K release from cells (tissue breakdown - surgery, trauma, hemolysis and metabolic acidosis)
What are causes of hyperkalemia?
oppose cardiac effects (IV Ca), promote K movement to ICF (using dex/insulin/bicarb)
What are 2 basic treatment strategies of hyperkalemia?
dextrose, insulin, bicarb (Acute) or beta agonists (non-acute, e.g., albuterol)
What solution can be used to promote the intracellular movement of potassium?
Kayexalate (sodium polystyrene sulfonate), loop diuretics, hemodialysis (only in CRF patients)
What drug can be used to remove potassium ions from the body?
Kayexalate, treats hyperkalemia (by removing K from the body)
What medication acts by exchanging Na for K in the gut and what is it used for?
CaCl2 injection (1mg or 13.5mEq - direct or diluted in D5W)
Treatment for hyperkalemia that works in 1-2mins and lasts only 30mins
(give with) 20U insulin (over 1-2hrs .. starts working in 30mins and lasts 2-6 hours)
How do you give dextrose 10% to treat hyperkalemia?
CaCl IV, dextrose50, dextrose10 with insulin, sodium polystyrene
What are 4 standard treatment strategies for hyperkalemia?
colonic necrosis and other GI effects (esp. when used with sorbitol)
Kayexalate is associated with what risks?
Vitamin D, calcitonin, PTH (parathyroid hormone)
[CA] and [phos] are regulated by a complex interaction between what 3 molecules?
it accounts for a decrease in percent of protein binding due to a decrease in serum albumin conc.
What is corrected calcium?
tetany, hypoactive (slow) reflex, CNS depression, hypotension, (trousseau's- hand and chvostek's - jaw signs)
What are the S/S of hypocalcemia?
hypoparathyroidism (low PTH), hypomagnesemia (causes low PTH secretion), hyperphosphatemia, chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, hypoalbuminemia, Mg depletion
What are the causes of hypocalcemia?
loop diuretics, corticosteroids, phenytoin, cisplatin, forcarnet, PO4 replacement products, pentamidine, alpha-interferon
What medications might cause hypocalcemia?
hypocalcemic symptoms present (paresthesia, tetany, Chvostek's sign), low serum [Ca], massive blood transfusion (esp with cardiac history), Ca chan blocker overdose, emergent hyperkalemia, receiving inotropic or vasopressor support
When is IV calcium appropriate?
200-300mg elemental Ca IV (this means 1g of CaCl or 2-3g of Ca gluconate)
Treatment of acute symptomatic hypercalemia requires what?
30-60mg/min (ELEMENTAL CALCIUM - the salts will vary)
What is the maximum speed of elemental calcium?
oral calcium (supplementation of) 2-4g daily (of elemental calcium)
Treatment of chronic hypocalcemia requires what?
CNS depression, muscle weakness/pain, polyuria, kidney stone development, ECF depletion, heart failure, htn, constipation, increase digoxin toxicity
What are the signs and symptoms of hypercalcemia?
EKG (decreased QT interval), ventricular arrhythmias, htn, heart failure
Cardiac changes associated with hypercalcemia?
malignancy, hyperparathyroidism, thyrotoxicosis, TPN, immobilization, acidosis (decrease affinity of albumin for Ca - which causes more free calcium), milk, medications
What are the causes of hypercalcemia?
thiazide diuretics, estrogens and antiestrogens, lithium, vitamins A and D, calcium supplements
Which medications can cause hypercalcemia?
normal saline + furosemide (use only after ECF depletion is corrected, functioning kidneys necessary, monitoring K and Mg necessary)
Hypercalcemia treatment to enhance urinary calcium excretion
calcitonin, prostaglandin synthesis inhibitors, mithramycin, bisphosphonates, gallium, PTH antagonists
Hypercalcemia treatment to inhibit bone resorption