Fluid and Electrolytes Flashcards Preview

• Moderate hypokalemia (2.5-3.5) without EKG change
  • Usually replace orally at dose of 40-120 mEq/day
• <2.5 and or EKG change
  • Initiate IV replacement 
    • 1 mEq fall in serum K from 4-3 is a 200 mEq deficit
    • Serum K <3.0
      • Total body deficit increases by 200-400 mEq for each 1 mEq reduction in serum concentration 

• Increased K intake
  • Excessive intake
  • Blood transfusion
  • Rapid excessive IV admin
• Decreased K elimination
  • Renal failure
  • Medications (ACEs, Bactrim, spironolactone, NSAIDs)
  • Addisons disease decrease cortisol production
• K release from cells
  • Tissue breakdown (surgery, trauma, hemolysis, rhabdomyolysis)
  • Metabolic acidosis
• Pseudo-hyperkalemia
  • Hemolyzed blood samples

1.4-1.8

280-350 mg/day

• Diarrhea may be dose-limiting with oral therapy
• Replace more cautiously in those with renal dysfunction
• Hypokalemia must be corrected concomitantly
• Generally takes 3-5 days to restore levels because up to 50% of a dose is excreted in urine, monitor renal function, adjust replacement if needed

• IV calsium gluconate- temporarily reverses neuromuscular and cardiavascular effects
  • Indicated if [Mg] > 5.0 mEq/L with symptoms or if >8 without
  • 1-2 grams repeat if needed
• 0.9% NaCl + furosemide (good renal function) or hemodialysis (renal failure)
• D/C all Mg containing medications (MOM, Maalox) 

• Identified and treated rapidly
• cause of electrolyte disturbances is important to ensure continued insult is not occurring
• Based on pts serum electrolyte levels
  • Including rate of adminitration based on IV access