Hypokalemia

Question 1

How does hypokalemia typically present?

Answer 1

1. Muscle weakness
2. Paralysis
3. loss of reflexes

Question 3

Define Hypokalemia

Answer 3

Serum potassium<= 3.5 mmol/l

Question 4

List 4 features of severe hypokalemia

Answer 4

1. Rhabdomyolysis
2. Cardiac arrhythmias
3. Diaphragmatic weakness
4. Paralysis

Question 5

Name one physical exam finding of hypokalemia

Answer 5

Cardiac arrhythmias

Question 6

What are the two most common causes of hypokalemia

Answer 6

1.GI losses through diarrhoea/vomiting
2. Renal losses through hyperaldosteronism/diuretics

Question 7

State the treatment of chronic asymptomatic hypokalemia

Answer 7

Mainstays is to find and treat the cause
Symptomatic relief: KCl 600 mg 1-2 tablets 8 hourly

Question 8

How much KCL does each 600 mg tablet contain

Answer 8

8 mmol/l

Question 9

What is the maximum dose that should not be exceeded of KCL in management of hypokalemia

Answer 9

6 g daily

Review after 4 weeks

Question 10

Is giving routine supplements of KCl in someone.using diuretics appropriate?

Answer 10

Nope

Question 11

What medications are given in addition to furosemide/thiazines diuretics to prevent hypokalemia?

Answer 11

ACEi/Spironolactone

Question 12

What is the treatment of mild to moderate hypokalemia(serum K 3-3.4 mmol/L)

Answer 12

KCL 600 mg til concentration is above 3.5 mmol/l

Question 13

State the treatment for severe hypokalemia

Answer 13

KCl IV infusion by peripheral line, 40 mmol in 1 L of 0.9% or 0.45% sodium chloride, mixed thoroughly.

NOTE: Maximum allowed daily dose of K+ is 3 mmol/kg/day (or 400 mmol/day).

Question 14

What do you need to be aware of when administering KCl IV?

Answer 14

Volume overload

Question 15

Should KCl ampoules always be dilute before administration?

Answer 15

Yes, I mean always

Question 16

What electrolyte abnormalities causes Hypokalemia and should be looked for?

Answer 16

Hypomagnesemia

Question 17

What is the target goal when treating hypokalemia?

Answer 17

Serum potassium levels to be within normal range and symptoms resolve

Question 18

What should be avoided by people with hypokalemia?

Answer 18

Glucose drinks

Question 19

What is Bartter syndrome

Answer 19

Bartter syndrome is the inability of the loop of Henle to absorb sodium and chloride. It causes secondary hyperaldosteronism and renal potassium wasting

Question 20

Which fungal medication causes Hypokalemia?

Answer 20

Amphotericin B by causing renal tubular acidosis

Question 21

What is the best initial test for hypokalemia?

Answer 21

EKG: shows U.waves and flattening of T wave

Question 22

What does a U wave indicate on an EKG?

Answer 22

Purkinje repolarization and it is seen in Hypokalemia

Question 23

Should KCl IV infusion be administered fast/slow?

Answer 23

Slow to prevent arrhythmias

Question 25

List 3 referral criteria for hypokalemia to a physician

Answer 25

1. Persistent hypokalemia despite treatment 2. Condition causing hypokalemia cannot be managed in your facility 3. Investigations as part of the work up is not offered in your facility

Question 26

What to do if you are unsure about referring someone with hypokalemia?

Answer 26

Call the physician who is at your closest referral facility

Question 27

List 6 criteria that are part of the discharge criteria list

Answer 27

1. Hypokalemia is resolved meaning potassium is within normal ranges and symptoms have resolved 2. Underlying cause has been found and treated 3. Drugs causing/aggravating hypokalemia has been stopped 4. Advice on potassium containing foods 5. Appropriate outpatient follow up has been arranged 6. Consider oral K for patients who are at a very high risk of cardiac arrythmias

Question 28

List 8 food products that contain potassium

Answer 28

1. Bananas 2. Spinach 3. Dried fruit especially dried apricots 4. Avocados 5. White mushrooms 6. Broccoli 7. French fries 8. Orange juice

Question 29

Different kinds of potassium given to patients

Answer 29

1. Potassium chloride 2. Potassium bicarbonate 3. Potassium phosphate 4. Potassium citrate

Question 30

What is the daily dosage of potassium used for prevention of hypokalemia

Answer 30

20 mmol/L per day As compared to 40-100 mmol/l per day for treatment

Question 32

When to give magnesium in Hypokalemia?

Answer 32

1. When suspecting/have proven hypomagnesemia 2. Refractory hypokalemia

Question 33

How should high concentration of potassium chloride or rapid infusion be done?

Answer 33

Use central line and monitor the heart closely as it leads to arrhythmias

Question 34

List 5 key management steps of hypokalemia

Answer 34

1.Stabilise ABCs 2. Find the cause 3. Stop drugs that aggravate or cause hypokalemia 4. Correct hypovolemia with isotonic fluids 5. Parenteral potassium chloride

Question 35

Name two arrhythmias that arise as a complication of hypokalemia

Answer 35

1. Asystole 2. Pulse less electrical activity

Question 36

Name one common cause of pseudohypokalemia

Answer 36

1. Acute myeloid leukemia

Question 37

Name 5 drugs that cause hypokalemia through shifting the K into the cell.

Answer 37

1. Beta agonists 2. Insulin used in DKA and HHS protocol 3. Theophylline 4. Caffeine 5.Chloroquine

Question 38

How does CCF, nephrotic syndrome and hepatic insufficiency lead to hypokalemia?

Answer 38

Secondary hyperaldosteronism

Question 39

What is hypokalemic periodic paralysis?

Answer 39

State of recurrent muscle weakness attacks associated with low potassium

Question 40

List three rare causes of Hypokalemia

Answer 40

1.Liddle syndrome 2. Barter syndrome 3. Gitelman syndrome

Question 41

How does hypomagnesemia lead to hypokalemia?

Answer 41

Increased renalmlosses

Question 42

What is considered life threatening hypokalemia?

Answer 42

Potassium<=2.5 mmol/l

Question 43

What is the intracellular levels of potassium

Answer 43

140-155 mmol/l

Question 44

How much of potassium is extracellular?

Answer 44

2%