L6: Potassium Disorders Flashcards
(89 cards)
1
Q
Levels of K
A
2
Q
High Intracellular concentration of K+ is necessary for several cellular functions.
A
…
3
Q
Routes for K+ excretion
A
Routes for K+ excretion are:
- The KIDNEY (primary route).
- The colon.
4
Q
Renal Handling of Potassium
A
Renal handling of K+ involves
① Filtration
② Reabsorption
③ Secretion.
5
Q
Renal Handling of Potassium
- Filtration
A
K+ is freely filtered at the glomerulus.
6
Q
Renal Handling of Potassium
- Reabsorbtion
A
7
Q
Renal Handling of Potassium
- Secretion
A
8
Q
Factors affecting K Execretion
A
9
Q
Renal Handling of Potassium
- Intake
A
10
Q
Renal Handling of Potassium
- hormones
A
11
Q
Renal Handling of Potassium
- Acid-Base Balance
A
12
Q
Renal Handling of Potassium
- Anions
A
13
Q
Renal Handling of Potassium
- Diuretics
A
14
Q
Def of Hypokalemia
A
Serum potassium level < 3.5 mEq/L.
15
Q
Psedo-Hypokalemia
A
- Hypokalemia is the result of K+ uptake by white blood cells when the sample is stored at room temperature. WBC (>75 x 109/L) as in AML (acute myeloid leukemia).
16
Q
Etiology of Hypokalemia
A
17
Q
Etiology of Hypokalemia
- Insufficient Intake
A
18
Q
Etiology of Hypokalemia
- Intracellular Shift
A
19
Q
Def of Hypokalemic periodic paralysis
A
- A rare inherited disorder characterized by episodes of muscle weakness in one or more limbs accompanied by low serum K+ levels
20
Q
Types of Hypokalemic periodic paralysis
A
① Familial Periodic Paralysis
② Thyrotoxic Periodic Paralysis.
21
Q
Etiology of Hypokalemic periodic paralysis
A
- Autosomal dominant inheritance
- spontaneous mutations
22
Q
Potential triggers of Hypokalemic periodic paralysis
A
- Physical activity
- Night rest
- High carbohydrate diet
- Alcohol intake
23
Q
Etiology of Hypokalemia
- Renal Loss
A
24
Q
Etiology of Hypokalemia
- Renal Loss (Drugs)
A
① Diuretics (thiazides - loop diuretics - osmotic diuretics).
② Beta-2 adrenergic agonists.
③ Glucocorticoids.
④ Catecholamines
25
Etiology of **Hypokalemia** D2 Renal Loss
- Hypokalemic Disorders
26
Etiology of **Hypokalemia** D2 Renal Loss
- Hypokalemic Disorders (Hypertensive)
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Etiology of **Hypokalemia** D2 Renal Loss
- Hypokalemic Disorders (Hypotensive)
28
Etiology of **Hypokalemia**
- Non-Renal Loss
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Most common causes of hypokalemia
① Losses caused by diuretics
② Gastrointestinal disorders.
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CP of **Hypokalemia**
31
CP of **Hypokalemia**
- manifestations of the cause
E.g., Cushing’s syndrome.
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CP of **Hypokalemia**
- Manifestations of Hypokalemia
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CP of **Hypokalemia**
- Neuromuscular
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CP of **Hypokalemia**
- CVS
① Arrhythmias
② Abnormal contractility
③ Potentiation of digitalis toxicity
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CP of **Hypokalemia**
- metabolic
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CP of **Hypokalemia**
- Renal
① Nephrogenic diabetes insipidus
② Chronic tubulointerstitial nephritis.
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Dx of **Hypokalemia**
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Dx of **Hypokalemia**
- Serum Potassium Level
Serum K+ <3.5 mEq/l means hypokalemia.
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Dx of **Hypokalemia**
- ECG
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Dx of **Hypokalemia**
- Determine Cause
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Dx of **Hypokalemia**
- Algorithm
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Algorithm for Dx of **Hypokalemia**
- Urine K
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Algorithm for Dx of **Hypokalemia**
- After Checking BP
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Algorithm for Dx of **Hypokalemia**
- Normal BP with decreased HCO3
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Algorithm for Dx of **Hypokalemia**
- Normal BP with Increased HCO3
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Algorithm for Dx of **Hypokalemia**
- Increased BP with Increased Renin & Increased aldosterone
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Algorithm for Dx of **Hypokalemia**
- Increased BP with Decreased Renin & Increased aldosterone
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Algorithm for Dx of **Hypokalemia**
- Increased BP with decreased Renin & decreased aldosterone
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TTT of **Hypokalemia**
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TTT of **Hypokalemia**
- repletion of K
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Repletion of K in **Hypokalemia**
- Mild
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Repletion of K in **Hypokalemia**
- Moderate
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Repletion of K in **Hypokalemia**
- Severe
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High concentrations of IV potassium can cause local venous irritation and potentially lead to cardiac arrhythmias.
...
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TTT of **Hypokalemia**
- TTT Cause
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Def of **Hyperkalemia**
Serum K+ >5.5 mEq/L.
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**Pseudo-Hyperkalemia**
Cells release K+ in vitro due to:
- Thrombocytosis
- Severe leukocytosis
- RBCs hemolysis (e.g., trauma from tourniquet application).
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Etiology of **Hyperkalemia**
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Etiology of **Hyperkalemia**
- high Intake
① Diet - Supplements.
② K+ containing salt substitutes.
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Etiology of **Hyperkalemia**
- Transcellualr Shift of K+
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Etiology of **Hyperkalemia**
- Impaired Renal Excretion
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**Hyperkalemia** D2 Impaired Renal Excretion
- primary Renal Disease
◈ Acute kidney injury (especially severe oliguric AKI)
◈ Advanced CKD.
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**Hyperkalemia** D2 Impaired Renal Excretion
- Hyperkalemic renal tubular acidosis (RTA)
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**Hyperkalemia** D2 RTA
- Decreased aldosterone secretion
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**Hyperkalemia** D2 RTA
- decreased aldosterone responsivness
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CP of **Hyperkalemia**
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CP of **Hyperkalemia**
- Asymptomatic
...
68
CP of **Hyperkalemia**
- symptomatic
69
CP of **Hyperkalemia**
- Neuromuscular
70
CP of **Hyperkalemia**
- Cardiac
- Arrhythmias (e.g., heart block - ventricular fibrillation).
- Palpitations.
71
CP of **Hyperkalemia**
- Metabolic
Metabolic acidosis (non-anion gap).
72
CP of **Hyperkalemia**
- GIT
Nausea or vomiting.
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Dx of **Hyperkalemia**
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Dx of **Hyperkalemia**
- Serum Potassium Level
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Dx of **Hyperkalemia**
- ECG
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Dx of **Hyperkalemia**
- Earliest Sign in ECG
Peaked T Wave
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Dx of **Hyperkalemia**
- Changes in waves/intervals/segments
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Dx of **Hyperkalemia**
- Arrhythmias
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- There is a weak correlation between serum K+ levels & the severity of ECG changes.
- Findings are more likely to occur with rapid-onset hyperkalemia.
...
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Dx of **Hyperkalemia**
- Investigations of the cause
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Dx of **Hyperkalemia**
- ABG
Blood gases often shows metabolic acidosis.
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TTT of **Hyperkalemia**
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TTT of **Hyperkalemia**
- COUNTERACTING MEMBRANE EFFECTS OF HYPERKALEMIA
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TTT of **Hyperkalemia**
- PROMOTING CELLULAR UPTAKE OF K+
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TTT of **Hyperkalemia**
- OTHER MEASURES
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TTT of **Hyperkalemia**
- Remove K from Body
① Potassium-lowering resins (potassium binders) or
② Loop diuretics or
③ Dialysis (to remove K+ rapidly in patients with kidney impairment).
87
TTT of **Hyperkalemia**
- Medications & supplements review
① Discontinue or modify dosing of medications that may be contributing to hyperkalemia.
② Stop K+ containing salt substitutes & K+ supplements.
88
TTT of **Hyperkalemia**
- Diet
Low K+ diet.
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TTT of **Hyperkalemia**
- Follow up
Repeat potassium regularly until it is within normal range.
