Potassium Levels: A Guide PDF

Potassium (3.5-5.0 mEq/L) Intracellular cation responsible Intake: diet for: Output: kidney excretion or Muscle contraction reabsorption Cardiac muscle contraction Nerve impulses Regula...

Potassium (3.5-5.0 mEq/L) Intracellular cation responsible Intake: diet for: Output: kidney excretion or Muscle contraction reabsorption Cardiac muscle contraction Nerve impulses Regulation of acid-base balance If kidneys are happy, we can excrete potassium Kidney function – essential for potassium balance Value you would look at to see if someone is having renal failure – POTASSIUM ****Potassium is intracellular – not as affected by changes in fluid volume like sodium is (sodium is extracellular) Magnesium isn’t affected by fluid volume too When wounds leak – lots of electrolyte loss If someone has a lot of vomiting – potassium is going to be dropped 20  Etiology Hypokalemia 5.0 mEq/L Excessive intake Deficient intake Kidney failure Loss of body fluids Tissue/crush injury Medications Hypomagnesemia Diuretics can cause hypokalemia; can cause hyponatremia but very significant for potassium Insulin can make potassium drop; it pushes potassium into cells which reflects as a drop in serum potassium labs ***potassium needs magnesium; if magnesium is low potassium isn’t properly absorbed Magnesium doesn’t really need potassium, but potassium needs magnesium (one-sided friendship) low potassium typically doesn’t affect magnesium levels Hyper Too much intake Kidney failure leads to increased potassium level Tissue/crush injuries from trauma cause potassium to be released from cells 21  Renal disease requires close monitoring of diet and to avoid high potassium foods Professor Jones noticed a lot of people came in during holidays for renal issues bc a lot of the holiday foods have potassium Salt substitute – potassium is considered one bc it tastes like salt 22 Signs and Symptoms Hypokalemia 5.0 mEq/L Cardiac: dysrhythmias / Cardiac: dysrhythmias / bradycardia tachyarrhythmias CNS: irritability and anxiety CNS: lethargy and confusion Muscular: twitching, progresses to Muscular: weakness, paralysis, weakness, paralysis shallow respirations GI: diarrhea, increased bowel sounds GI: nausea, vomiting, constipation, paralytic ileus If someone is hypokalemic – a lot of things slow down (CNS, Not enough potassium leads to paralytic ileus (peristalsis is unable to work and move bowels) Muscles get weak tachyarrhythmias Hyperkalemia Irritability, anxious Muscle twitching, can progress to paralysis GI increased bowel sounds Bradycardia – nerve impulses in the muscles are different than cardiac muscles 23  Treatment Hypokalemia 5.0 mEq/L Correct cause Correct cause Potassium replacement Diuretics/ dialysis Nutritional therapy Sodium polystyrene sulfonate Cardiac and respiratory monitoring (Kayexalate) Insulin / glucose Nutritional therapy Cardiac monitoring Tablets will help bring back up potassium or IV solution Very common treatment and protocol If protocol is in place, you can use it if the situation is necessary instead of constantly contacting doc If intense nausea, vomiting – work to correct this specific issue too Nutritional therapy – use Lexicomp to find high potassium diets or low potassium diets Tachyarrhymias and shallow breathing is seen with this Hyperkalemia Dialysis is need for high potassium values, usu. for patients already on dialysis Diuretics – loop of Henle has highest amount of potassium Kayexalate – binds with potassium in the bowels and allows passing of potassium in bowels Insulin – pushes potassium into cells; insulin works quickly to push insulin into cell 26  If we’re giving potassium we also give glucose to keep blood sugar from dropping too low Cardiac monitoring is needed  Giving Intravenous Potassium Give carefully! Hyperkalemia can cause fatal cardiac dysrhythmias. NEVER give IV push. Give slowly, no faster than 10mEq/hr. ALWAYS use a pump. Can be irritating to the veins. Deadly if not done properly Never, EVER give potassium without an IV pump Lethal injection – uses potassium Never give faster than 10 mEq/hr You can flow it slower than 10 mEq/hour tho, some providers want that bc it’s so irritating 25  Protocol Pointers Don’t memorize. Do get familiar with them! Are there contraindications for using the protocol (weight, Cr)? Is the patient NPO or unable to take PO medications? Read the question! Read the protocol. Take your time. Protocol – order set ordered by physician Never memorized, is subject to change so ALWAYS check protocol first (5 rights) **protocols will always be given during exams, don’t memorize SSC ones either You should be familiar with the protocol and not confused by it Contraindications for protocol Is there potential for us to overtreat potassium with said protocol? If yes – may need low dose potassium protocol Monitor creatinine Is pt NPO? Always give PO w snack since it’s very ***for testing: read the QUESTION and protocol; extra 15 minutes given for tests with those 26  DO NOT memorize Many hospitalized pts are at risk for cardiac dysfunction Some cardiac patients will have greater than 3.9 PO potassium is absorbed better and more comfortably Do not crush or chew tablet – due to med being extended release and is not meant to be consumed all at once If level is critically low – check it more soon If level is 3.5 – check it 4 hours after last potassium dose DO NOT use IF: 30  Creatinine more than 2 w normal body weight Pt with normal creatinine and weight less than 40 kg  DO NOT use if wording isn’t on this bc it’s the lowest protocol 28  Physician will typically provide both protocols and RN will decide which one is best If max rate is 10 mEq/100 mL; we can’t run the IV any faster than that For lines that say call MD in addition to instructions given, do the med instructions first then call (or having someone else call) 29