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Informatics in Pharmacy

Disorders of Potassium

August 12, 2018 By Dr. G, PharmD

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Potassium normal: 3.5-5.5

Hypokalemia:

  • Mild: 3.0-3.5, moderate: 2.5-3.0, severe=<2.5
  • Common causes: thiazide and loop diuretics, kidney injury, GI loss, sweating, burns, Beta blockers, insulin, sodium bicarbonate
  • Every 0.3 mEq decrease is a 100 mEq deficit
  • Symptoms start at < 3.0
  • Correct Mg too. It’s used in potassium transport.
  • Seen in EKG as U waves.

Hyperkalemia:

  • Arrhythmias when >6.5, peaked T-waves: 5.5-6.5, wide QRS: 6.5-7.5
  • Drugs that can cause: ACEI, ARB, Beta blockers, digoxin, triamterene, spironolactone, NSAIDs, renin inhibitors, succinylcholine.
  • Treatment:
    • If no EKG changes: insulin and D50.
    • EKG Changes: CaCl or CaGluconate and Insulin and D50 +/- albuterol (increases tachycardia). Calcium stabilizes the cardiac membrane. You don’t need it if not symptoms.
    • Bicarb is useful if acidotic.
    • Kayexeltae isn’t good for acute hyperkalemia, it only decreases K+ by 0.4-1 over 24 hours.
    • In digoxin toxicity, DO NOT GIVE CALCIUM (“stone heart” – but may not really be a risk, don’t give anyway).  Give digibind, and can give dextrose and insulin.

Filed Under: Fluid, Electrolytes, & Nutrition

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020