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Electrolyte: POTASSIUM (K+)Major Electrolyte (Cation) in ICF (Normal: 3.5 – 5.0 mEq/L)LOWCOMPARE & CONTRASTHIGHHYPOKALEMIATermsHYPERKALEMIASerum K+ level < 3.5 mEq/LResult of ↑ loss of K+ from body or movement of K+ into cells.DefinitionSerum K+ level > 5.0 mEq/LResult of ↑ intake of K+, movement of K+ out of cells, or inadequate renal excretion. Decreased total body potassiumAbnormal GI losses: vomiting, NG suctioning, diarrhea, inappropriate laxative useRenal losses: excessive use of diuretics (Lasix), large dose corticosteroids, hyperaldosteronism, high does Na+ PCNsSkin losses: diaphoresis, wound losses, traumaUncontrolled diabetesMeds: diuretics, laxatives, insulinInsufficient potassiumInadequate dietary intake (rare)TPN or IVF without K+ replacement (ex: D5W) CausesIncreased total body potassiumIV K+ administration Salt substitute High K+ intakeExtracellular shift ↓ insulin, acidosis (ex: diabetic ketoacidosis), tissue catabolism (sepsis, trauma, surgery, fever, MI), release of K+ from damaged cellsHypertonic statesUncontrolled diabetesDecreased excretionRenal failure (#1 cause), severe dehydration, potassium-sparing diuretics, ACE I, NSAIDs, adrenal insufficiencyAddison’s Disease, MedicationsFatigue, anorexia, N/V, ↓ bowel motility, muscle weakness & leg cramps, impaired glucose tolerance, paresthesias, impaired renal concentrating ability, diminished deep tendon reflexes, flaccid paralysis (late sign), ↑ sensitivity to digitalis, dysrhythmias, severe hypokalemia Cardiac: ↓ strength of contraction; myocardium irritability; ST segment depression; K+ < 2.7 mEq/L may result in PACs, PVCs, V-fib or cardiac arrest; K+ < 3.5 assoc. with met. alkalosis, high pH & high HCO3; Digoxin toxicity Signs & SymptomsCardiacRespiratoryNeurologicalGeneralMainly affects cardiac function, muscle weakness & paralysis, ventricular conduction slowed, paresthesia & irritability (resp. & speech muscles), flaccid muscular paralysis (legs-trunk-arms-including resp.), GI hyperactivity (N/V/D, colic)Cardiac:Slows heart rate, ECG changes (tall, peaked T wave, short QT interval; longer PR interval, widening QRS complex; risk for heart block, A-fib, or V-fib), Severe ↑K+ → decreased heart contraction strength, dilated & flaccid heart, bradycardia K+ deficit < 3.5 mEq/LK+ < 3.5 mEq/L often assoc. with metabolic alkalosis, high pH, & high HCO3K+ < 2.7 → dangerous dysrhythmias↑ pH & HCO3Lab & Diagnostic TestsSerum K+ > 5.0 mEq/LECG abnormalitiesABGs – low pH indicating metabolic acidosis K+ replacement (PO or IV)Increase on a daily basis – 40-80 mEq/dayAt risk pt. – 50-100 mEq/dayK+ rich foodsTreat underlying causeOral K+ Supplements Minimize GI irritation: dilute liquid & effervescent supplement, give tabs & capsules w/ 8 oz. water, give K+ with foodAdverse reaction – N/V, diarrhea, GI bleedAvoid overdose (hyperkal…)↓ K+ dose if using K+ salt substituteNot used w/ K+ sparing diureticsIntravenous K+ SupplementMust be dilutedDo NOT give by direct IVPMax. dose: 60 mEq at a timeMust use IV pumpMonitor renal outputCHS policy – pt. on heart monitorMonitor IV siteLR, NS (watch for S/S of fluid overload or pulmonary edema)*Serum Na+ must not be increased > 12 mEq/L in 24 hoursWater gain:Restrict H2O safer than giving Na (800ml/24hr)Hypertonic solution 3%-5% NaCLEdema only – restrict Na+Edema & Na+ – restrict both Loop diureticsTreatmentK+ restricted dietStop K+ containing medsMonitor for “Digitalis toxicity”Cation-exchange resins: Kayexalate PO or PR, 1 gm of resin removes 1 mEq K+ Dialysis – if conservative methods not sufficient Emergency Medical TreatmentCa++ Gluconate IV – does not ↓ K+ (keeps heart from getting flaccid), antagonizes K+ action on heart, monitor ECGHypertonic glucose & insulin – insulin facilitates K+ into cells; glucose ↑ insulin release from pancreas NaHCO3 (Sodium Bicarb) → K+ shifts into cells very quickly (reverses acidosis)Identify pt. at risk – esp. if on DigoxinMonitor ECG & BPMonitor serum K+Pt. education – diuretics & laxativesAdminister K+ supplements PO or IV↑ dietary K+Monitor urine output Nursing InterventionsBe aware at risk pt. (elderly)Monitor for: generalized weakness & dysrhythmias, irritability & GI symptoms, nausea & intestinal colic, ECG or lab abnormalitiesPrevention of hyperkalemiaEducate pt. – meds & dietDo NOT draw blood above K+ infusion sitePotassium Rich FoodsBananasApricotsOrangesCantaloupeBroccoliPotatoesCarrotsAvocadosDried fruitLegumesMeatsWhole grain breadDairy products Coffee/tea/cocoaHYPOKALEMIAS – skeletal muscle weaknessU – u-waveC – constipation or ileus T – toxicity of DigoxinI – irregular or weak pulse O – orthostatic hypotensionN – numbness or paresthesia 409448014605KEY POINTS:Potassium plays a vital role in cell metabolism, transmission of nerve impulses, functioning of cardiac, lung, and muscle tissues, and acid-base balancePotassium has a reciprocal action with sodiumMinor variations in potassium levels are significantImbalancesRenal system important in keeping balanced potassiumBody does not conserve potassium ................
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