Hypokalemia

HYPOKALEMIA

1. HYPOKALEMIA

2. Hypokalemia is a serum potassium level of less than 3.5mEq/L, it is common electrolyte disorder. CAUSES:- Gastrointestinal losses:- Vomitting , diarrhea , nasogastric suctioning, intestinal fistula, laxative abuse, excessive tap water, enemas. Dietary changes:- Malnutrition, starvation, potassium free diet, some weight reduction

3. diets, potassium free intravenous solutions, when there is no dietary intake. Medications:- Potassium wasting diuretics ( thiazide , loop of Henle and osmotic steroids, cortisone preperations ), large amounts of licorice ( aldosterone like effect), gentamycin , amphoterecin B, digitalis preperations and beta adrenergic promote potassium loss. Redistribution of potassium:- Insulin moves

4. glucose and potassium back into cells, potassium loss from osmotic diuresis , in diabetic acidosis, alkalosis causes potassium to shift into cells in exchange for hydrogen ion. Disorders:- Cushing’s syndrome, diuretic phase of acute renal failure, alcoholism, hyperaldosteronism .

5. RISK FACTORS- Elderly and young Patients taking potassium wasting diuretics Severe tissue injury. PATHOPHYSIOLOGY:- Serum potassium level decreases ↓ Increased potassium gradient between cell and plasma

6. ↓ Reduced excitability ↓ Slowed muscular contractions ↓ Respiratory movement and ventilation is slowed ↓ Slow and thready pulse

7. CLINICAL MANIFESTATIONS:- GI:- Anorexia, vomitting , diarrhea , ileus distension. Musculoskeletal:- Muscle weakness, paralysis, leg cramps, muscle flabbiness. Cardiovascular:- Dysrrhythmia , vertigo, postural hypotension, flattened T wave, prominent U wave, slow weak pulse. Respiratory:- Shallow respirations, shortness of breathe.

8. Neurologic:- Fatigue, lethargy, decreased tendon reflexes, confusion, depression. Renal:- Polyuria , decreased reum osmolality , nocturia . PATHOPHYSIOLOGIC BASIS:- Smooth muscle contraction slowed. Slowed smooth muscle and skeletal muscle contraction. Increase in cell excitability, prolongation

9. of myocardial replarization . Dysrrythmias are more pronounced when the client is taking digitalis preperation . Weakness of respiratory muscles due to decrease in muscular contractions. Decreased transmission and conduction of nerve impulses. Inhibition of kidney’s ability to concentrate urine.

10. LABORATORY FINDINGS:- Serum potassium<35mEq/L- Hypokalemia . Serum Osmolality <275mOsm/Kg- Polyuria . which leads to loss of body potassium and other solutes. MEDICAL MANGEMENT:- Extreme hypokalemia require cardiac monitoring.

11. PHARMACOLOGIC MANAGEMENT:- Oral potassium replacement therapy is prescribed for mild hypokalemia (serum potassium 3.3-3.5mEq/L). Oral potassium chloride or potassium gluconate is available in liquid or tablet form. Potassium is extremely irritating to gastric mucosa, therefore the drug must be taken with one half to one glass of water or juice or during meals.

12. Potassium chloride can be administered IV for moderate or severe hypokalemia . (Potassium is not given IM and never given as a bolus (Intravenous push) injection. Potassium given IV, must always be dilutes in intravenous fluids. Administration of potassium by IV push may result in cardiac arrest. Potassium can be given in doses of 10-20 mEq /hour diluted in intravenous fluids

13. for patients with mild or moderate hypokalemia . Patients with severe hypokalemia . Patients with severe hypokalemia need 40-80 mEq in liter of fluid. High conc of potassium are extremely irritating to the heart muscle. Thus correcting a potassium deficit may take several days. For patients who are NPO, usually after surgery or because of intestinal

14. problems that prevent eating, a maintainence dose of potassium is reuired . A common dose is 40 mEq /day in IV solution. DIETARY MANAGEMENT:- The administration of foods that are high in potassium losses. The adult recommended allowance of potassium is 1875 to 5625 mg. SOURCES OF POTASSIUM IN FOODS:- VEGETABLES:-

15. Cabbage, carrots, cucumber, mushrooms. FRUITS:- Apple, apple juice, blueberries. NURSING MANAGEMENT:- ASSESSMENT:- Evaluate about inadequate dietary intake of potassium and potassium losses due to vomitting , diarrhea and drugs. ( eg - diuretics, cortisone).

16. Assess for serum potassium level, cardiac, gastrointestinal and neuromuscular changes. Assess patients who are on NPO without intravenous potassium supplements, or have renal disease. Nursing diagnosis:- Hypokalemia related to vomitting , diarrhea , Cushing syndrome, Cortisone therapy or decreased intake.

17. Planning :- Patient should return to serum potassium level to normal range, absence of complications related to intravenous administration of potassium chloride and absence of signs and symptoms of cardiac and neuromuscular changes associated with hypokalemia . Implementation:- - Administer IV potassium chloride for

18. maintaining potassium balance and correcting potassium deficit. IV KCl must be diluted in IV fluids, it cannot be given as IV push. A large loading dose of potassium can cause cardiac arrest, thus IV solution bags should always be agitated before being hung. The usual dose of IV potassium is 20-40 mEq in liter of IV solution. Intravenous potassium is irritating to veins and can cause

19. phlebitis, thus the rate of flow must be carefully monitored. IV fluids with potassium chloride are usually delievered by a controlled infusion pump to assist with maintainence of the correct intravenous flow rate. Serum potassium levels should be closely monitored by the nurse. If the serum potassium level is less than 3mEq/L, the potassium deficit will take longer to correct potassium. Care should also be taken that

20. continuous correction does not cause hyperkalemia . The nurse should continue to assess for signs and symptoms of potassium deficit. Neuromuscular changes are more pronounced with moderate and severe hypokalemia . Renal function should also be assessed. The nurse should monitor bowel function because constipation may be a problem. Patients with digitalis derivatives

21. are at risk for digitalis toxicity if they are hypokalemic . The nurse should assess apical pulses for dysrrythmias . Nursing diagnosis:- Risk of injury related to muscle weakness and hypotension. Planning:- The patient will remain free of injury, as evidenced by no falls or near falls. Implementation:- The nurse must employ safely measures to reduce the risk of injury. The

22. bed must be kept in low position with side rails up. Before the patient ambulates, the path should be cleared of obstacles and the patient should be cleared of obstacles and the patient should wear shoes to prevent slipping. An ambulation belt should be worn by the patient and used by the nurse. Restraints should be used as needed to prevent harm.

23. Nursing diagnosis:- Nutrition less than body requirement, related to insufficient intake of foods rich in potassium. Planning:- Patient will increase dietary intake to correct hypokalemia , as evidenced by selection of a diet. Consisting of potassium rich foods such as bananas, cantaloupe and nuts, containing 1875 to 5625 mg of potassium each day, consumption of oral

24. potassium supplements as prescibed to prevent potassium deficit, and an absence of signs and symptoms of hypokalemia . Implementation:- The nurse should instruct the patient to choose and consume foods rich in potassium, such as fruits, fruit juices, dried fruits, vegetables including potatoes (potato skins are very rich in potassium than others, bananas, cantaloupe and honey dew melons

25. have twice as much as potassium as oranges do. Meats and milk have a moderate amount of potassium. If patient is taking a liquid or tablet potassium supplement, the patient should be instructed to take the potassium in or with atleast one-half glass or more water or juice.. Evaluation:- The nurse evaluates whether the expected

26. outcomes have been met, the serum potassium level is within normal range the patient is free of signs and symptoms of hypokalemia , and a patient did not suffer from any preventable adverse effects of potassium therapy. A revision of the plan of care may be required if outcomes are not met.

27. Patient education:- Provide food rich in potassium. Prolonged cooking of vegetables may result in potassium and vitamin loss. These foods should be steamed or cooked quickly.

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