In and Out of Potassium - Dr Satish Deopujari
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Transcript of In and Out of Potassium - Dr Satish Deopujari
1 mL/kg of 3% sodium chloride raises the serum sodium by 1.6 mEq.
In and out of potassium
Dr deopujari
In and out of potassium Is no OUTDOOR BUISNESS ?
Miss Munira
Urinary potassium is for the most part secretory potassium. Distal potassium secretion is regulated by the amount of sodium in the the distal and collecting tubules, and the aldosterone activity. Serum potassium in itself is an important factor in the regulation of aldosterone activity.
98 % 2 %
98 % 2 %
CausesHyperkalemia
K+
Causes of spurious Hyperkalemia
Fist clenching during blood withdrawal Hemolysis High platelet count : more than 1 × 106/mm3 leukocytosis : more than 2 × 106/mm3
Abnormal potassium permeability of erythrocytes Infectious mononucleosis Cold agglutinins
Clinical features…………….
138
Hyperkalemia and ECG
The earliest ECG manifestation of Hyperkalemia is peaked or tented T waves.
Serum potassium and ECG5.5 to 6.5 peaking of T waves6.5 to 7.5 QRS widening7.5 to 8.5 decrease in P wave and increase in PR interval8.5 and more Sine wave , and V.F,Asystole
True Hyperkalemia
Excess K+ intake
Redistribution
Decreased excretion
Renal failureOliguriaHypoaldo.NsaidsAce inhibitors
AcidosisDiabetes.Adrenal Ins.Periodic P.
98 %
2 %
Calcium chloride: 0.2 mL /kg/dose of 10% sol IV over 5 min; not to exceed 5 mL (stop infusion if bradycardia develops)Calcium gluconate: 100 mg/kg (1 mL/kg) of 10% sol IV over 5 min; not to exceed 10 mL (stop infusion if bradycardia develops)
Soda bi carb …( with acidosis )
2 ml / kg 25 % dextrose with .1 units /kg insulin .over 30 minutes (1 U regular insulin/5 g glucose )
Beta agonists
Hyperkalemia
Drug Dose Onset of action
Duration
Calcium gluconate (10%)
1-2 ml/Kg IV 1-3 min. 20-30 min.
Sodium bicarbonate (7.5%)
1-2 ml/Kg IV 5-20 min. 1-2 hours
Insulin - glucose
0.1 U/Kg of insulin & 0.5-1.0 g/Kg of glucose
20-30 min. 2 hours
Salbutamol
4 i:micro g/Kg IV over 15-20 minutes5 - 10 mg via inhalation
30 min. 4-6 hours
potassium exchange resins
Hemodialysis
Hypokalemia…
Causes…………..
Hypokalemia true Distribution
Increased loss Urinary K + Decreased
Hypertension Normal B.P.
Acidosis Alkalosis
Renin
G.I.lossBiliary ETC.
88
Hypokalemia and ECG..
I . V . Kesol should be considered for Significant arrhythmia Sever muscle weakness Severe hypokalemia (< 2.5.0 mEq. / L). Digoxin toxicity Hepatic encephalopathy Maximum concentrations of KCl used in peripheral veins generally should not exceed 4 meq. /100 cc due to the damaging effects on the veins , at a rate of 1 mEq/kg per hour.
If serum [K+ ] level does not appreciably rise by 48 hours, concomitant magnesium depletion should be suspected
3 months female weighing 2.3 kg with persistent diarrhea .Serum potassium 2.3 and not rising in spite of good Potassium replacement.Cause ?
Potassium should be administered slowly,
preferably Orally, at a dosage of 4 to 6 mEq/kg per day.
Human milk contains small amounts of K+ , about (12.8 mEq) per liter, whereas cow's milk contains almost three times.
SERUM K 5
INCREASE POTASSIUMNORMAL POTASSIUMDECREASE POTASSIUM
CNANGE IN PH AND POTASSIUM
7.4
TOTALBODYPOTA.
HIONS
K
ACIDOSIS CAUSESHYPERKALEMIA
ALKALOSIS ……… LOW K+
THANKS