Checklist Approach to Hypokalemia
Consider risk factors for arrhythmia:
- EKG changes (especially QT prolongation)
- Myocardial ischemia
- Concomitant severe hy pomagnesemia
- Check magnesium lev el
- Repeat electrolytes if doubt exists about their validity (e.g. incongruous with clinical context & EKG)
Consider magnesium repletion
- May be the fastest way to reduce the risk of arrhythrnia (aggressive magnesium can be given safely, whereas potassium needs to be given at a controlled rate).
- Repletion Of Mg is often necessary to successfully replete the potassium.
Consider target potassium level
- Most patients (including cardiac patients): > 3.5
- Severe renal failure: > 3 mM ?
- DKA: >5.3mM ?
Enteral potassium is preferred if possible
- Contraindications to enteral route = severe hypokalemia (<2.5 mM), NPO, or profound shock with questionable enteral absorption.
- Dose & monitoring depend on renal function & estimated potassiurn deficit.
- Use only if cmtraindication to enteral.
- Rate of 10 mEq/hr for routine repletion.
- Rate of 20 mEq/hr for severe hypokalemia or DKA (either via central line or split into two simultaneous infusions of 10 mEq/hr in two peripheral lines).
- Dose & frequency Of monitoring depend on renal function & estimated deficit.
Dr. Josh Farkas @pulmcrit - Internet Book of Critical Care
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