↓↑Potassium (Hyperkalaemia and Hypokalaemia) | Armando Hasudungan 11/06/19, 11(07 AM

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↓↑Potassium (Hyperkalaemia and

Hypokalaemia)
Overview Potassium (K+) is an important ion in the body. K+ is found
mainly intracellularly (inside the cells) whereas sodium (Na+) is found
extracellularly (outside the cells). Therefore: Serum Potassium: 3.5mmol/L
– 5.0mmol/L Serum Sodium: Therefore: Hyperkalaemia: >5mmol/L
Hypokalaemia: <3.5mmol/L As the pH rises , K+ is shifted intracellularly
and the serum levels falls; conversely […]

Overview Potassium (K+) is an important ion in the body. K+ is found mainly intracellularly (inside the cells)
whereas sodium (Na+) is found extracellularly (outside the cells). Therefore:

Serum Potassium: 3.5mmol/L – 5.0mmol/L

Serum Sodium:

Therefore:

Hyperkalaemia: >5mmol/L
Hypokalaemia: <3.5mmol/L

As the pH rises , K+ is shifted intracellularly and the serum levels falls; conversely when serum pH
decreases, intracellular K+ shits extracellularly into the vascular space and so the serum level increases.
This is because H+ and K+ are both positive and it is important to have normal +ions levels in the serum to
maintain a gradient across the cell membrane to maintain the excitability of nerve and muscle cells,
including the myocardium.

Causes of Hyperkalaemia

Excessive intake

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↓↑Potassium (Hyperkalaemia and Hypokalaemia) | Armando Hasudungan 11/06/19, 11(07 AM

Increased production

Haemolysis
Rhabdomyolysis
Intense physical activity
Burns
Tumour lysis syndrome

Shift from intracellular to extracellular fluid

Acidosis
Insulin deficiency/resistance
Medications

β-blocker
Suxamethonium
Digoxin
Spironolactone

Hyperkalaemic periodic paralysis

Decreased excretion

Renal failure
Addison’s disease
Medications

Potassium sparing diuretics

ACE inhibitors
NSAIDs
Trimethoprim, cyclosporin, tacrolimus

Signs and symptoms

Non-specific
Generalised muscle weakness
Respiratory depression
Ascending paralysis
Palpitations, Arrhythmia, Cardiac arrest

ECG CHANGES:

Management – nonpharmacological

ECG
Assess

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↓↑Potassium (Hyperkalaemia and Hypokalaemia) | Armando Hasudungan 11/06/19, 11(07 AM

Reassess after pharmacological

Management – pharmacological

IV Frusemide (provided patient normal urine output)

IV Calcium Gluconate
Drive K+ into the cell

Insulin + Glucose
Salbutamol
Sodium bicarbonate – if acidotic

Monitor serum K+ every hour

Eliminate K+ from the body

Calcium Resonium (this is slow)

Dialysis (last line)

Pharmacology Calcium Gluconate is a myocardium stabiliser and is cardioprotective. Side effects:

Bradycardia, hypotension and peripheral vasodilation.

Pharmacology Calcium Resonium is a large insoluble molecule that binds to K+ in the large intestine,
where it is excreted in faeces. Side effects:

MANAGEMENT OF HYPERKALAEMIA

Mild Moderate Severe

Calcium Resonium IV Frusemide IV Frusemide

Calcium Resonium Calcium gluconate/Calcium chloride

Insulin + Dextrose/N.Saline Insulin + Dextrose/N.Saline

Salbutamol Salbutamol

Complications of Hyperkalaemia

Cardiac arrest
Weakness
Paraesthesiae
Decreased reflexes
Ascending paralysis

Hypokalaemia

Defined as potassium <3.5mmol’L

Signs and symptoms

Generalised muscle weakness

Respiratory depression
Ascending paralysis
Ileus, constipation
Palpitations, Arrhythmia, Cardiac arrest
Nephrogenic diabetes insipidus (characterised by polyuria and polydipsia)

Treatment

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↓↑Potassium (Hyperkalaemia and Hypokalaemia) | Armando Hasudungan 11/06/19, 11(07 AM

Chlorvescent – Given STAT

Slow K
KCl IV (10mmol in 100ml of normal saline)

ECG findings

Peaked P waves
T wave flattening and inversion

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