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