Archive for the ‘electrolytes’ Category

  I recently assisted in the management of a patient who presented in DKA with critical acidosis and hypokalemia. This presents a variety of therapeutic challenges: what to do about insulin, which treats the acidemia but worsens the hypokalemia? How can I safely supplement potassium as aggressively as possible? In contrast to the previously-posted recommendations from Micromedex, a protocol from the Bon Secours system in Richmond, VA presents the most clinically useful summary we have come across. ___ *If potassium < 3 meq/liter and the patient is symptomatic 40 meq/hour may be administered to intensive care patients. Hourly serum potassium determinations should be drawn to avoid severe hyperkalemia and/or cardiac arrest. Symptoms of hypokalemia include: fatigue, malaise, generalized muscle weakness, respiratory failure, paralysis; EKG changes include T wave flattening or inversion, U waves, or ST segment depression, and arrhythmia’s. Recommended maximum dose should not usually exceed 10 meq/hour or 200 meq for a 24 hour period if the serum potassium level is greater than 2.5 meq/liter per product package insert ___ Additionally, there is literature‚Ć to support providing a baseline rate of 40 mEq/hr (through a central line) with hourly supplementation using “runs” of up to 40 mEq (through a central line). Patients having their potassium replaced this aggressively should be on a monitor and have hourly electrolyte checks. Regarding the benefit/drawback of using insulin in DKA patients, the ADA strongly recommends withholding insulin when K < 3.3. If you want to disregard this recommendation, which I do (seems overly cautious), remember you can slow…

1370. Hyperphosphatemia causes, s/sx, Rx

November 17th, 2009
by reuben in electrolytes

1363. Treatment of hyperkalemia

November 15th, 2009
by reuben in electrolytes

1362. Causes of hyperkalemia

November 15th, 2009
by reuben in electrolytes