Kalemia Cindy Chung, Annel Garcia, Keaton Hambrecht, Carly Hoisington, Kirk Jones, Tiffany Le, Amy McCready, Jessica Medrala, Raquel Robayo-Krause, Jomay Ruiz, Jodi Schwartz, Anh Thi

Serum Potassium Levels ●Normal: mEq/ L ●Abnormal: 6.5 mEq/ L

Common Causes of Hyperkalemia ● Increased K+ intake ● Shifts of K+ from ICF → ECF ● Decreased renal excretion ● Insulin deficiency ● Cell Trauma ● Addison’s disease ○ Decreased production and secretion of aldosterone ○ Impaired K+ excretion by kidneys

Clinical Manifestations of Hyperkalemia ● Muscle cramping followed by weakness ○ skeletal muscle ○ respiratory muscles ○ GI upset (cramping, diarrhea) ● Cardiac dysrhythmia ○ Decreased depolarization ■ Flattened P wave, widened QRS ○ Increased repolarization time- ■ Shortened QT interval ○ RISK OF V-FIB

How to Correct Hyperkalemia ● Decrease potassium intake ● dialysis if patient is in renal failure ● Increase fluid intake ● Medications: insulin forces K+ out of extracellular space into intracellular space. Kayexalate: helps excrete potassium through feces. ● Treat underlying diseases like Addison's disease and hypoaldosteronism with corticosteroids.

Hyperkalemia: Nursing Implications and Patient Teaching ● Monitor/Educate about low potassium diet: Avoid: high K+ foods - potatoes, bananas, carrots, orange juice, and V8 Enjoy: low K+ foods - most bread, most cheese, and cranberry juice ● Monitor ECG and Vital signs ● Check for signs of muscle weakness. ● Administer adequate amount of insulin. ● If lab value doesn’t seem right (lysed RBCs), redraw. ● Talk to your PCP about stopping potassium supplements and K+ sparing diuretics like spironolactone

Common Causes of Hypokalemia ● Deficient intake of potassium ● Increased entry of potassium into cells so less is available in the bloodstream ● Black licorice ingestion/ toxicity ● Increased excretion of potassium from the kidneys ○ Burns ○ Metabolic alkalosis ○ Hyperaldosteronism ○ Cushing’s Syndrome

Clinical Manifestations of Hypokalemia Common Manifestations: Other: EKG Changes SHALLOW T-wave PROMINENT U-wave ST DEPRESSION *Manifestations depend on RATE and SEVERITY

How to correct Hypokalemia ● Estimation of total body potassium loss ● Correction of acid-base imbalances ● Monitor Kidney Function (secretes K+) ● Encouragement of K+ rich foods ○ Bananas, potatoes, V8, orange juice ● Max PO ○ mEq/day ● Max IV rate ○ 20 mEq/hr. ○ IV K+ is irritating (phlebitis) ● Monitor serum K+ until normokalemia is achieved

Hypokalemia: Nursing Implications ● Monitor for signs and symptoms of hypokalemia ● Monitor ECG continuously ● Strict monitoring of intake and output ● Monitor vital signs especially BP and venous pressure ● Observe for dehydration ● Observe for neuromuscular changes such as fatigue and muscle weakness