Dave Porter presented on hyperkalemia and hypokalemia. Hyperkalemia is caused by conditions like kidney disease or medications and can lead to arrhythmias. Treatment depends on severity but may include calcium gluconate, insulin, or sodium bicarbonate. Hypokalemia is more common and can be caused by vomiting, diarrhea, or medications. It often has no symptoms but severe cases can cause heart problems. Treatment involves replacing potassium orally or intravenously depending on the situation. Both conditions need to be treated to keep potassium levels between 3.5-5.0 mEq/L.

1. A brief presentation by Dave Porter
Pharm.D Candidate, Class of 2015
Albany College of Pharmacy and
Health Sciences

2. Background
Hyperkalemia
 Causes
 Complications
 Treatment
Hypokalemia
 Causes
 Complications
 Treatment
Conclusions
Q&A

3. Most abundant cation in the body
 75% in skeletal muscle; 25% in liver and RBCs
Involved in action potentials
 Determinant of resting membrane potential
 Intracellular ion (98% of 3000-4000mEq total)
Concentrations maintained by Na+/K+
ATPase
 Pumps 3 K+ ions in for every 2 Na+ ions out
Normal [K+] = 3.5-5.0mEq/L

4.  Stage 4-5 or dialysis patients and potassium
restricted diet noncompliance
 Too much fruit and vegetables
 Salt substitutes with KCl  ~200mEq per tablespoon
 CKD and AKI
 Kidneys excrete 80% of daily K+ intake normally
 Drug-induced
 ACE-Is, ARBs, NSAIDs and Aldosterone Antagonists
 Digoxin, SMX-TMP, heparin, cyclosporine, tacrolimus
 Tumor Lysis Syndrome and Rhabdomyolysis
 Cell lysis

5. Treatment goals:
 [K+] between 3.5-5.0mEq/L;
 Reverse any cardiac effects
Immediate treatment required
 [K+] > 7.0mEq/L, or
 6.0 ≤ [K+] ≤ 7.0mEq/L with clinical
symptoms/EKG changes
Consider treatment if 5.0≤[K+]≤6.0mEq/L
 Conservative treatment with furosemide
If patient is also has hypomagnesemia,
correct Mg2+ level first

6.  Calcium Gluconate
 1g IV over 5-10 mins
 Insulin (RA or Regular)
 5-10 units IV/SC
 Dextrose (BGL < 250mg/dL)
 1000mL D10% IV
 50mL D50% IV
 Albuterol
 10-20mg nebulized over 10
mins
 Sodium Bicarbonate
 50-100mEq IV over 2-5 min
 SPS
 15-60g PO/PR

7. Metabolic alkalosis
 Loss of H+ from serum causes release of H+ from
cells
 To maintain electroneutrality, cells take in serum
K+
Vomiting/Diarrhea
 1L vomit can waste 30-50mEq of K+
 Normal feces contains 10mEq K+, but diarrhea
increases this proportional to stool volume
Drug-Induced
 Insulin overdose will stimulate the Na+/K+ ATPase
to transport K+ back into muscle, liver and
adipose tissues
 Loop and THZ diuretics inhibit renal reabsorption
of K+

8. For each 1mEq/L decrease in [K+] below
3.5mEq/L  100-400mEq K+ deficit
Replete K+ with potassium chloride
 PO if asymptomatic, IV if symptomatic or NPO
 If mild/moderate, 40-100mEq of KCl usually
sufficient
 If [K+] < 3.0mEq (moderate/severe), treat
until [K+] is between 4.0 and 4.5mEq/L
Hypomagnesemic?  correct [Mg2+] first
 50% of clinically significant hypokalemic
patients are also hypomagnesemic

9. Hyperkalemia
 Frequently asymptomatic
 Can present with palpitations/irregular rhythms
 Arrhythmias
Hypokalemia
 increases mortality in CKD or CHF
 Symptoms are dependent on severity
 Often asymptomatic
 Cramping, impaired muscle contraction, weakness,
fatigue and myalgia
 Severe hypokalemia ([K+] < 2.5mEq/L) may
result in EKG changes and heart block, atrial
flutter and ventricular fibrillation

10. Hypokalemia is more common than
hyperkalemia
Concurrent hypomagnesemia  correct
[Mg2+] first
If mild hyperkalemia, use furosemide
If severe hyperkalemia or if EKG changes,
give IV calcium gluconate, place on
constant telemetry, and monitor [K+]
levels hourly until [K+] < 5.0mEq/L
 RA/Regular insulin +/- dextrose can be an
add-on option
If hypokalemic, replete K+ with KCl po/IV

12. 1. Brophy, Donald F. "Chapter 36. Disorders of
Potassium and Magnesium Homeostasis."
Pharmacotherapy: A Pathophysiologic Approach,
9e. Eds. Joseph T. DiPiro, et al. New York, NY:
McGraw-Hill, 2014. n. pag. AccessPharmacy. Web.
22 Mar. 2015.
<http://accesspharmacy.mhmedical.com.acphs.id
m.oclc.org/content.aspx?bookid=689&Sectionid=4
5310485>.