Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
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.
Causes of spurious Hyperkalemia
Fist clenching during blood withdrawal
High platelet count : more than 1 × 106/mm3
leukocytosis : more than 2 × 106
Abnormal potassium permeability of erythrocytes
Hyperkalemia and ECG
The earliest ECG manifestation of Hyperkalemia is
peaked or tented T waves.
Serum potassium and ECG
5.5 to 6.5 peaking of T waves
6.5 to 7.5 QRS widening
7.5 to 8.5 decrease in P wave and increase in PR interval
8.5 and more Sine wave , and V.F,Asystole
Calcium chloride: 0.2 mL /kg/dose of 10% sol IV over 5
min; not to exceed 5 mL (stop infusion if bradycardia
Calcium gluconate: 100 mg/kg (1 mL/kg) of 10% sol IV over
5 min; not to exceed 10 mL (stop infusion if bradycardia
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 )
1-2 ml/Kg IV 1-3 min. 20-30 min.
1-2 ml/Kg IV 5-20 min. 1-2 hours
0.1 U/Kg of
insulin & 0.5-
1.0 g/Kg of
20-30 min. 2 hours
4 i:micro g/Kg
IV over 15-20
minutes5 - 10
30 min. 4-6 hours
potassium exchange resins
I . V . Kesol should be considered for
Sever muscle weakness
Severe hypokalemia (< 2.5.0 mEq. / L).
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,
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 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.
CNANGE IN PH AND POTASSIUM
ALKALOSIS ……… LOW K