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In and Out of Potassium - Dr Satish Deopujari

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Presentation on In and out of potassium by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA

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In and Out of Potassium - Dr Satish Deopujari

  1. 1. 1 mL/kg of 3% sodium chloride raises the serum sodium by 1.6 mEq. In and out of potassium Dr deopujari
  2. 2. In and out of potassium Is no OUTDOOR BUISNESS ?
  3. 3. Miss Munira
  4. 4. 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.
  5. 5. 98 % 2 %
  6. 6. 98 % 2 % Causes Hyperkalemia K +
  7. 7. 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
  8. 8. Clinical features…………….
  9. 9. 138 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
  10. 10. True Hyperkalemia Excess K+ intake Redistribution Decreased excretion Renal failure Oliguria Hypoaldo. Nsaids Ace inhibitors Acidosis Diabetes. Adrenal Ins. Periodic P.
  11. 11. 98 % 2 %
  12. 12.  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
  13. 13. 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
  14. 14. Hypokalemia…
  15. 15. Causes…………..
  16. 16. Hypokalemia true Distribution Increased loss Urinary K + Decreased Hypertension Normal B.P. Acidosis Alkalosis Renin G.I.loss Biliary ETC.
  17. 17. 88 Hypokalemia and ECG..
  18. 18. 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.
  19. 19. 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 ?
  20. 20. 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.
  21. 21. SERUM K 5 INCREASE POTASSIUM NORMAL POTASSIUM DECREASE POTASSIUM CNANGE IN PH AND POTASSIUM 7.4 TOTAL BODY POTA.
  22. 22. H I O N S K ACIDOSIS CAUSES HYPERKALEMIA ALKALOSIS ……… LOW K +
  23. 23. THANKS

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