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

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In and Out of Potassium - Dr Satish Deopujari

  • 1. 1 mL/kg of 3% sodium chloride raises the serum sodium by 1.6 mEq. In and out of potassium Dr deopujari
  • 2. In and out of potassium Is no OUTDOOR BUISNESS ?
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. 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.
  • 10. 98 % 2 % Causes Hyperkalemia K +
  • 11. 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
  • 13. 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
  • 14. True Hyperkalemia Excess K+ intake Redistribution Decreased excretion Renal failure Oliguria Hypoaldo. Nsaids Ace inhibitors Acidosis Diabetes. Adrenal Ins. Periodic P.
  • 16.  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
  • 17. 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
  • 20. Hypokalemia true Distribution Increased loss Urinary K + Decreased Hypertension Normal B.P. Acidosis Alkalosis Renin G.I.loss Biliary ETC.
  • 22. 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.
  • 23. 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 ?
  • 24. 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.
  • 25. SERUM K 5 INCREASE POTASSIUM NORMAL POTASSIUM DECREASE POTASSIUM CNANGE IN PH AND POTASSIUM 7.4 TOTAL BODY POTA.