The document discusses evaluation and treatment of hypokalemia. It states that the urine potassium-to-creatinine ratio is usually less than 13 mEq/g creatinine with hypokalemia caused by transcellular shifts, GI losses, diuretic use, or poor diet, and is higher with renal potassium wasting. Oral or IV potassium replacement should be based on severity, with mild cases receiving tablets and moderate cases receiving higher doses orally or IV. Severe hypokalemia under 2.5 mEq/L or with symptoms requires IV replacement at 10-20 mmol/hour depending on the route and ECG monitoring. Guidelines recommend KCl infusion in non-dextrose solutions under

1. HYPOKALEMIA

3. URINE K+ TO CR. RATIO

4. URINE K+ TO CR. RATIO
• The urine potassium-to-creatinine ratio is usually less than 13
mEq/g creatinine(1.5 mEq/mmol creatinine) when hypokalemia is
caused by transcellularpotassium shifts, gastrointestinal losses,
previous use of diuretics, or poor dietary intake. Higher values are
seen with renal potassium wasting.Dec 12, 2017
• Evaluation of the adult patient with hypokalemia - UpToDate
https://www.uptodate.com/contents/evaluation-of-the-adult-
patient-with-hypokalemia

8. CORRECTION
• Whether Oral or Intravenous Potassium will be administered, this
should be decided according the severity of the Hypokalemia. It is
important to remember that every 1 mEq/L decrease in Serum
Potassium, represents a Potassium deficit of approximately 200–
400 mEq. However, this calculation could either overestimate or
underestimate the true Potassium deficit.

9. Hypokalemia Treatment Comments
Mild (3.0–3.4 mEq/L) Potassium tablets (72 mmol/day) or i.v.
potassium infusion 25 mL (75 mmol/day)
• Usually asymptomatic
• Monitor potassium levels daily and
adjust treatment accordingly
• Consider i.v. potassium if patient
cannot tolerate oral potassium
Moderate (2.5–2.9 mEq/L) Potassium tablets (96 mmol/day) or i.v.
potassium infusion 25 mL
(100 mmol/day)
• No or minor symptoms
• Monitor potassium levels daily and
adjust treatment accordingly
• Consider i.v. potassium if patient
cannot tolerate oral potassium
Severe (<2.5 mEq/L or symptomatic) Intravenous replacement 40 mmol KCl in
1 L 0.9% NaCl (glucose 5% may be used)
• Standard infusion rate: 10 mmol/h
• Maximum infusion rate: 20 mmol/h
• Check magnesium levels (reported
automatically if K < 2.8 mEq/L)
• If patient hypomagnesemic: initially
give 4 mL MgSO4 50% (8 mmol) diluted
in 10 mL of NaCl 0.9% over 20 min, then
start first 40 mmol KCl infusion, followed
by magnesium replacement
Table 3
Treatment of hypokalemia.

10. INTRAVEINOUS INFUSION: WHEN? HOW?
[KDIGO GUIDELINES]
• KCl should be given in a non-dextrose-containing solution, usually in a
concentration of 40 mmol/l. No more than 50 mmol/l (4 g KCl/L) should be
given through a peripheral vein at a maximum rate of 10 mmol/hour.
Placing a sleeve for heating the forearm infused may limit the pain and
rinsing the vein at the end of infusion with isotonic saline could be helpful
to prevent sclerosis of the vein used. For central venous line the maximum
concentration of 80 mmol/L and a maximum rate of 20 mmol / hour
(depending hypokalemia, ECG monitoring). Beyond 10 mmol/hr, the
patient should be in intensive care.

12. HYPERNATREMIA

13. Meq/L
Meq/L
Meq/L

14. MANAGEMENT

15. MANAGEMENT

20. • Asymptomatic:
More Slow – 6-8 meq/L/Day