This document provides guidelines for managing acute hypokalemia in adults. It defines normal and abnormal potassium levels and describes common causes and symptoms of hypokalemia. Treatment aims to rapidly raise potassium levels to a safe range and then slowly replace remaining deficits over days to weeks while also addressing the underlying cause. Oral and intravenous potassium replacement therapies are outlined along with associated cautions, interactions, and adverse effects. The guidelines specify patient groups where hypokalemia should be avoided due to increased risks and provide a treatment flowchart. It describes monitoring compliance and effectiveness through audits.
This document provides guidelines for the management of hypokalemia according to NICE guidelines. It defines hypokalemia as a serum potassium level below 3.5 mmol/L. The major causes are decreased intake, increased losses through the kidneys or GI tract, and shifts in distribution. Treatment involves identifying and correcting the underlying cause, monitoring for magnesium deficiency, and replacing potassium orally or intravenously depending on the severity. Close monitoring of serum potassium levels, ECG, renal function, and for side effects is important when replacing potassium.
This document discusses heart failure, including its causes, types, symptoms, diagnosis, and treatment approaches. It notes that heart failure can be caused by abnormalities in systolic or diastolic cardiac function. Treatment involves managing underlying conditions, optimizing medication regimens including ACE inhibitors, ARBs, ARNIs, beta-blockers, diuretics, and device-based therapies, and making lifestyle modifications like sodium and fluid restriction. The goals are to improve quality of life, relieve symptoms, prevent hospitalizations, slow disease progression, and prolong survival for those with this chronic condition.
This guideline covers the management of hyperkalaemia in inpatients and outpatients. It does not apply to diabetic ketoacidosis (follow separate DKA guideline).
For potassium >6.0 mmol/L (or >6.5 mmol/L in renal dialysis patients), request an ECG and repeat potassium. Renal dialysis patients with potassium >6.5 mmol/L should be referred to the renal team.
Treatment involves reducing potassium intake, promoting urinary potassium loss, removing excess potassium, and considering dialysis if other measures are unsuccessful. IV calcium and insulin with glucose are used for emergency treatment if ECG changes are present.
This document summarizes information about albumin (human) 20% solution. It discusses that albumin is a protein produced in the liver that regulates plasma volume and tissue fluid balance. Albumin (human) 20% solution is a concentrated sterile solution of albumin derived from human plasma. It is indicated to restore circulating blood volume in conditions like hypovolemic shock, neonatal hemolytic disease, acute liver failure, nephrosis, and respiratory distress syndrome. Precautions for its use include monitoring for circulatory overload and incompatibility with some other IV solutions.
Cardiologia anaesthesia for the feline cardiac patientGuillaume Michigan
1. Patients with heart disease face several risks during anesthesia due to reduced cardiac reserve and output, including decreased tissue perfusion and organ dysfunction.
2. A thorough pre-anesthetic evaluation of organ function and tissue perfusion is essential, along with correction of any abnormalities.
3. During anesthesia, fluid therapy should be carefully managed and hypotension actively treated to support cardiac function while avoiding overload, and inotropic drugs may help support cardiac contractility as needed.
Diagnostic TESTS FOR PHARMACISTS 3rd year.pptxkalaman3
Laboratory tests should only be ordered if the results will impact patient care. Normal values can help assess clinical disorders, establish diagnoses, and evaluate therapy but vary between labs. Baseline values are important for monitoring disease progression and response to treatment. Medical decision limits help differentiate between disease presence and absence. Sensitivity measures the likelihood of an abnormal test result predicting disease given presence of disease. Specificity measures the likelihood of a normal test result excluding disease given absence of disease. Errors can occur due to patient factors, specimen handling, and technical issues. Electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia
This document provides guidelines for the management of hypokalemia according to NICE guidelines. It defines hypokalemia as a serum potassium level below 3.5 mmol/L. The major causes are decreased intake, increased losses through the kidneys or GI tract, and shifts in distribution. Treatment involves identifying and correcting the underlying cause, monitoring for magnesium deficiency, and replacing potassium orally or intravenously depending on the severity. Close monitoring of serum potassium levels, ECG, renal function, and for side effects is important when replacing potassium.
This document discusses heart failure, including its causes, types, symptoms, diagnosis, and treatment approaches. It notes that heart failure can be caused by abnormalities in systolic or diastolic cardiac function. Treatment involves managing underlying conditions, optimizing medication regimens including ACE inhibitors, ARBs, ARNIs, beta-blockers, diuretics, and device-based therapies, and making lifestyle modifications like sodium and fluid restriction. The goals are to improve quality of life, relieve symptoms, prevent hospitalizations, slow disease progression, and prolong survival for those with this chronic condition.
This guideline covers the management of hyperkalaemia in inpatients and outpatients. It does not apply to diabetic ketoacidosis (follow separate DKA guideline).
For potassium >6.0 mmol/L (or >6.5 mmol/L in renal dialysis patients), request an ECG and repeat potassium. Renal dialysis patients with potassium >6.5 mmol/L should be referred to the renal team.
Treatment involves reducing potassium intake, promoting urinary potassium loss, removing excess potassium, and considering dialysis if other measures are unsuccessful. IV calcium and insulin with glucose are used for emergency treatment if ECG changes are present.
This document summarizes information about albumin (human) 20% solution. It discusses that albumin is a protein produced in the liver that regulates plasma volume and tissue fluid balance. Albumin (human) 20% solution is a concentrated sterile solution of albumin derived from human plasma. It is indicated to restore circulating blood volume in conditions like hypovolemic shock, neonatal hemolytic disease, acute liver failure, nephrosis, and respiratory distress syndrome. Precautions for its use include monitoring for circulatory overload and incompatibility with some other IV solutions.
Cardiologia anaesthesia for the feline cardiac patientGuillaume Michigan
1. Patients with heart disease face several risks during anesthesia due to reduced cardiac reserve and output, including decreased tissue perfusion and organ dysfunction.
2. A thorough pre-anesthetic evaluation of organ function and tissue perfusion is essential, along with correction of any abnormalities.
3. During anesthesia, fluid therapy should be carefully managed and hypotension actively treated to support cardiac function while avoiding overload, and inotropic drugs may help support cardiac contractility as needed.
Diagnostic TESTS FOR PHARMACISTS 3rd year.pptxkalaman3
Laboratory tests should only be ordered if the results will impact patient care. Normal values can help assess clinical disorders, establish diagnoses, and evaluate therapy but vary between labs. Baseline values are important for monitoring disease progression and response to treatment. Medical decision limits help differentiate between disease presence and absence. Sensitivity measures the likelihood of an abnormal test result predicting disease given presence of disease. Specificity measures the likelihood of a normal test result excluding disease given absence of disease. Errors can occur due to patient factors, specimen handling, and technical issues. Electrolyte imbalances like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia
This document summarizes alterations in calcium metabolism, including hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism, or increased intestinal calcium absorption. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood compartment, or by decreased calcium flow from intestines or bones into the blood, as seen in hypoparathyroidism. The document outlines the clinical presentations, diagnostic evaluations, and treatments for hypercalcemia and hypocalcemia.
This document summarizes alterations in calcium metabolism, including hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism, or increased intestinal calcium absorption. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood compartment, or by decreased calcium flow from intestines or bones into the blood, as seen in hypoparathyroidism. The document outlines the clinical presentations, diagnostic evaluations, and treatments for hypercalcemia and hypocalcemia.
This document discusses alterations in calcium metabolism, specifically hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism or bone metastases from cancers like breast or lung cancer. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood into tissues, as seen in kidney failure, or by decreased intestinal calcium absorption, as seen in vitamin D deficiency. Symptoms, diagnosis, and treatment approaches are described for both hypercalcemia and hypocalcemia.
Calcium homeostasis and hypercalcemia/hypocalcemia are summarized. Calcium plays important roles and is tightly regulated. Hypercalcemia can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms involve bones, kidneys, GI tract, and neuromuscular systems. Treatment focuses on increasing calcium excretion and inhibiting bone resorption. Hypocalcemia has causes like hypoparathyroidism, vitamin D deficiency, and alkalosis. Symptoms are weakness, tingling, and muscle spasms. Treatment provides calcium supplementation and addresses the underlying cause.
Calcium homeostasis and hypercalcemia/hypocalcemia are summarized. Calcium plays important roles and is tightly regulated. Hypercalcemia can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms involve bones, kidneys, GI tract, and neuromuscular systems. Treatment focuses on increasing calcium excretion and decreasing absorption or treating the underlying cause. Hypocalcemia has causes like hypoparathyroidism or vitamin D deficiency. Symptoms include weakness, tingling, and muscle spasms. Treatment provides calcium supplementation and addresses the underlying condition.
Hypokalemia is a low serum potassium level defined as less than 3.5 mEq/L. It can be caused by gastrointestinal losses from vomiting, diarrhea, or medications like diuretics. Symptoms include muscle weakness, paralysis, cardiac arrhythmias, respiratory issues, and neurological effects. Treatment involves oral or IV potassium supplementation depending on severity while monitoring for hyperkalemia. Dietary sources of potassium like fruits and vegetables can help correct hypokalemia.
This document provides information on dietary considerations for individuals with renal disease. It begins by defining renal failure and discussing the types and causes of both acute and chronic renal failure. Key principles of diet modification for renal disease include restricting fluids, sodium, potassium, and protein based on the individual's condition and lab values. Micronutrients may need to be supplemented depending on the stage of renal disease. The document provides dietary recommendations and strategies for managing conditions like renal calculi. Overall, the document outlines the essentials of medical nutrition therapy for supporting individuals with acute or chronic kidney injury or disease.
This document provides a summary of a presentation on the management of anemia and mineral bone disorders in chronic kidney disease. It defines anemia and its causes in CKD, including relative erythropoietin deficiency and iron deficiency. It outlines the evaluation, treatment, and monitoring of anemia in CKD patients, including the use of iron supplementation, erythropoiesis-stimulating agents, and blood transfusions. It also describes chronic kidney disease-mineral bone disorder, including abnormalities in calcium, phosphorus, PTH, and vitamin D metabolism. It discusses the pathogenesis and types of CKD-MBD, including high turnover bone disease and adynamic bone disease, and their treatment through dietary phosphorus restrictions,
Heart failure treatment II european guidlines 2012Basem Enany
This document discusses various treatments and considerations for heart failure. It covers topics like ventricular reconstruction surgery, aortic valve replacement, mitral valve repair, heart transplantation challenges, exercise recommendations, mechanical circulatory support issues, managing comorbidities, and treating conditions like anemia, hypertension, cachexia, cancer effects on the heart, COPD, depression, diabetes, kidney dysfunction, gout, obesity, and sleep disorders. Management of heart failure involves addressing the underlying cardiac problem while balancing treatments for comorbidities and potential drug interactions.
Scope: This subject is intended to impart the fundamental knowledge on various aspects
(classification, mechanism of action, therapeutic effects, clinical uses, side effects and
contraindications) of drugs acting on different systems of body and in addition,emphasis
on the basic concepts of bioassay. Objectives: Upon completion of this course the student should be able to
1. Understand the mechanism of drug action and its relevance in the treatment of
different diseases
2. Demonstrate isolation of different organs/tissues from the laboratory animals by
simulated experiments
3. Demonstrate the various receptor actions using isolated tissue preparation
4. Appreciate correlation of pharmacology with related medical sciences
Hypertension treatment strategies: By RxVichuZ!!RxVichuZ
The document summarizes key points about treating hypertension. It discusses four main drug classes used: diuretics, sympathoplegics, vasodilators, and RAAS inhibitors. Specific drugs within each class are described, noting their mechanisms of action, indications, advantages, and important considerations for use. Thiazide diuretics are first-line, while loop diuretics carry risks. Various sympathoplegics like clonidine and methyldopa reduce sympathetic outflow through different mechanisms. Calcium channel blockers, nitric oxide releasers, and dopamine agonists are described as vasodilator classes.
The document defines hypophosphatemia and its severity levels. Mild to moderate hypophosphatemia is usually asymptomatic, while major clinical issues occur with severe hypophosphatemia below 1 mg/dL. Treatment aims to correct the underlying cause, with oral phosphate supplementation for mild cases and intravenous treatment for very severe cases below 1 mg/dL. The guidelines provide dosing recommendations for oral and intravenous phosphate repletion based on serum phosphate levels and symptoms.
Hypercalcemia and hypocalcemia are disorders of calcium homeostasis. Hypercalcemia is defined as a serum calcium level >10.2 mg/dL and can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms include nausea, constipation, weakness and arrhythmias. Treatment focuses on rehydration, bisphosphonates, calcitonin and addressing the underlying cause. Hypocalcemia is a serum calcium <8.5 mg/dL and can result from hypoalbuminemia, hypoparathyroidism, vitamin D deficiency or sepsis. Symptoms include tingling, muscle spasms and seizures. Acute treatment involves calcium supplementation while long
This document discusses chronic kidney disease (CKD), including its causes, symptoms, complications, diagnostic tests, management, and treatment options. It notes that CKD refers to irreversible deterioration of renal function over years and is asymptomatic until the glomerular filtration rate falls below 30 mL/min/1.73 m2. Common symptoms when it falls below 15-20 mL/min/1.73 m2 include tiredness, breathlessness, pruritus, and in advanced cases, Kussmaul breathing and coma. The aims of management are to monitor renal function, prevent further damage, limit complications, treat risk factors, and prepare for renal replacement therapy. Treatment involves controlling blood pressure and proteinuria, managing
General management of poisoning involves stabilization, evaluation, gastrointestinal decontamination if recent, urinary alkalinization for some toxins, haemodialysis/haemoperfusion, lipid emulsion therapy, supportive care, and antidotes if available. Stabilization focuses on airway, breathing, circulation. Evaluation includes examination. Gastrointestinal decontamination includes activated charcoal orally or via tube for some toxins within 1 hour, or whole bowel irrigation for sustained release drugs. Urinary alkalinization enhances excretion of weak acids/bases. Haemodialysis/haemoperfusion effectively removes some toxins. Lipid emulsion therapy counters cardiac effects of some lipophilic drugs. Supportive care monitors until effects
This document discusses several oncologic emergencies including hypercalcemia, hyponatremia, superior vena cava syndrome, and malignant pericardial effusion. Hypercalcemia is one of the most common oncologic emergencies and can be caused by parathyroid hormone-related peptide or vitamin D overproduction from tumors. Treatment involves intravenous fluids and bisphosphonates. Hyponatremia is also common in cancer patients, often due to inappropriate antidiuretic hormone secretion, and requires fluid restriction or saline infusion depending on symptoms. Superior vena cava syndrome occurs when the superior vena cava is compressed by tumors and causes edema, and stenting or radiation are treatments.
The document discusses potassium imbalance and its management. It provides reference ranges for normal serum electrolyte levels including potassium. It then describes causes, classifications, signs and symptoms of hyperkalemia. Treatment for hyperkalemia involves stabilizing cell membranes, shifting potassium into cells, and removing potassium from the body. Management differs based on severity, with severe hyperkalemia over 6.5 mmol/L treated as a medical emergency. Hypokalemia is also discussed, outlining its causes, signs, and initial treatment involving potassium replacement and identifying its cause.
This document discusses potassium imbalance and its management. It provides reference ranges for normal serum electrolyte levels including potassium. It then discusses causes, classifications, signs, and treatments for both hyperkalemia and hypokalemia. For hyperkalemia, it outlines approaches for managing severe cases including using calcium, insulin, beta-agonists, and dialysis. For hypokalemia it discusses causes like drugs and investigations to identify the cause before outlining oral and IV supplementation approaches.
This document provides an overview of total parenteral nutrition (TPN). It discusses that TPN involves intravenous administration of nutrients like proteins, carbohydrates, fats, minerals, electrolytes and vitamins for patients unable to meet nutritional needs enterally. It outlines the types of patients that require TPN, its composition, routes of administration, potential complications, and the role of pharmacists in monitoring patients on TPN. Close monitoring of fluid, electrolytes, glucose and organ function is important to manage risks and optimize outcomes for patients receiving TPN.
This document summarizes alterations in calcium metabolism, including hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism, or increased intestinal calcium absorption. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood compartment, or by decreased calcium flow from intestines or bones into the blood, as seen in hypoparathyroidism. The document outlines the clinical presentations, diagnostic evaluations, and treatments for hypercalcemia and hypocalcemia.
This document summarizes alterations in calcium metabolism, including hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism, or increased intestinal calcium absorption. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood compartment, or by decreased calcium flow from intestines or bones into the blood, as seen in hypoparathyroidism. The document outlines the clinical presentations, diagnostic evaluations, and treatments for hypercalcemia and hypocalcemia.
This document discusses alterations in calcium metabolism, specifically hypercalcemia and hypocalcemia. Hypercalcemia is defined as elevated serum calcium levels and can be caused by increased bone resorption, as seen in primary hyperparathyroidism or bone metastases from cancers like breast or lung cancer. Hypocalcemia is defined as low serum calcium levels and can be caused by calcium exiting the blood into tissues, as seen in kidney failure, or by decreased intestinal calcium absorption, as seen in vitamin D deficiency. Symptoms, diagnosis, and treatment approaches are described for both hypercalcemia and hypocalcemia.
Calcium homeostasis and hypercalcemia/hypocalcemia are summarized. Calcium plays important roles and is tightly regulated. Hypercalcemia can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms involve bones, kidneys, GI tract, and neuromuscular systems. Treatment focuses on increasing calcium excretion and inhibiting bone resorption. Hypocalcemia has causes like hypoparathyroidism, vitamin D deficiency, and alkalosis. Symptoms are weakness, tingling, and muscle spasms. Treatment provides calcium supplementation and addresses the underlying cause.
Calcium homeostasis and hypercalcemia/hypocalcemia are summarized. Calcium plays important roles and is tightly regulated. Hypercalcemia can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms involve bones, kidneys, GI tract, and neuromuscular systems. Treatment focuses on increasing calcium excretion and decreasing absorption or treating the underlying cause. Hypocalcemia has causes like hypoparathyroidism or vitamin D deficiency. Symptoms include weakness, tingling, and muscle spasms. Treatment provides calcium supplementation and addresses the underlying condition.
Hypokalemia is a low serum potassium level defined as less than 3.5 mEq/L. It can be caused by gastrointestinal losses from vomiting, diarrhea, or medications like diuretics. Symptoms include muscle weakness, paralysis, cardiac arrhythmias, respiratory issues, and neurological effects. Treatment involves oral or IV potassium supplementation depending on severity while monitoring for hyperkalemia. Dietary sources of potassium like fruits and vegetables can help correct hypokalemia.
This document provides information on dietary considerations for individuals with renal disease. It begins by defining renal failure and discussing the types and causes of both acute and chronic renal failure. Key principles of diet modification for renal disease include restricting fluids, sodium, potassium, and protein based on the individual's condition and lab values. Micronutrients may need to be supplemented depending on the stage of renal disease. The document provides dietary recommendations and strategies for managing conditions like renal calculi. Overall, the document outlines the essentials of medical nutrition therapy for supporting individuals with acute or chronic kidney injury or disease.
This document provides a summary of a presentation on the management of anemia and mineral bone disorders in chronic kidney disease. It defines anemia and its causes in CKD, including relative erythropoietin deficiency and iron deficiency. It outlines the evaluation, treatment, and monitoring of anemia in CKD patients, including the use of iron supplementation, erythropoiesis-stimulating agents, and blood transfusions. It also describes chronic kidney disease-mineral bone disorder, including abnormalities in calcium, phosphorus, PTH, and vitamin D metabolism. It discusses the pathogenesis and types of CKD-MBD, including high turnover bone disease and adynamic bone disease, and their treatment through dietary phosphorus restrictions,
Heart failure treatment II european guidlines 2012Basem Enany
This document discusses various treatments and considerations for heart failure. It covers topics like ventricular reconstruction surgery, aortic valve replacement, mitral valve repair, heart transplantation challenges, exercise recommendations, mechanical circulatory support issues, managing comorbidities, and treating conditions like anemia, hypertension, cachexia, cancer effects on the heart, COPD, depression, diabetes, kidney dysfunction, gout, obesity, and sleep disorders. Management of heart failure involves addressing the underlying cardiac problem while balancing treatments for comorbidities and potential drug interactions.
Scope: This subject is intended to impart the fundamental knowledge on various aspects
(classification, mechanism of action, therapeutic effects, clinical uses, side effects and
contraindications) of drugs acting on different systems of body and in addition,emphasis
on the basic concepts of bioassay. Objectives: Upon completion of this course the student should be able to
1. Understand the mechanism of drug action and its relevance in the treatment of
different diseases
2. Demonstrate isolation of different organs/tissues from the laboratory animals by
simulated experiments
3. Demonstrate the various receptor actions using isolated tissue preparation
4. Appreciate correlation of pharmacology with related medical sciences
Hypertension treatment strategies: By RxVichuZ!!RxVichuZ
The document summarizes key points about treating hypertension. It discusses four main drug classes used: diuretics, sympathoplegics, vasodilators, and RAAS inhibitors. Specific drugs within each class are described, noting their mechanisms of action, indications, advantages, and important considerations for use. Thiazide diuretics are first-line, while loop diuretics carry risks. Various sympathoplegics like clonidine and methyldopa reduce sympathetic outflow through different mechanisms. Calcium channel blockers, nitric oxide releasers, and dopamine agonists are described as vasodilator classes.
The document defines hypophosphatemia and its severity levels. Mild to moderate hypophosphatemia is usually asymptomatic, while major clinical issues occur with severe hypophosphatemia below 1 mg/dL. Treatment aims to correct the underlying cause, with oral phosphate supplementation for mild cases and intravenous treatment for very severe cases below 1 mg/dL. The guidelines provide dosing recommendations for oral and intravenous phosphate repletion based on serum phosphate levels and symptoms.
Hypercalcemia and hypocalcemia are disorders of calcium homeostasis. Hypercalcemia is defined as a serum calcium level >10.2 mg/dL and can be caused by primary hyperparathyroidism, malignancy, vitamin D excess, or renal failure. Symptoms include nausea, constipation, weakness and arrhythmias. Treatment focuses on rehydration, bisphosphonates, calcitonin and addressing the underlying cause. Hypocalcemia is a serum calcium <8.5 mg/dL and can result from hypoalbuminemia, hypoparathyroidism, vitamin D deficiency or sepsis. Symptoms include tingling, muscle spasms and seizures. Acute treatment involves calcium supplementation while long
This document discusses chronic kidney disease (CKD), including its causes, symptoms, complications, diagnostic tests, management, and treatment options. It notes that CKD refers to irreversible deterioration of renal function over years and is asymptomatic until the glomerular filtration rate falls below 30 mL/min/1.73 m2. Common symptoms when it falls below 15-20 mL/min/1.73 m2 include tiredness, breathlessness, pruritus, and in advanced cases, Kussmaul breathing and coma. The aims of management are to monitor renal function, prevent further damage, limit complications, treat risk factors, and prepare for renal replacement therapy. Treatment involves controlling blood pressure and proteinuria, managing
General management of poisoning involves stabilization, evaluation, gastrointestinal decontamination if recent, urinary alkalinization for some toxins, haemodialysis/haemoperfusion, lipid emulsion therapy, supportive care, and antidotes if available. Stabilization focuses on airway, breathing, circulation. Evaluation includes examination. Gastrointestinal decontamination includes activated charcoal orally or via tube for some toxins within 1 hour, or whole bowel irrigation for sustained release drugs. Urinary alkalinization enhances excretion of weak acids/bases. Haemodialysis/haemoperfusion effectively removes some toxins. Lipid emulsion therapy counters cardiac effects of some lipophilic drugs. Supportive care monitors until effects
This document discusses several oncologic emergencies including hypercalcemia, hyponatremia, superior vena cava syndrome, and malignant pericardial effusion. Hypercalcemia is one of the most common oncologic emergencies and can be caused by parathyroid hormone-related peptide or vitamin D overproduction from tumors. Treatment involves intravenous fluids and bisphosphonates. Hyponatremia is also common in cancer patients, often due to inappropriate antidiuretic hormone secretion, and requires fluid restriction or saline infusion depending on symptoms. Superior vena cava syndrome occurs when the superior vena cava is compressed by tumors and causes edema, and stenting or radiation are treatments.
The document discusses potassium imbalance and its management. It provides reference ranges for normal serum electrolyte levels including potassium. It then describes causes, classifications, signs and symptoms of hyperkalemia. Treatment for hyperkalemia involves stabilizing cell membranes, shifting potassium into cells, and removing potassium from the body. Management differs based on severity, with severe hyperkalemia over 6.5 mmol/L treated as a medical emergency. Hypokalemia is also discussed, outlining its causes, signs, and initial treatment involving potassium replacement and identifying its cause.
This document discusses potassium imbalance and its management. It provides reference ranges for normal serum electrolyte levels including potassium. It then discusses causes, classifications, signs, and treatments for both hyperkalemia and hypokalemia. For hyperkalemia, it outlines approaches for managing severe cases including using calcium, insulin, beta-agonists, and dialysis. For hypokalemia it discusses causes like drugs and investigations to identify the cause before outlining oral and IV supplementation approaches.
This document provides an overview of total parenteral nutrition (TPN). It discusses that TPN involves intravenous administration of nutrients like proteins, carbohydrates, fats, minerals, electrolytes and vitamins for patients unable to meet nutritional needs enterally. It outlines the types of patients that require TPN, its composition, routes of administration, potential complications, and the role of pharmacists in monitoring patients on TPN. Close monitoring of fluid, electrolytes, glucose and organ function is important to manage risks and optimize outcomes for patients receiving TPN.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
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Hypokalaemia Guidelines v1 - May 2018.pdf
1. Version 1.0 Page 1 of 9 Review Date – May 2020
1. Guidelines for the Management of Acute Hypokalaemia in
Adults
1.1. Scope
This guideline applies to all medical staff, all agency staff and bank staff and
staff with honorary contracts working on clinical wards throughout HDFT.
1.2. Procedure / Guideline
The HDFT reference range for serum potassium 3.5 to 5.3 mmol/L.
Table 1 - Serum Potassium Classification
Normal (3.5-5.3
mmol/L)
Mild (3.0-<3.5
mmol/L)
Moderate (2.5-
2.9 mmol/L)
Severe (<2.5
mmol/L)
Causes of Hypokalaemia:
Most commonly, hypokalaemia will result from intestinal loss (e.g. diarrhoea)
or renal loss (e.g. metabolic alkalosis). However there are several drugs
which can cause a decrease in potassium levels including;
- Thiazide diuretics (e.g. bendroflumethiazide) and loop diuretics (e.g.
furosemide)
- Amphotericin, cisplatin
- Aminoglycosides (e.g. amikacin, gentamicin)
- Beta-agonists (e.g. salbutamol, terbutaline)
- Insulin treatment (e.g. in the treatment of diabetic ketoacidosis)
- Corticosteroids (e.g. fludrocortisone, hydrocortisone)
- Caffeine, theophylline
- Adrenaline, pseudoephedrine
- High dose penicillin
Signs and Symptoms of Hypokalaemia
Hypokalaemia is found in over 20% of hospitalised patients. Symptoms do not
generally manifest until the serum potassium is <3.0 mmol/L, unless the
serum potassium falls rapidly or the patient has a potentiating factor, such as
a predisposition to arrhythmia due to the use of digitalis. This document is a
guideline and treatment should be commenced based on the clinical picture.
2. Version 1.0 Page 2 of 9 Review Date – May 2020
Serum potassium
concentration
Potential symptoms
3.0-3.5 mmol/L Usually no symptoms, *arrhythmias
2.5-2.9 mmol/L Generalised weakness, lassitude and constipation,
*arrhythmias
2.0-2.4 mmol/L Muscle weakness and necrosis, *arrhythmias
Less than 2.0 mmol/L Paralysis and impairment of respiratory function,
*arrhythmias
*In patients with ischaemic heart disease, heart failure, or left ventricular
hypertrophy, even mild hypokalaemia increases the likelihood of arrhythmias.
(Table from UKMI/Leeds Guidelines)
Severity of the condition depends on serum potassium level and the rate of
decline, associated and/or comorbid conditions and treatment with digoxin or
antiarrhythmic drugs.
Treatment of hypokalaemia
Aims of Treatment
- To prevent or treat life-threatening complications (arrhythmias, paralysis,
rhabdomyolysis, and diaphragmatic weakness)
- To rapidly raise the serum potassium concentration to a safe level and then
replace the remaining deficit at a slower rate over days to weeks
- To diagnose and correct the underlying cause
Patient Groups Where Hypokalaemia Should be Avoided
Due to the risk of morbidity and mortality, the underlying cause of clinical
hypokalaemia should be identified and treated. Maintenance of normal
potassium levels is particularly important for:
- Patients taking digoxin or other anti-arrhythmic drugs; hypokalaemia
increases the risk of digoxin toxicity and its arrhythmogenic potential
- Patients with hypoaldosteronism secondary to renal artery stenosis, liver
cirrhosis, nephrotic syndrome and severe heart failure
- Patients with excessive loss of potassium in the faeces e.g. chronic
diarrhoea
- Patients who are nil by mouth or those receiving total parenteral nutrition
Chronic hypokalaemia indicates a profound deficit in total body potassium and
replacement may take several days. Failure to correct hypokalaemia despite
appropriate treatment may be due to underlying hypomagnesaemia
3. Version 1.0 Page 3 of 9 Review Date – May 2020
Table 2 -Treatment Flowchart
This monograph aims to provide guidance only. The dose of potassium to correct
hypokalaemia must be established on an individual patient basis.
Adapted from Clinical Guideline for the Treatment of Hypokalaemia in adults. Leeds Teaching Hospitals NHS Trust
4. Version 1.0 Page 4 of 9 Review Date – May 2020
Oral Potassium Replacement Therapy:
Intravenous Potassium Replacement Therapy:
Intravenous (IV) therapy is indicated in the following situations:
- Patients with serum potassium concentration of less than 2.5 mmol/L
- Patients with symptoms of hypokalaemia
- Patients who are nil by mouth
- Patients who are unable to tolerate oral administration
- Patients who are unlikely to absorb oral potassium
Precautions for IV potassium use:
- Intravenous potassium is very irritant and rapid administration can be
cardiotoxic. If pain occurs, reduce the rate or concentration
- Ready-made diluted potassium infusions containing 10-40mmol of potassium
per litre can be given by a peripheral venous catheter. Ensure the bag is
shaken well before and during administration. The rate of intravenous infusion
of ready-made diluted potassium via a peripheral venous catheter should not
exceed 20mmol/hour.
- Concentrations greater than 40mmol of potassium per litre must always be
given via a central venous access device, using a suitable infusion pump.
Ensure the bag is shaken well before and during administration. Ready-made
solutions should be used wherever possible. The usual maximum rate is
20mmol/hour but in circumstances when higher rates are administered
continuous ECG monitoring is needed.
Preparation K
+
mmol Dose Comments
Sando-K 12mmol/tab 1-4 TDS/QDS 8mmol/tab Cl
-
Potassium chloride 7.5%
Syrup
1mmol/ml 10ml TDS
1mmol/ml Cl
-
Can be more palatable than
dispersible Sando-K
Potassium chloride 600mg
MR tablets
8mmol/tab 2-3 TDS/QDS
8 mmol/tab Cl-
Avoid MR preparation due
to risk of gastric ulceration
– give with meals if only
option
Preparation K
+
mmol Dose Comments
Potassium chloride 0.15% in
Sodium chloride 0.9% (1L)
20mmol/L Infuse over 6-8 hours
Potassium chloride 0.3% in
Sodium chloride 0.9% (1L)
40mmol/L Infuse over 6-8 hours
Potassium chloride 0.45% in
Sodium chloride 0.9% (1L)
60mmol/L Infuse over 6-8 hours
ONLY use if HDU bed
unavailable. ECG
monitoring required
5. Version 1.0 Page 5 of 9 Review Date – May 2020
- Only ready-made bags must be used in non-intensive care clinical areas.
Potassium chloride 50mmol in 50mL syringes are for use in ITU/HDU only
Adverse Drug Reactions
Excessive doses of potassium may lead to the development of
hyperkalaemia, particularly in patients with renal impairment. Symptoms
include
- paraesthesia of the
extremities
- cardiac arrhythmias*
- muscle weakness - heart block*
- paralysis - cardiac arrest*
- confusion
(*cardiac toxicity is of particular concern after IV dosage)
Other adverse reactions include:
- Pain, phlebitis or serious injury following intravenous administration via
peripheral veins, particularly at higher concentrations
- Nausea, vomiting, diarrhoea, and abdominal cramps (with oral therapy)
Interactions
Potassium supplements should be used with caution in patients receiving drugs
that increase serum potassium concentrations. These include:
- potassium-sparing diuretics (e.g. spironolactone, amiloride, triamterene, co-
amilofruse, co-amilozide)
- ACE inhibitors (ACEI) (e.g. ramipril, lisinopril)
- angiotensin II receptor antagonists (e.g. irbesartan, losartan, candesartan)
- tacrolimus
- ciclosporin
- drugs that contain potassium such as the potassium salts of penicillin
Cautions to potassium replacement therapy
- Severe renal impairment (exercise extreme caution and monitor frequently)
- Renal insufficiency (lower doses of replacement therapy may be required for
patients with renal disease)
- Concomitant ACEI or potassium-sparing diuretic therapy
2. CONSULTATION, APPROVAL AND RATIFICATION PROCESS
This Guideline has been consulted on with the key stakeholders identified in
Appendix 1.
ONLY USE READY MIXED IV POTASSIUM
NEVER ADD TO A PRE-MADE BAG
(Potassium Chloride Syringes 50mmol in 50mL are for ITU/HDU USE ONLY)
6. Version 1.0 Page 6 of 9 Review Date – May 2020
This Guideline will be approved by the HaRD Area Prescribing Committee
3. DOCUMENT CONTROL
The Guideline will be published on the Trust electronic document library.
The pharmacy document library administrator will be responsible for archiving
previous versions and replacing with the current ratified version.
4. DISSEMINATION AND IMPLEMENTATION
The new Guideline will be rolled out through existing meeting structures (e.g.
Pharmacy staff meeting) and an all user email. Ward pharmacists will brief
their clinical teams as necessary.
5. MONITORING COMPLIANCE AND EFFECTIVENESS
An audit will be carried out in order to assess compliance.
An audit will be carried out in order to assess effectiveness.
6. REFERENCE AND ASSOCIATED DOCUMENTS
Barth, JH., Butler, GE., Hammond, P., Biochemical Investigations in
Laboratory Medicine, 2001. ACB Venture Publications, London
BMJ Group, BNF: British National Formulary, April 2014, online edition. The
Pharmaceutical Press, London. (Date Accessed 05/02/2018)
Knochel JP. Neuromuscular manifestations of electrolyte disorders. Am J
Med. 1982;72(3):521
Leeds Teaching Hospitals NHS Trust. Clinical Guideline for the Treatment of
Hypokalaemia in adults. Issue date Jan 2013.
Medusa Injectable Medicines Guide. Available at http://medusa.wales.nhs.uk
(Date accessed 05/02/2018)
Mujais, SK., Katz, AL., Potassium deficiency. In: The Kidney: Physiology and
Pathophysiology, Seldin DW, Giebisch G (Eds), Lippincott Williams & Wilkins,
2000. p.1615.
NHS Greater Glasgow and Clyde. Therapeutics . A Handbook for Prescribing
in Adults.
2012: 288-9.
NHS Specialist Pharmacy Services, UKMI (2017) How is hypokalaemia
treated in adults? https://www.sps.nhs.uk/articles/how-is-hypokalaemia-
7. Version 1.0 Page 7 of 9 Review Date – May 2020
treated-in-adults/
NPSA, Potassium solutions: risks to patients from errors occurring during
intravenous administration, 2002. Available at
http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59882
Rose, BD, Post, TW. Hypokalaemia. In: Clinical physiology of acid-base and
electrolyte disorders, 5th ed, Rose, BD, Post, TW (Eds), McGraw-Hill, 2001.
p.836
Summary of Product Characteristics. Electronic Medicines Compendium.
Datapharm Communications Ltd. (HK Pharma Limited, Sando-K).
https://www.medicines.org.uk/emc/ medicine/812/SPC/Sando-K/ (date
accessed 05/02/2018; date last updated: September 2014)
Summary of Product Characteristics. Electronic Medicines Compendium.
Datapharm Communications Ltd. (Alliance Pharmaceuticals, Slow-K).
https://www.medicines.org.uk/emc/ medicine/130/SPC/Slow-
K+Tablets+600+mg/ (date accessed 05/02/2018; date last updated: March
2012)
Adapted from previous guidelines by: Kathryn Hornsby (original guidelines
written by Mat Croft)
7. APPENDICES
Appendix 1: Consultation Summary
Appendix 2: Monitoring, audit and feedback summary
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7.1. Consultation Summary
Those listed opposite have
been consulted and any
comments/actions
incorporated as
appropriate.
The author must ensure that
relevant individuals/groups
have been involved in
consultation as required prior
to this document being
submitted for approval.
List Groups and/or Individuals Consulted
Dr Jassam – Consultant Clinical Biochemist
HaRD Area Prescribing Committee
9. Version 1.0 Page 9 of 9 Review Date – May 2020
7.2. Monitoring, Audit and Feedback Summary
KPIs Audit / Monitoring
required
Audit /
Monitoring
performed
by
Audit /
Monitoring
frequency
Audit /
Monitoring
reported to
Concerns
with results
escalated to
Audit of
adherence to
the guidelines
Audit on adherence to
the guidelines
Pharmacy
staff or
medical
staff
Every 2
years
Audit
Committee
Author of
guideline
Pharmacy staff
Improving
Patient Safety
Steering
Group
Audit of
effectiveness
of the
guidelines
Audit of effectiveness
of the guidelines
Pharmacy
staff or
medical
staff
Every 2
years
Audit
Committee
Author of
guideline
Pharmacy staff
Improving
Patient Safety
Steering
Group