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.

1. HYPOKALEMIA

2. Hypokalemia is a serum potassium level of less
than 3.5mEq/L, it is common electrolyte
disorder.
CAUSES:-
- Gastrointestinal losses:-Vomitting, diarrhea,
nasogastric suctioning, intestinal fistula,
laxative abuse, excessive tap water, enemas.
- Dietary changes:- Malnutrition, starvation,
potassium free diet, some weight reduction

3. diets, potassium free intravenous solutions,
when there is no dietary intake.
Medications:- Potassium wasting diuretics
(thiazide, loop of Henle and osmotic steroids,
cortisone preperations), large amounts of
licorice (aldosterone like effect), gentamycin,
amphoterecin B, digitalis preperations and
beta adrenergic promote potassium loss.
Redistribution of potassium:- Insulin moves

4. glucose and potassium back into cells,
potassium loss from osmotic diuresis, in
diabetic acidosis, alkalosis causes potassium
to shift into cells in exchange for hydrogen
ion.
Disorders:- Cushing’s syndrome, diuretic phase
of acute renal failure, alcoholism,
hyperaldosteronism.

5. RISK FACTORS-
 Elderly and young
 Patients taking potassium wasting diuretics
 Severe tissue injury.
PATHOPHYSIOLOGY:-
Serum potassium level decreases
↓
Increased potassium gradient between cell and
plasma

6. ↓
Reduced excitability
↓
Slowed muscular contractions
↓
Respiratory movement and ventilation is slowed
↓
Slow and thready pulse

7. CLINICAL MANIFESTATIONS:-
 GI:- Anorexia, vomitting, diarrhea, ileus
distension.
 Musculoskeletal:- Muscle weakness,
paralysis, leg cramps, muscle flabbiness.
 Cardiovascular:- Dysrrhythmia, vertigo,
postural hypotension, flattenedT wave,
prominent U wave, slow weak pulse.
 Respiratory:- Shallow respirations, shortness
of breathe.

8.  Neurologic:- Fatigue, lethargy, decreased
tendon reflexes, confusion, depression.
 Renal:- Polyuria, decreased reum osmolality,
nocturia.
PATHOPHYSIOLOGIC BASIS:-
- Smooth muscle contraction slowed.
- Slowed smooth muscle and skeletal muscle
contraction.
- Increase in cell excitability, prolongation

9. of myocardial replarization.
- Dysrrythmias are more pronounced when the
client is taking digitalis preperation.
- Weakness of respiratory muscles due to
decrease in muscular contractions.
- Decreased transmission and conduction of
nerve impulses.
- Inhibition of kidney’s ability to concentrate
urine.

10. LABORATORY FINDINGS:-
 Serum potassium<35mEq/L- Hypokalemia.
 Serum Osmolality<275mOsm/Kg-Polyuria.
which leads to loss of body potassium
and other solutes.
MEDICAL MANGEMENT:-
Extreme hypokalemia require cardiac
monitoring.

11. PHARMACOLOGIC MANAGEMENT:-
 Oral potassium replacement therapy is
prescribed for mild hypokalemia (serum
potassium 3.3-3.5mEq/L).
 Oral potassium chloride or potassium
gluconate is available in liquid or tablet form.
Potassium is extremely irritating to gastric
mucosa, therefore the drug must be taken
with one half to one glass of water or juice or
during meals.

12. Potassium chloride can be administered
IV for moderate or severe hypokalemia.
(Potassium is not given IM and never given as a
bolus (Intravenous push) injection. Potassium
given IV, must always be dilutes in
intravenous fluids. Administration of
potassium by IV push may result in cardiac
arrest.
Potassium can be given in doses of 10-20
mEq/hour diluted in intravenous fluids

13. for patients with mild or moderate
hypokalemia. Patients with severe
hypokalemia. Patients with severe
hypokalemia need 40-80 mEq in liter of fluid.
High conc of potassium are extremely
irritating to the heart muscle.Thus correcting
a potassium deficit may take several days.
For patients who are NPO, usually
after surgery or because of intestinal

14. problems that prevent eating, a maintainence
dose of potassium is reuired. A common dose
is 40 mEq/day in IV solution.
DIETARY MANAGEMENT:-
The administration of foods that are high in
potassium losses.The adult recommended
allowance of potassium is 1875 to 5625 mg.
SOURCES OF POTASSIUM IN FOODS:-
VEGETABLES:-

15. Cabbage, carrots, cucumber, mushrooms.
FRUITS:-
Apple, apple juice, blueberries.
NURSING MANAGEMENT:-
ASSESSMENT:-
Evaluate about inadequate dietary intake of
potassium and potassium losses due to
vomitting, diarrhea and drugs. (eg- diuretics,
cortisone).

16. - Assess for serum potassium level, cardiac,
gastrointestinal and neuromuscular changes.
- Assess patients who are on NPO without
intravenous potassium supplements, or have
renal disease.
Nursing diagnosis:- Hypokalemia related to
vomitting, diarrhea, Cushing syndrome,
Cortisone therapy or decreased intake.

17. Planning:- Patient should return to serum
potassium level to normal range, absence of
complications related to intravenous
administration of potassium chloride and
absence of signs and symptoms of cardiac
and neuromuscular changes associated with
hypokalemia.
Implementation:-
- Administer IV potassium chloride for

18. maintaining potassium balance and
correcting potassium deficit. IV KCl must be
diluted in IV fluids, it cannot be given as IV
push. A large loading dose of potassium can
cause cardiac arrest, thus IV solution bags
should always be agitated before being hung.
The usual dose of IV potassium is
20-40 mEq in liter of IV solution. Intravenous
potassium is irritating to veins and can cause

19. phlebitis, thus the rate of flow must be
carefully monitored. IV fluids with potassium
chloride are usually delievered by a controlled
infusion pump to assist with maintainence of
the correct intravenous flow rate.
Serum potassium levels should be
closely monitored by the nurse. If the serum
potassium level is less than 3mEq/L, the
potassium deficit will take longer to correct
potassium. Care should also be taken that

20. continuous correction does not cause
hyperkalemia.The nurse should continue to
assess for signs and symptoms of potassium
deficit. Neuromuscular changes are more
pronounced with moderate and severe
hypokalemia. Renal function should also be
assessed.The nurse should monitor bowel
function because constipation may be a
problem. Patients with digitalis derivatives

21. are at risk for digitalis toxicity if they are
hypokalemic.The nurse should assess apical
pulses for dysrrythmias.
Nursing diagnosis:- Risk of injury related to
muscle weakness and hypotension.
Planning:-The patient will remain free of injury,
as evidenced by no falls or near falls.
Implementation:-The nurse must employ safely
measures to reduce the risk of injury.The

22. bed must be kept in low position with side
rails up. Before the patient ambulates, the
path should be cleared of obstacles and the
patient should be cleared of obstacles and
the patient should wear shoes to prevent
slipping. An ambulation belt should be worn
by the patient and used by the nurse.
Restraints should be used as needed to
prevent harm.

23. Nursing diagnosis:- Nutrition less than body
requirement, related to insufficient intake of
foods rich in potassium.
Planning:- Patient will increase dietary intake to
correct hypokalemia, as evidenced by
selection of a diet. Consisting of potassium
rich foods such as bananas, cantaloupe and
nuts, containing 1875 to 5625 mg of
potassium each day, consumption of oral

24. potassium supplements as prescibed to
prevent potassium deficit, and an absence of
signs and symptoms of hypokalemia.
Implementation:-The nurse should instruct the
patient to choose and consume foods rich in
potassium, such as fruits, fruit juices, dried
fruits, vegetables including potatoes (potato
skins are very rich in potassium than others,
bananas, cantaloupe and honey dew melons

25. have twice as much as potassium as oranges
do. Meats and milk have a moderate amount
of potassium. If patient is taking a liquid or
tablet potassium supplement, the patient
should be instructed to take the potassium in
or with atleast one-half glass or more water
or juice..
Evaluation:-
The nurse evaluates whether the expected

26. outcomes have been met, the serum
potassium level is within normal range the
patient is free of signs and symptoms of
hypokalemia, and a patient did not suffer
from any preventable adverse effects of
potassium therapy.A revision of the plan of
care may be required if outcomes are not
met.

27. Patient education:-
- Provide food rich in potassium.
- Prolonged cooking of vegetables may result
in potassium and vitamin loss.These foods
should be steamed or cooked quickly.

28. THANKYOU