Hamad Medical Corporation Protocol No: 2

Hamad General Hospital Page No: 1 of 4

Emergency Department Effective Date:
Clinical Protocol Revised Date:

Management of Hypokalemia

PURPOSE: To Provide ED Doctors and Nursing Staff Essential Guidelines To Deal with the
Cases Of Hypokalemia.

2.1 INTRODUCTION

HYPOKALEMIA: Serum K less than 3.5 MEq/L

Causes

Increased loss (GE, Diuretics).

Drugs - B-adrenergic agonist, Insulin

Periodic hypokalemic paralysis.

Dialysis.

Decreased intake.

Megaloblastic anemia-after treatment.

Chloriquine toxicity.

2.2 CLINICAL FEATURES

A. History

Tiredness.

Palpitation.

Muscle pain.

Muscle cramps.

Muscle weakness.

Irritability.

Inquire about above mentioned causes

B. Examination

Dehydration

Muscle weakness (skeketal and respiratory muscles)

Muscle tenderness

Hyporeflexia

Signs of Ileus
Protocol No: 2 Page No: 2 of 4

2.3 INVESTIGATIONS

Serum electrolytes including S. Magnesium and S. Calcium

BUN and creatinine

Blood glucose

ECG
o ST depression (diffuse)
o Flat T wave or T inversion
o U wave
o Prolonged PR interval
o Wide P wave
o Arrythmias



ABG

CBC

Emergency department management

Serum Potassium level 3-3.5 Serum Potassium level <3

Oral KCL 40-60 mEq/day Start KCL infusion

Modify the dose of diuretic or add 20 mEq in 100ml
K-sparing diuretic. 0.9%saline over 1hour and

Enhance oral intake of potassium under cardiac monitoring
rich food

Discharge Admit to medical ward /

Medical OP MICU / SSU
appointment

No more than 40mEqof KCL should be given in 1 hour(in peripheral vein)

(In central vein 60mEq / hour can be given
 Protocol No: 2 Page No: 3 of 4

Nursing Management:

1. Provide patient comfort and safety.

2. Assess alertness and level of consciousness of the patient and observe behavior.

3. All patients receiving IV KCL should have continuous cardiac monitoring. Should be
closely observed for Dysrhythmias (PVC’s, atrial tachycardia, ventricular tachycardia,
ventricular fibrillation, respiratory or cardiac arrest)

4. An initial rhythm strip should be obtained and analysed. 12 lead ECG should also be
obtained.

5. Monitor vital signs hourly or as needed and notify changes in pulse or BP.

6. Extract blood for CBC, U/E and ABG.

7. Monitor serum potassium and other electrolytes.

8. Administer KCl drip as ordered.

Select a large vein and use large bore IV cannula for KCl infusions.

Use an IV infusion pump.

NOT TO GIVE IV BOLUS. Administer at the rate of 10-20 mEq/h. Never

> 40 mEq/h.

Explain to the patient the reason for pain in the arm.

Monitor closely for phlebitis as KCl is irritating to veins.

At the first sign of redness or tenderness at the IV site, discontinue the IV. Treat
IV site with warm compresses and consider re insertion of canula at another
site.

Report any change in patient's condition directly to physician.
 Hamad Medical Corporation Protocol No: 2
Hamad General Hospital Page No: 4 of 4
Emergency Department Effective Date:
Clinical Protocol Revised Date:

Management of Hypokalemia

Developed by: _ED clinical protocol committee Date:__05/07/2004_________

Reviewed by: _____________________________ Date: ________________

Approved by: ____________________ /___________ Date:________

Name Signature

Approved by: ____________________ /____________ Date:________

Name Signature

Approved by: ____________________ /____________ Date:________

Name Signature