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In and out of potassium

1 mL/kg of 3% sodium chloride raises the serum sodium by 1.6 mEq.

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

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 Serum potassium and ECG


5.5 6.5 7.5 8.5 to 6.5 peaking of T waves to 7.5 QRS widening to 8.5 decrease in P wave and increase in PR interval and more Sine wave , and V.F,Asystole

The earliest ECG manifestation of Hyperkalemia is peaked or tented T waves.

True Hyperkalemia Excess K+ intake Decreased excretion Redistribution Acidosis Diabetes. Adrenal Ins. Periodic P. Renal failure Oliguria Hypoaldo. Nsaids Ace inhibitors

2%

98 %

Hyperkalemia
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

Drug Calcium gluconate (10%) Sodium bicarbonate (7.5%) Insulin glucose

Dose 1-2 ml/Kg IV

Onset of action

Duration 20-30 min.

1-3 min.
5-20 min.

1-2 ml/Kg IV

1-2 hours

0.1 U/Kg of - insulin & 0.520-30 min. 1.0 g/Kg of glucose 4 i:micro g/Kg IV over 15-20 minutes5 - 10 30 min. mg via inhalation

2 hours

Salbutamol

4-6 hours

potassium exchange resins Hemodialysis

Hypokalemia

Causes..

Hypokalemia true Increased loss Urinary K +

Distribution Decreased

Hypertension

Normal B.P.

G.I.loss Biliary ETC.

Acidosis Renin

Alkalosis

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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.

3 months female weighing 2.3 kg with persistent diarrhea . If serum [K+ ] level does not Serum potassium 2.3 not rising in appreciably rise byand 48 hours, spite of good magnesium concomitant Potassium replacement. depletion should be suspected 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.

TOTAL BODY POTA.

INCREASE POTASSIUM NORMAL POTASSIUM DECREASE POTASSIUM

SERUM K

7.4

CNANGE IN PH AND POTASSIUM

ALKA

LOSIS LOW K

ACIDOSIS CAUSES
HYPERKALEMIA

H I O N S

THANKS