Electrolyte imbalance

Hipokalemia
• Hypokalemia, defined as plasma [K + ] less
than 3.5 mEq/L
A decrease in plasma [K + ]

from 4 mEq/L to 3 mEq/L usually represents a 100- to

200-mEq deficit,

whereas plasma [K + ] below 3 mEq/L can represent a

defi cit anywhere between 200 mEq and 400 mEq
• Intracellular Movement of Potassium
• Increased Potassium Losses
• Decreased Potassium Intake
• intravenous replacement should not exceed
8 mEq/h
• rapid intravenous potassium replacement (10–
20 mEq/h) requires central venous
administration
• The decision to proceed with elective surgery
is oft en based on lower plasma [K + ] limits
somewhere between 3 and 3.5 mEq/L
 precaution
• Glucose-free intravenous solutions should be
used and hyperventilation avoided to prevent
further decreases in plasma [K + ].

• Glucose-free intravenous solutions should be

used and hyperventilation avoided to prevent
further decreases in plasma [K + ]. Increased
sensitivity to neuromuscular blockers (NMBs)
may be seen; therefore dosages of NMBs should
be reduced 25–50%
 Hiponatremia
• Children are prone to developing
hypoglycemia following 4 – 8 h fast

• When given in large volumes, normal saline

produces a dilutional hyperchloremic acidosis
because of its high sodium and chloride
content (154 mEq/L): plasma bicarbonate
concentration decreases as chloride
concentration increases.