A simple and rapid approach to hypokalemic paralysis. Introduction hypokalemia is a common clinical problem, the cause of which can usually be determined from the history as with diuretic use, vomiting, or diarrhea. Sep 15, 2015 hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. A more practical approach is calculation of the urine potassium to creatinine ratio from a spot urine specimen. Dec 06, 2018 hypokalemia is defined as a condition in which the serum potassium level is less than 3. He denied vomiting, diarrhea, palpitation, tremor or excessive sweating. Diuretic use and gastrointestinal losses are common. If you continue browsing the site, you agree to the use of cookies on this website. Disturbances in potassium homoeostasis presenting as low or high serum potassium are common, especially among hospitalised patients. Hong kong j nephrol april 2008 vol 10 no 1 19 practical and pathophysiologic approach to hypokalemia figur e 4. Potassium enters the body via oral intake or intravenous infusion, is largely stored in the cells, and then excreted in the urine. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart.
A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. If you have hypokalemia, that means you have low levels of potassium in your blood. Hypokalaemia is defined as serum potassium concentration below 3. Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. Gpnotebook stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. Hypokalemia metabolic alkalosis patient with severe development delay, polyuria and nocturia complementary evaluation elevated plasma levels of renin and aldosterone high urinary levels of potassium and chloride renal concentrating defect renal structure and function abnormal chronic renal failure renal artery stenosis.
Management of severe hypokalemia in hospitalized patients. Patients who experienced severe hypokalemia had a long length of stay and a high risk of inhospital death. Thus, decreased intake, increased translocation into the cells, or, most often, increased losses in the urine, gastrointestinal tract, or sweat can lead to a reduction in. Hypokalemia is serum potassium concentration hypokalemia.
This is the commonest electrolyte disorder in hospitalised patients. Hypokalemia is when bloods potassium levels are too low. Practical approach to hypokalaemia evaluate for life threatening consequences of hypokalaemia ecg examine for weakness exclude hypomagnesemia assess for etiology exclude pseudohypokalaemia abnormal wbcs artifact of storage procedure rapid separation of plasmastoring at 4 deg c confirms diagnosis. Moderate and especially severe hyperkalemia can lead to cardiotoxicity, which can be fatal. Approach to hypokalemia ranjita pallavi internal medicine pgy2 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Apr 29, 2014 approach to hypokalemia ranjita pallavi internal medicine pgy2 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypokalemia purpose potassium disorders are a frequent occurrence in the inpatient setting. The traditional approach to hypokalemia is based on stratifying the u k to more or less than 1520 mmoll to distinguish between renal and extrarenal causes of hypokalemia. Jun 30, 2010 in this paper, our approach to hypokalemia is introduced and the genetic causes of hypokalemia are discussed to provide some insights in the field. Severe hypokalemia is defined as a level less than 2. The cause of hyperkalemia has to be determined to prevent future episodes. In some cases, however, the diagnosis is not readily apparent. They are intended to provide assistance to organization planners as they develop workplace violence prevention programs and assess their readiness to handle these types of. Welcome to the eighth edition of the calgary black book.
Definition hypokalemia is defined as a persistently low levels of serum potassium lower than 3. Hokrelated symptoms and signs ss17 often asymptomatic. He also denied use of over the counter medications or supplements. Approach to the patient with hypertension, unexplained.
Case studies and practice exercises these case studies have been prepared to provide specific risk and threat factors for examination and to create useful learning tools. Patients are often asymptomatic, particularly with mild hypokalemia. A more practical approach is calculation of the urine potassiumtocreatinine ratio from a spot urine specimen. Rate of change since previous sample falls are of increasing significance as they approach 0. The frequency of intended or accidental diuresis occurring with, for example, heart failure, diabetes, and alcoholism makes hypokalemia prevalent. Potassium is a mineral your body needs to work normally. If you do not want to receive cookies please do not use gpnotebook. Approach to the patient with hypertension and hypokalemic alkalosis resulting from primary aldosteronism the initial approach to patients such as ours presenting with hypertension, hypokalemia, and metabolic alkalosis consists of a sequential clinical evaluation including history and physical examination as well as preliminary laboratory data. By far the most common causes of hypokalemia are potassium losses caused by diuretics or gastrointestinal disorders. An integrative approach to gerd gastroesophageal reflux disease. We are proud that healthcare practitioners and trainees across canada find the black book to be a useful tool. In most cases, the cause of hypokalemia is apparent from the history and physical examination. The presence of a u wave is not speci c for hypokalemia since it can also be a normal nding.
Most cases were hospital acquired 72% and associated with potassiumdepleting medications 75%. Case studies in electrolyte disorders final handout. An integrative approach to gerd gastroesophageal reflux. Symptoms depend on degree and duration of hypokalemia. Jan 28, 2011 hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. The clinical manifestations, etiologies, diagnostic evaluation, and treatment of hypokalemia, including states of mineralocorticoid excess. Since then, he has been receiving potassium supplement, but his serum potassium has remained low or low normal. Introduction we owe the recognition of periodic paralysis as a distinct entity and the understanding of its muscle origin to the early german school of the late 19th century. Hypokalemia renal losses remember the distal nephron diuretics, increased aldosterone activity polyuria, type 1 or type 2 rta salt wasting nephropathies liddles, barters, giddlemens hypokalemia diagnosis is almost always based on history ekg changes may occur complications are rare check. If the patient is acidotic, correct the potassium first to prevent an. Recent advances with respect to the role of kidney in handling of the potassium, the regulation of renal ion transporters in hypokalaemia, and treatment of. A practical and pathophysiologic approach to hypokalemia.
Hyperkalemia is often asymptomatic, but patients may complain of nonspecific symptoms such as palpitations, nausea, muscle pain, weakness, or paresthesia. It helps muscles to move, cells to get the nutrients. Management of hypokalaemia 5 hypokalaemia hok is a serum potassium concentration sk,3. In this paper, our approach to hypokalemia is introduced and the genetic causes of hypokalemia are discussed to provide some insights in the field. Early in the 20th century, physicians observed that decreased blood potassium levels occurred during attacks histori. If the patient is severely hypokalemic, avoid glucosecontaining parenteral fluids to prevent an insulininduced shift of potassium into the cells.
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