Hypokalemia

Hypokalemia

Causes •

Loop diuretics

Vomiting and diarrhea

Diuresis including diuretic phase of ARF

On IV fluids without supplementation of potassium.

Features

• ECG changes-T wave flattening, inversion, ST depression, prominent U and P waves,  low voltage QRS and bradycardia.
• Muscle weakness, absent deep tendon reflexes and diminished bowel sounds.

Hypokalemia Treatment

Mild hypokalemia (serum K’ of 3 – 3.5 mEq/L)

• Advise potassium rich diet like fruits, tender coconut water etc.,
• Syrup KCL (Potklor 10ml Q8H PO with 50 ml of water)

Severe hypokalemia (serum K'< 2.5mEq/L)

Never give potassium through central venous line or as bolus. Always give through a peripheral vein as an infusion.

• KCI 60mEq to be given in 1 litre of NS IV at a rate of 10mEq/hour (Up to 100- 200 mEq/day is needed)
• If there is severe ECG changes or neuromuscular abnormality like respiratory muscle weakness maximum of 40 mEq of KCL per hour can be given as uniform speed infusion in 500ml NS.
• Avoid dextrose drip

Hypomagnesaemia

(< 1.5mg%) – Look for associated hypomagnesaemia, which is known to make management of hypokalemia difficult, hence it also need to be corrected simultaneously.

• Magnesium sulphate 50% (2ml ampule contains 5 mEq or 96mg of elemental magnesium) 2ml Q6H in 100ml NS infused over 2-3 hour with close monitoring of vital parameters and ECG.
• In severe symptomatic hypomagnesaemia 2 ampules (4ml or 2gms) of magnesium sulphate in 100ml NS infused over 1 hour with close monitoring of vital parameters and ECG.
• In the presence of renal failure magnesium infusion is contraindicated. Manipal Medical Manual

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