Denisse Audrey D.

Leonar

BSN -3

NCM 113

Understanding Hypokalemia
Abstract (summary)
In hypokalemia, the serum potassium levels drops below 3.5 mEq/liter. Some of the
causes of potassium loss are examined, including not enough intake and too much
output, and diagnosis and treatment recommendations are offered.
Full Text
IN HYPOKALEMIA, the serum potassium level drops below 3.5 mEq/liter. Because the
normal range for a serum potassium level is a narrow one (3.5 to 5 mEq/liter), a
slight decrease has profound consequences.
How it happens
Remember that the body can't conserve potassium; inadequate intake and
excessive output of potassium upsets the balance and causes a deficiency of total
body potassium. Let's take a closer look at these and other causes of potassium
loss.
Not enough intake. Very simply, a lack of potassium intake decreases the
body's potassium level. That happens if a person isn't eating enough food
containing potassium or is getting potassium-deficient I.V. fluids.
Too much output. Intestinal fluids contain a lot of potassium. Thus, severe
gastrointestinal fluid losses from suction, lavage, prolonged vomiting,
diarrhea, or laxative abuse can deplete the body's potassium supply. Fistulas
and severe diaphoresis also contribute to potassium loss.
In addition, potassium can be depleted through the kidneys. High glucose
concentration in the urine causes osmotic diuresis, and potassium is lost
through the urine. Potassium losses are also seen in renal tubular acidosis,
magnesium depletion, Cushing's syndrome, and periods of high stress.
Diuresis that occurs with a newly functioning transplanted kidney can lead
to hypokalemia.
Drugs upsetting the balance. Certain drugs also trigger potassium loss:
diuretics (such as thiazide and loop diuretics), certain antibiotics (such as
gentamicin, carbenicillin, and amphotericin B), laxatives (when abused),
corticosteroids, insulin, cisplatin, and adrenergic agents (such as albuterol
and epinephrine).
Excessive secretion of insulin, whether endogenous or exogenous, may shift
circulating potassium into the cells. Potassium levels also drop when
adrenergic agents, such as epinephrine or albuterol, are used to treat
asthma.
Diseases wreak havoc too. Any condition that leads to the loss of gastric
acids can cause alkalosis and hypokalemia. With alkalosis, potassium ions
move into the cells as hydrogen ions move out, leaving less potassium in the
blood. Disorders associated with hypokalemia include hepatic disease,
hyperaldosteronism, acute alcoholism, heart failure, malabsorption
syndrome, nephritis, and Bartter's syndrome.

Denisse Audrey D. Leonar

BSN -3

NCM 113

What to look for

The signs and symptoms of a low potassium level reflect how important this
electrolyte is to normal body functions.
Neuromuscular alerts. Skeletal muscle weakness, especially in the legs, is a
sign of a moderate potassium loss. Weakness progresses and paresthesia
develops. Leg cramps occur. Deep tendon reflexes may be decreased or
absent, and the respiratory muscles could be paralyzed or weakened.
Because of potassium's effects on cell function, hypokalemia can lead to
rhabdomyolysis, a breakdown of muscle fibers leading to myoglobin in the
urine. As smooth muscle is affected by hypokalemia, the patient may develop
anorexia, nausea, and vomiting.
ECG alerts. The patient's pulse may be weak and irregular, and he may have
orthostatic hypotension. The ECG may show a flattened T wave, a depressed
ST segment, and a characteristic U wave.
Ventricular arrhythmias and cardiac arrest can result from hypokalemia.
Closely watch a hypokalemic patient who's taking digitalis glycosides and a
diuretic; hypokalemiacan potentiate digitalis toxicity.
Other problems. In addition, the pabent may experience intestinal problems
such as decreased bowel sounds, constipation, and paralytic ileus.
When hypokalemia is prolonged, the kidneys can't concentrate urine and
diuresis occurs.
What tests show
The following test results help confirm the diagnosis of hypokalemia:
serum potassium level less than 3.5 mEq/liter
elevated pH and bicarbonate levels
slightly elevated serum glucose level characteristic ECG changes.
How hypokalemia is treated
Treatment of hypokalemia focuses on restoring a normal potassium balance,
preventing serious complications, and removing or treating the underlying causes.
Treatment varies depending on the severity of the imbalance.
Provide a high-potassium diet.
If increased dietary potassium isn't sufficient to treat less-acute hypokalemia,
provide oral potassium supplements using potassium salts, preferably
potassium chloride, as ordered.
If hypokalemia is severe or the patient can't take oral supplements,
administer IN. potassium replacement therapy.
Once the serum potassium level is back to normal, the patient may get a sustainedrelease oral potassium supplement as well as increased dietary potassium. Patients
taking diuretics may be switched to a potassium-- sparing diuretic to prevent
excessive urinary potassium loss.
How you intervene
Careful monitoring and skilled interventions can help prevent hypokalemia and
spare
your
patient
complications.
For
patients
at
risk
for
developing hypokalemia and those who have hypokalemia already, you'll want to
perform these actions:

Denisse Audrey D. Leonar

BSN -3

NCM 113

Assess and monitor

Monitor vital signs, especially pulse and blood pressure. Hypokalemia can
cause orthostatic hypotension.
Monitor serum potassium levels. Changes in them can lead to serious cardiac
complications.
Assess heart rate and rhythm and ECG tracings in the severely hypokalemic
patient whose serum potassium level is less than 3 mEq/liter.
Assess the patient's respiratory rate, depth, and pattern. Notify the patient's
health care provider at once if respirations become shallow and rapid. Keep a
manual resuscitation bag at the bedside of a severely hypokalemic patient.
Assess for clinical evidence of hypokalemia, especially in patients getting
diuretics or digitalis glycosides.
Monitor and document fluid intake and output. Each liter of urine contains
about 40 mEq of potassium. Diuresis can put the patient at risk for potassium
loss.
Check for signs of metabolic alkalosis, including irritability and paresthesia.
Give oral potassium supplements
To prevent gastric irritation from oral potassium supplements, administer the
supplements in at least 4 ounces of fluid or with food.
Don't crush slow-release tablets; if crushed, they'll trigger a quick load of
potassium into the body.
Provide a safe environment for the patient who's weak from hypokalemia.
Explain any activity restrictions.
Check for signs of constipation. Although medication may be prescribed to
combat constipation, don't use laxatives that promote potassium loss.
Emphasize the importance of taking potassium supplements as prescribed,
especially if the patient also takes digoxin or diuretics. If appropriate, teach
him to recognize and report signs of digitalis toxicity, such as pulse
irregularities, anorexia, nausea, and vomiting.
Make sure he can identify the signs and symptoms of hypokalemia.
Here are some guidelines for administering IN. potassium and for monitoring
patients getting it. Remember that IN. replacement of potassium is necessary only if
hypokalemia is severe or if the patient can't take oral potassium supplements.
Never administer potassium by IN. push or bolus; doing so may cause cardiac
arrhythmias or cardiac arrest.
When adding the potassium preparation to an IN. solution, mix well. Don't
add it to a container in the hanging position; the potassium will pool and the
patient will get a highly concentrated bolus.
To avoid or lessen toxic effects, make sure I.V. infusion concentrations don't
exceed 60 mEq/liter. Rates usually are 10 mEq/hour, sometimes 20 mEq/hour.
More-rapid infusions may be ordered in severe cases, but this requires closer
monitoring of cardiac status, The maximum adult dose shouldn't exceed 200
mEq/24 hours, unless prescribed.
Use an I.V. pump when administering potassium solutions to control flow rate.
Monitoring patients

Denisse Audrey D. Leonar

BSN -3

NCM 113

Monitor the patient's cardiac rhythm during I.V. potassium administration of

more than 5 mEq/hour or a concentration of more than 40 mEq/liter of fluid.
Report any irregularities immediately.
Evaluate the results of treatment by checking serum potassium levels and
assessing the patient for signs of toxicity, such as muscle weakness or
paralysis.
I.V. potassium preparations can irritate peripheral veins, so watch the I.V. site
for signs and symptoms of infiltration, phlebitis, or tissue necrosis. If possible,
administer potassium through a central line to decrease vein irritation.
Monitor the patient's urine output and notify his health care provider of
inadequate volume. Urine output should be greater than 30 ml/hour to avoid
hyperkalemia.

Copyright Springhouse Corporation Nov 2000

Publisher: Springhouse Corporation
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