BSN Notes: Common Signs And Symptoms: Hypokalemia

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Serum potassium imbalance 
Potassium:
            It is a major intracellular cation.
            The normal plasma potassium concentration is 3.5-5.0 mEq/L whereas that inside the cells is about 150 mmol/L.
Disorders of Potassium includes
Hypokalemia
Hyperkalemia

HYPOKALEMIA 
DEFINTION:
Hypokalemia is defined as a plasma potassium concentration level of less than 3.5mEq/L. It is a common disorder especially in older adult population.
CAUSES
1.Potassium loss:
·         GI losses - Vomiting and Diarrhea, fistulas, NG suction
·         Renal losses -  potassium wasting Diuretics (thiazide, loop and osmotic diuretics)  hyperaldosteronism (mineralocorticoid excess), magnesium depletion.
·         Skin losses -  Diaphoresis   
·         Dialysis
2.Shift of potassium into cells:
·         Increased insulin
·         Alkalosis  - potassium exchange with hydrogen ion across the cell wall, thus increasing the level of hydrogen but decreasing the level of potassium in the plasma  
·         Tissue repair
·         Beta adrenergic agonists (basically K goes inside the cells)
3.Lack of potassium intake:
·         Starvation
·         Potassium restricted diet.
·         Failure to include potassium in parenteral fluids if NPO
            CLINICAL FEATURES        
·         Slowed skeletal muscle contraction
·         Slowed smooth muscle contraction
·         Deterioration of respiratory muscle contraction
·         Decrease in myocardial contraction
·         Increased conduction of nerve impulses
·         Slowed smooth muscle contraction leads to GI manifestations - anorexia, abdominal distension and constipation.
·         Slowed Skeletal muscle contractions - weakness muscle cramps, may progress to paralysis.
·         Decreased nerve conduction -  Fatigue, paresthesia, hyporeflexia and irritability  
·         Decreased myocardial contractility -  hypotension weak and slow pulse. If K less than
·         2.5 mEq/L
·         ventricular fibrillation and cardiac arrest.
·         Pulmonary - Shallow respiration, shortness of breath, apnea and respiratory arrest.
ECG Changes:
·         ST segment depression
·         Flattened T wave
·         Presence of U wave
·         Ventricular dysrhythmias
·         Bradycardia
·         Enhanced digitalis effects
In Progressive stage
·         Confusion, depression, convulsions, areflexia, and coma
·         Vomiting, urinary retention
·         Paralysis
·         Inability of kidney to concentrate urine leads to Polyuria, nocturia, and decreased plasma osmolality.
DIAGNOSIS:
History and physical examination:-A detailed history and physical examination
Serum potassium levels
ECG

MANAGEMENT
Medical Management:
·         It is focused on identifying and correcting the cause of the imbalance.
·         The aggressiveness of the therapy depends on the potassium level and the clinical manifestations.
Minor potassium deficit
·         Administering foods high in potassium helps correct the deficit and offsets losses.
Mild to moderate potassium deficits:
·         Oral potassium replacement
·         Oral potassium is extremely irritating to the gastric mucosa and can produce small bowel lesion and must be taken with a glass of water or juice or with meals.
Severe hypokalemia:
·         KCl supplement added to IV solution.
·         Should not add more than 60 mEq/L.
·         The preferred level is 40 mEq/L.
·         The rate of administration should not exceed 10 to 20 mEq per hour to prevent hyperkalemia and cardiac arrest.
·         Potassium given intravenously must always be diluted in IV fluids
Nursing management:
Assessment
Physical examination
 Nursing diagnosis
·         Hypokalemia related to nausea, vomiting or prolonged use of diuretics

·         Risk for injury related to muscle weakness and hypotension or seizures secondary to hypokalemia.


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