Hypokalemia


THE CALL

Overview

Etiology

History/Symptoms

Physical Exam/Signs

Diagnosis

Differential Diagnosis

Management

Correct hypovolemia if present (secondary hyperaldosteronism).
** KCL 40 mEq = Serum 1.0 mEq/L
  1. Initial/Prep/Goals
  2. Mild (3.0 - 3.5), asymptomatic
  3. Moderate (< 3.0 mEq/L)
  4.  Severe (< 2.5 mmol/L) and symptomatic, signs of rhythm disturbance

Disposition

  1. Admit for K+ < 2.5 mEq/L [<2.7 mmol/L]
  2. If patient discharged:

 

Potassium (K) PO Replacement:
(Normal Range 3.5 to 5.0 mEq/L)

Potassium (K)
Level (mEq/L)
Potassium Dose *
for Cr. <1.5
Potassium Dose *
for Cr. 1.5-1.9
Repeat K level
(Lab)
> 4 No Treatment No Treatment Next AM Lab
3.8 - 3.9 3.8 - 3.9 20 mEq KCL PO x 1 dose 10 mEq KCL PO x 1 dose Next AM Lab
3.6 - 3.7 40 mEq KCL PO x 1 dose 20 mEq KCL PO x 1 dose Next AM Lab
3.3 - 3.5** 30 mEq KCL PO q 4 hrs x 2 doses 30 mEq KCL PO x 1 dose Next AM Lab
3.0 - 3.2** 40 mEq KCL PO q 3 hrs x 2 doses 30 mEq KCL PO q 4 hrs x 2 doses BMP 2 hours after
last dose given
< 3.0**
(Notify MD)
Start TELEMETRY
40 mEq KCL PO STAT (Solution
preferred for first dose), then
40 mEq KCL PO q 2 hrs x 2 doses
Start TELEMETRY
40 mEq KCL PO STAT (Solution preferred for first dose), then 40 mEq KCL PO in 4 hrs x 1 dose
BMP 2 hours after
last dose given
* Use KlorCon M20 if patient can swallow whole tablet (DO NOT CRUSH TABLETS)
Use KCL Oral solution (20mEq/15 cc) if patient has a feeding tube or cannot swallow whole tablets.
** Add Magnesium level to same lab if K is < 3.6 and refer to Mg protocol below
 

Potassium (K) IV Replacement:
(Normal Range 3.5 to 5.0 mEq/L)

K+ Replacement Repeat K level (Lab)
3.6 - 3.9 KCL 20 meq over 2 hours IV (20 mEq/100 ml water) or by PO) 6 hrs after infusion complete.
3.1 - 3.5 KCL 40 meq over 2 hours IV (20 mEq /100 ml water) (or by PO) 6 hrs after infusion complete.
2.5 - 3.0 KCL 60 meq over 3 hours IV (20 mEq /100 ml water) 6 hrs after infusion complete.
1.8 - 2.4 KCL 80 meq over 4 hours IV (20 mEq /100 ml water) 6 hrs after infusion complete.
< 1.8 Start TELEMETRY
Notify physician. KCL 80 mEq over 4 hrs IV (20 meq /100 ml water)
6 hrs after infusion complete.

ADMISSION ORDERS:

1. Admit to:
2. Diagnosis: Hypokalemia
3. Condition:
4. Vital Signs: Vitals, urine output q4h. Call physician if BP >160/90, <90/60; P>120, <50; R>25, <10; T >38.5°C.
5. Activity: Bed rest; up in chair as tolerated.
6. Nursing: Inputs and outputs
7. Diet: Regular
8. Special Medications:
Acute Therapy:
-KCL 10 mEq in 100 cc saline infused IVPB over 1-2 hours; or add 40-80 mEq to 1 liter of IV fluid and infuse over 4-8 hours.
-KCL elixir 40 mEq PO tid (in addition to IV); max total dose 100-200 mEq/d (3 mEq/kg/d).
Chronic Therapy:
-Micro-K 10 mEq tabs 2-3 tabs PO tid after meals (40-100 mEq/d) OR
-K-Dur 20 mEq tabs 1 PO bid-tid.
Hypokalemia with metabolic acidosis:
-Potassium citrate 15-30 mL in juice PO qid after meals (1 mEq/mL).
-Potassium gluconate 15 mL in juice PO qid after meals (20 mEq/15 mL).
9. Extras: ECG, dietetics consult.
10. Labs: CBC, magnesium, chem 7&12. UA, urine Na, 24h urine for K, creatinine.