Checklist Approach to Hypokalemia Consider risk factors for arrhythmia: - EKG changes (especially QT prolongation) - Digoxin - Myocardial ischemia - Concomitant severe hy pomagnesemia Evaluation - Check magnesium lev el - Repeat electrolytes if doubt exists about their validity (e.g. incongruous with clinical context & EKG) Consider magnesium repletion - May be the fastest way to reduce the risk of arrhythrnia (aggressive magnesium can be given safely, whereas potassium needs to be given at a controlled rate). - Repletion Of Mg is often necessary to successfully replete the potassium. Consider target potassium level - Most patients (including cardiac patients): > 3.5 - Severe renal failure: > 3 mM ? - DKA: >5.3mM ? Enteral potassium is preferred if possible - Contraindications to enteral route = severe hypokalemia (<2.5 mM), NPO, or profound shock with questionable enteral absorption. - Dose & monitoring depend on renal function & estimated potassiurn deficit. Intravenous potassium - Use only if cmtraindication to enteral. - Rate of 10 mEq/hr for routine repletion. - Rate of 20 mEq/hr for severe hypokalemia or DKA (either via central line or split into two simultaneous infusions of 10 mEq/hr in two peripheral lines). - Dose & frequency Of monitoring depend on renal function & estimated deficit. Dr. Josh Farkas @pulmcrit - Internet Book of Critical Care #Checklist #Hypokalemia #Management #CriticalCare
