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



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