Hypokalemia - initial diagnosis and treatment

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Hypokalemia - initial diagnosis and treatment
MMH A1 ???
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Lin SH et al. Am J Emerg Med 2003 (
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Low Renin Low Aldosterone
Cortisol
Low
High
Normal
Liddles Licorice AME DOC
Ectopic ACTH Cushing syndrome
11 b hydorxylase D 17 a hydorxylase D
Lin SH, et al. Am J Med Sci 2003 325 153-156.
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How to supply K

• Decrease 1 meq/L means deficient 200400 meq K
• Check the Osmolarity and Acid-base status,
  especially DKA and acidosis will mask the K
  deficient condition
• Dont use sugar content IVF
• Cl
• Every bottlelt 20 meq KCl, except femoral line is
  available

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Acid base disorder in hypokalemia
Metablic acidosis Metabolic alkalosis
DKA Diuretic therapy
RTA Vomiting, NG
LGI loss( diarrhea, laxative abuse Mineralocorticoid excess
Salt-wasing nephropathy Penicillin derivatives
Liddle, Bartter, Gitelman
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Vomiting and UCl
Time Na K Cl HCO3- pH
Day 1-3 ? ? ? ? gt 6.5
Late ? ? ? ? lt 5.5
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Summary

• Please collect urine before supplement
• Check Serum Na, K, Cl, Ca, P, Mg, BUN, Cr, Osmo,
  Ht, Hct, (P,???????????????cell lysis ?????)
• Check Urine Na, K, Cl, P, Ca, Mg, Cr, Osm,
  (uric acid, Urea, protein)
• Check Blood gas vein is also OK
• ?? elevated GOT, please check CPK
• We are always available !!!

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