Hypokalemia and Hyperkalemia admission

Hypokalemia:

Usually this is noticed incidentally when patients come to ER with some other acute problem like severe diarrhea, arrhythmia, alcohol abuse, syncope or dizziness (dehydration), malnutrition etc.

ER:

Routine Labs

May give tiny doses of PO Potassium

Hospitalist:

If very low, Telemetry admission

Serum Magnesium Level, Phosphorus level

Potassium Chloride 10meq IV every 3-4hrs X 1-4 (in ICU via Central Line, 20meq IV can be given)

Potassium Chloride (K-Dur) 20-40meq PO X 2 [Liquid form is available for patients with swallowing issues]

Hold HCTZ/Chlorthalidone

Nephrology evaluation rarely for refractive Hypokalemia (rare)

 Hyperkalemia:

Patient can be in ER with some other acute illness. Patient could be having Acute Renal Failure or chronic kidney disease, taking Potassium Supplements, on lisinopril or Angiotensin Receptor Blocker

Check if BMP is hemolyzed. I prefer to repeat blood work just to confirm Hyperkalemia before giving multiple treatments to correct it. Sometimes, keeping the torniquet for prolonged time while drawing blood and the way the specimen is handled can lead to false high potassium level.

Stop fruit juice, fruits

Stop all potentially offending drugs-ACEI, ARBs,  Spironolactone, Amiloride, NSAIDs and K+ containing laxatives

12-lead ECG and cardiac monitoring

Calcium Gluconate 10ml of 10% intravenously over 2 minutes, (If patient is taking digoxin, calcium gluconate should be given slowly over 20 minutes mixed in 100ml of glucose 5% to prevent myocardial digoxin toxicity)

50ml of Dextrose 50% and administer by slow IV injection over 5 minutes PLUS Insulin 6-10 units of Regular Human Insulin (I prefer giving 6 units of Insulin)

Albuterol 7.5 -15mg Continuous nebulization for 30 min to one hour

Kayexalate 15-30mg PO X 1

Low potassium diet

Nephrology Evaluation if needed as a last resort for Hemodialysis.