POTASSIUM IMBALANCE
Potassium imbalance plays a vital role in cell METABOLISM, and TRANSITION of
nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance.
3.5 - 5 mEq/L
HYPERKALEMIA > 5 mEq/L HYPOKALEMIA < 3.5 mEq/L
✹ TIGHT & CONTRACTED ✹ Thready, weak, irregular pulse
✹ Orthostatic hypotension
SIGNS & SYMPTOMS
M uscle cramps & weakness
✹ Shallow respirations
U rine abnormalities ✹ Anxiety, lethargy, confusion, coma
R espiratory distress ✹ Paresthesias
✹ Hyporeflexia
D ecreased cardiac contractility (↓HR, ↓BP)
✹ Hypoactive bowel sounds (constipation)
E CG changes
• Tall peaked T waves
✹ Nausea, vomiting, abdominal distention
R eflexes (↑ DTR ) • Flat P waves ✹ ECG changes
• Widened QRS complexes • ST depression
• Prolonged PR intervals • Shallow or inverted T wave
• Prominent U wave
✹ Medication
➥ Potassium-sparing diuretics (Spironolactone) ✹ Actual total body potassium loss
➥ Ace inhibitors ✹ Inadequate potassium intake
➥ NSAIDs ➥ Fasting, NPO
✹ Excessive potassium intake ✹ Movement of potassium from the
RISK FACTORS
(Example: rapid infusion of potassium-containing IV solutions) extracellular fluid to the intracellular fluid
✹ Kidney disease or those on Dialysis ➥ Alkalosis
➥ Decreased potassium excretion ➥ Hyperinsulinism
✹ Adrenal insufficiency (Addison’s disease) ✹ Dilution of serum potassium
➥ Water intoxication
✹ Tissue damage
➥ IV therapy with potassium-deficient solutions
✹ Acidosis
✹ Hyperuricemia
Potassium imbalance can cause cardiac dysrhythmias
✹ Hypercatabolism that can be life-threatening!
✹ Monitor EKG ✹ Oral potassium supplements
✹ Discontinue IV & PO potassium ✹ Liquid potassium chloride
MANAGEMENT
✹ Initiate a potassium-restricted diet ✹ Potassium-retaining diuretic
✹ Potassium-excreting diuretics ✹ Potassium is NEVER administered
✹ Prepare the client for dialysis by IV push, IM, or subcut routes.
✹ Prepare for administration: ➥ IV potassium is always diluted &
administered using an infusion device!
➥ IV calcium gluconate & IV sodium bicarb
✹ Avoid the use of salt substitutes or
other potassium-containing substances
Potassium & sodium = opposites Example: ↑ Na = ↓ K+
© 2020 NurseInTheMaking LLC
Potassium imbalance plays a vital role in cell METABOLISM, and TRANSITION of
nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance.
3.5 - 5 mEq/L
HYPERKALEMIA > 5 mEq/L HYPOKALEMIA < 3.5 mEq/L
✹ TIGHT & CONTRACTED ✹ Thready, weak, irregular pulse
✹ Orthostatic hypotension
SIGNS & SYMPTOMS
M uscle cramps & weakness
✹ Shallow respirations
U rine abnormalities ✹ Anxiety, lethargy, confusion, coma
R espiratory distress ✹ Paresthesias
✹ Hyporeflexia
D ecreased cardiac contractility (↓HR, ↓BP)
✹ Hypoactive bowel sounds (constipation)
E CG changes
• Tall peaked T waves
✹ Nausea, vomiting, abdominal distention
R eflexes (↑ DTR ) • Flat P waves ✹ ECG changes
• Widened QRS complexes • ST depression
• Prolonged PR intervals • Shallow or inverted T wave
• Prominent U wave
✹ Medication
➥ Potassium-sparing diuretics (Spironolactone) ✹ Actual total body potassium loss
➥ Ace inhibitors ✹ Inadequate potassium intake
➥ NSAIDs ➥ Fasting, NPO
✹ Excessive potassium intake ✹ Movement of potassium from the
RISK FACTORS
(Example: rapid infusion of potassium-containing IV solutions) extracellular fluid to the intracellular fluid
✹ Kidney disease or those on Dialysis ➥ Alkalosis
➥ Decreased potassium excretion ➥ Hyperinsulinism
✹ Adrenal insufficiency (Addison’s disease) ✹ Dilution of serum potassium
➥ Water intoxication
✹ Tissue damage
➥ IV therapy with potassium-deficient solutions
✹ Acidosis
✹ Hyperuricemia
Potassium imbalance can cause cardiac dysrhythmias
✹ Hypercatabolism that can be life-threatening!
✹ Monitor EKG ✹ Oral potassium supplements
✹ Discontinue IV & PO potassium ✹ Liquid potassium chloride
MANAGEMENT
✹ Initiate a potassium-restricted diet ✹ Potassium-retaining diuretic
✹ Potassium-excreting diuretics ✹ Potassium is NEVER administered
✹ Prepare the client for dialysis by IV push, IM, or subcut routes.
✹ Prepare for administration: ➥ IV potassium is always diluted &
administered using an infusion device!
➥ IV calcium gluconate & IV sodium bicarb
✹ Avoid the use of salt substitutes or
other potassium-containing substances
Potassium & sodium = opposites Example: ↑ Na = ↓ K+
© 2020 NurseInTheMaking LLC
