Potassium (K+) 3.5 5.0 MEq/L Major Cation of ICF (98%) Function: 1. Regulates intracellular osmolality and 2.

. Promotes cellular growth K+ moves into cells during formation of new tissues and leaves the cell during tissue breakdown 3. Sodium-potassium pump Adequate intracellular magnesium is necessary for normal function of the pump (fueled by the breakdown of ATP) 4. Neuromuscular and cardiac function 5. Assists in regulation of acid-base balance by cellular exchange with H+ Regulation: Dietary intake (source of potassium) Loss of potassium o Primarily via kidneys (90% elimination) Body conserves K+ poorly, so, any condition that UOP will serum K+ concentration o GI secretions, stool o Sweat Aldosterone Factors that cause Na+ retention ( blood volume, aldosterone) ----will cause K+ loss in urine Hypokalemia: Causes: o Abnormal losses via kidneys or GI tract Renal increased UOP, K+ wasting diuretics GI diarrhea, laxative abuse, vomiting, & ileostomy drainage, NG drainage o Hyperaldosteronism o Shift of K+ into cells Insulin Alkalosis Beta-adrenergic stimulation (catecholamine release in stress, coronary ischemia, delirium tremens, B-agonists medications) Rapid cell building (TX of anemia with folic acid, vitamin B-12, erythropoietin) o Diaphoresis o Magnesium depletion ( Mg stimulates renin release & subsequent aldosterone which results in K+ excretion) o Treatment of DKA With DKA----K+ may be , , or normal o Dialysis o Decreased intake starvation, diet low in potassium, failure to include IV K+ when NPO) Signs and Symptoms (due excitability of cells): Fatigue; muscle weakness; leg cramps; nausea; vomiting; paralytic ileus; soft, flabby muscles; parestheisas; decreased reflexes; weak, irregular pulse; may have weakness or paralysis of respiratory muscles; insulin release is impaired resulting in hyperglycemia. (Cardiac concerns): EKG changes ST depression, flattened T wave, presence of U wave, Ventricular dysrhythmias (PVCs), bradycardia, enhanced digitalis effect ( risk of digitalis toxicity), P wave may become peaked Treatment: o Potassium replacement (always make sure adequate UOP)---at least 0.5 ml/kg/hr Oral (irritating to GI tract)---give with food and full glass of water IV (never give IVP, no more than 10 20 mEq/hour, ideal concentration is 40 mEq/L----if severe may be 80 mEq/L, irritating to veins, always use IV pump) Monitor IV site

Invert bag several times to mix well Increasing dietary intake

Hyperkalemia: Causes: o Excessive K+ intake Excessive or rapid parenteral administration Salt substitute o Rapid transfusion of stored, hemolyzed blood o Fluid volume deficit (possible acute kidney injury) o Shift of K+ out of cells Acidosis DKA (K+ may be , , or normal) Tissue catabolism (fever, sepsis, burns, crush injury, tumor lysis, exercise) o Failure to eliminate K+ Renal failure (most common reason for hyperkalemia) Some medications (potassium sparing diuretics, ACE-I, ARB, Beta-blockers, spironolactone (Aldactone); triamterene (Dyrenium), potassium-penicillin) Adrenal insufficiency Signs and Symptoms (due to cell excitability): Irritability; anxiety; abdominal cramping; diarrhea; weakness of lower extremities & leg cramps; parestheisas; irregular pulse (Cardiac concerns): o EKG changes Tall, peaked T wave; prolonged PR interval; ST segment depression; loss of P wave; bradycardia, widening QRS; ventricular fibrillation; ventricular standstill Treatment: o Elimination of K+ intake (oral and/or IV) o Increased elimination K+ Diuretic, dialysis, ion-exchange (sodium polystyrene sulfonate {Kayexalate}; increased fluid intake o Force K+ from ECF to ICF IV insulin along with glucose IV sodium bicarbonate o Reverse the membrane potential effects of ECF K+ by administering calcium gluconate IV. Calcium ion can immediately reverse the membrane excitability. Dietary Sources: Fruits (especially bananas, oranges, & dried fruits) Vegetables Meats Nuts Salt substitute Milk, yogurt Nursing Diagnosis with Hypokalemia: Risk for electrolyte imbalance r/t to excessive loss of potassium Risk for injury r/t muscle weakness and hyporeflexia Activity intolerance r/t muscle weakness Risk for decreased cardiac tissue perfusion r/t possible dysrhythmias from electrolyte imbalance PC: Dysrhythmias Nursing Diagnosis with Hyperkalemia: Risk for electrolyte imbalance r/t excessive retention or cellular release of potassium Risk for injury r/t lower extremity muscle weakness and seizures PC: dysrhythmias

 Risk for Activity intolerance r/t muscle weakness Risk for excess fluid volume r/t untreated renal failure Risk for decreased cardiac tissue perfusion r/t abnormal electrolyte level affecting hart electrical conduction Common Clinical Indications for Potassium- Controlled Diets: Renal failure, K+ wasting or K+ sparing diuretics.
BNorton---01/05/11; 06/07/11