Lifestyle
Patients with hyperkalemia without CKD/HF can be treated with lifestyle interventions if potassium is in ___ to ___ range.
5.3-5.5
Name 3 medications that cause hypokalemia due to renal losses.
Thiazides, Loops Diuretics, Mineralocorticoids, Exogenous Steroids, Drugs that cause hypomagnesemia like amphotericin, aminoglycosides
T/F: EKG changes have a low sensitivity for detecting hyperkalemia and do not reliably correlate with serum potassium concentration levels
True
a) Chloride B) Bicarbonate C) Citrate d) Phosphate
A - Chloride
What electrolyte abnormality is associated with hypokalemia?
Hypomagnesemia
Which of the following meats has > 250 mg K+ per serving?
A) Beef B) Chicken C) Pork D) Lamb E) All of the above
E - All of the Above
Name 2 medications (besides ACE/ARB, potassium sparing diuretics) that cause hyperkalemia
NSAIDs, heparin, digoxin, Bactrim
Hypokalemia in patients with CHF or MI is associated with increased risk of which arrythmias?
Ventricular Tachycardia or V Fib, Torsades
What are the 3 treatment options for hyperK+ that work by driving extracellular potassium into cells?
Insulin, beta agonists, sodium bicarbonate (used if metabolic acidosis, no ESRD)
What is the duration of effect for insulin, bronchodilators for hyperkalemia treatment?
2 hours
The WHO recommends a potassium intake of at least __ mg / day
3510
Which of the following conditions causes hypokalemia due to intracellular shifts?
a) Hyperthermia b) Thyrotoxicosis c) Metabolic acidosis d) Hypomagnesemia
B - Thyrotoxicosis
Which of the following is NOT a common EKG finding associated with hyperkalemia?
A) Prolonged PR interval B)T wave inversion C) Peaked T wave
D) Bradyarrythmia E) Flattening of P wave
B - T wave inversion
What is the mechanism of action of IV calcium gluconate?
Stabilizes cardiac membrane by rapid reduction of excitatory effects of potassium in cardiac tissue membrane
Dose calcium gluconate: 1000-2000 mg over 2-5 minutes; used if EKG changes, or potassium >6.5
Name 2 genetic syndromes that can cause hypokalemia
Liddle's, Bartter, Gitelman syndrome
The dietary potassium recommendation for CKD stage 4/5 is < ___ mg/day
Name 3 drugs that cause hypokalemia due to intracellular shifts
Insulin, beta agonists (epinephrine, bronchodilators), caffeine, theophylline
Late EKG finding in hyperkalemia
Sine wave pattern
___ is the preferred potassium sparing diuretic for treatment of hypokalemia due to renal wasting (exception: primary aldosteronism)
Amiloride
In evaluation of hypokalemia, the most accurate method for evaluating urinary potassium excretion is ___. A more practical approach is calculation of ___
24 hour timed urine K collection
Urine potassium to creatinine ratio from spot urine specimen
Which of the following vegetables has the highest potassium content?
A) Spinach B) Tomatoes C) Broccoli D)Seaweed E) Potatoes
D- Seaweed
Name a cause of pseudo-hypokalemia
Recent insulin administration, WCC > 100k
The earliest EKG change in hypokalemia is?
A) Prolonged PR interval B) Decreased amplitude of T wave C) Wide QRS d) U wave
B - decreased amplitude of T wave
Which of the following potassium phosphate binders is associated with serious adverse GI effects like intestinal ischemia and thrombosis?
a) Sodium polystyrene sulfonate (Kayexalate)
b)Sodium zirconium cyclosilicate (Lokelma)
c) Patiromer (Veltassa)
d) All of the above
A - Kayexalate
Hypokalemic ___ is a rare neuromuscular disorder characterized by potentially fatal episodes of muscle weakness or paralysis that can affect the respiratory muscles
Hypokalemic periodic paralysis