Correct the underlying cause and replace it with normal (isotonic) saline. Remember to check serum sodium frequently.
Hyper-Kalemia (K+)
Diagnosis:
First peaked T-waves occur, then loss of the P-wave, and then the widened QRS complex occurs.
Management:
Moderate HyperKalemia with no EKG abnormalities:
1 – Insulin and glucose intravenously.
2 – Bicarbonate to shift K+ into the cell when acidosis is the cause of the K+ or there is rhabdomyolysis, hemolysis, or another reason to alkalinize the urine.
3 – Kayexalate (K+-binding resin) is administered orally to remove K+ from the body. This takes several hours.
Severe HyperKalemia with EKG abnormalities:
1 – Administer Ca++ gluconate IV to protect the heart.
2 – Follow with insulin and glucose IV.
3 – Conclude with Kayexalate.
Bicarbonate MOA to lower K+:
When alkalosis pulls H+ out of cells, another cation must go in to maintain electrical neutrality. As H+ ions come out of cells, K+ goes in.
HypO-Kalemia
EKG
Show “Uwaves,” which have an extra wave after the T-wave indicative of Purkinje fiber repolarization.
Management:
IV K+ replacement must be slow so as not to cause an arrhythmia with overly rapid administration.
Avoid:
Glucose-containing fluids in cases of HYPO-K+. They will increase insulin release and worsen hypokalemia.
Hyper-Magnesimia
Presentation:
muscular weakness and loss of deep tendon reflexes.
