Favored for hypokalemia and concurrent acidosis

^Favori.'d for hypokalemia and concurrent alkalosis

Potassium deficit (mEq) = (4.0 - current serum potassium) x 100

Severe hypokalemia is defined as a serum potassium less than 2.5 mEq/L (2.5 mmol/L) or hypokalemia of any magnitude that is associated with ECG changes (e.g., flattening of T-wave or elevation of U-wave) and cardiac arrhythmias. In these situations, IV replacement should be initiated urgently. Potassium infusion at rates exceeding 10 mEq/h requires cardiac monitoring given the potential for cardiac arrhythmias. Although the maximally concentrated solution for potassium replacement is 80 mEq/L (80 mmol/L), the maximum infusion rate is 40 mEq/h (40 mmol/h), and must be administered via a central line. Table 27-8 outlines current IV potassium replacement guidelines.

Caution must be exercised when repleting potassium with IV agents given possible vein irritation and/or thrombophlebitis. The risk of these complications is minimized by using less concentrated solutions and by giving infusions via central access if possible. Administration of potassium in vehicles containing glucose is discouraged, as glucose facilitates the intracellular movement of potassium. Post-therapy improvements in serum potassium may be transient and continuous monitoring is required. Patients with a low serum magnesium will have exaggerated potassium losses from the kidneys and GI tract leading to refractory hypokalemia. In this situation, the magnesium deficit must be corrected in order to successfully treat the concurrent potassi um deficiency. In the hypokalemic patient with concurrent acidosis, potassium is often given as the acetate salt, given that acetate is metabolized to bicarbonate. In the patient with depleted phosphorus and potassium, therapy with potassium phosphate is the natural choice.22,26,27

Table 27-7 Oral Potassium Replacement Products

Product

Salt

Strength0

F xtended/controE√Čed

Chloride

S mEq (600 rng)

release tablets

10 mEq (750 my)

15 mEq (1,125 mg)

20 mEq 0,500 rjig)

Effervescent tablets

Chloride and

20 mEq

bicarbonate

25 mEq

50 mEq

Liquid

Chloride

20 rnEq/15 mL {10%)

30 mEq/15 mL (15M0

40 mEq/15 ml (?0%)

Powder packets

Chloride

15 mEq

20 mFq

25 mEq

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