Hypokalemia - initial diagnosis and treatment.pptVIP

Hypokalemia - initial diagnosis and treatment How to supply K Decrease 1 meq/L means deficient 200~400 meq K Check the Osmolarity and Acid-base status, especially DKA and acidosis will mask the K deficient condition Don’t use sugar content IVF Cl Every bottle 20 meq KCl, except femoral line is available Acid –base disorder in hypokalemia Vomiting and UCl Summary Please collect urine before supplement Check Serum: Na, K, Cl, Ca, P, Mg, BUN, Cr, Osmo, Ht, Hct, (P,抽完先請檢驗室離心處理檢體否則cell lysis 會影響數據) Check Urine: Na, K, Cl, P, Ca, Mg, Cr, Osm, (uric acid, Urea, protein) Check Blood gas: vein is also OK 如有 elevated GOT, please check CPK We are always available !!! * * MMH A1 施孟甫 Blood pressure Renin Renin Aldo K + excretion rate and acid - base status ? H H y y p p o o k k a a l l e e m m i i a a P P a a r r a a l l y y s s i i s s L L o o w w K K + + e e x x c c r r e e t t i i o o n n a a n n d d n n o o r r m m a a l l a a c c i i d d - - b b a a s s e e l SPP l Barium poisoni ng l FPP l Hypernatremic HPP None Family history Hypernatremia High K + excretion and abnormal acid - base Acid - base state ? Clue Hyperthyroidism ? l TPP YES NO Metabolic Acidosis NH + 4 excretion (UAG, UOG) Low High Toluene Profound diarrhea RTA Metabolic Alkalosis R enin Normal GS or BS Diuretics Vomiting High Primary mineralocorticoid excess Aldo Aldo Primary Aldo steronism Licorice use AME Ectopic ACTH Liddle syndrome Lin SH et al. Am J Emerg Med 2003 ( Low Renin Low Aldosterone Cortisol Ectopic ACTH Cushing syndrome Liddle’s Licorice AME DOC 11 b hydorxylase D 17 a hydorxylase D High Normal Low Lin SH, et al. Am J Med Sci 2003; 325: 153-156. Liddle, Bartter, Gitelman Penicillin derivatives Salt-wasing nephropathy Mineralocorticoid excess LGI loss( diarrhea, laxative abuse Vomiting, NG RTA Diuretic therapy DKA Metabolic alkalosis Metabli