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The nurse should monitor a patient for the signs and symptoms of hyper-
kalemia. The more common of these are:

• Nausea.


• Cold skin; grayish pallor.


• Hypotension.


• Mental confusion and irritability.


• Abdominal cramps.


• Oliguria (decreased urine output).


• Tachycardia (fast pulse) and later bradycardia (slow pulse).


• Muscle weakness to flaccid paralysis.


• Numbness or tingling in the extremities.


• Peaked T waves on the EKG.

The nurse must respond quickly once signs and symptoms of hyperkalemia
develop as the patient is at risk for seizures, injury related to muscle weakness,
and cardiac arrhythmias. Here is what needs to be done.

• Restrict intake of potassium rich foods.


• Administer diuretics and ion-exchange resins such as Kayexalate (reten-
  tion enema) as directed to increase the elimination of potassium.


• Dialysis therapy may be ordered in critical cases to remove potassium.


• Administer insulin and glucose parenterally to force potassium back
  inside cells.


• Administer sodium bicarbonate intravenously to correct the acidosis (ele-
  vate pH).


• Administer calcium gluconate intravenously to decrease the irritability of
  the heart; it does not promote potassium loss.

Hypokalemia

Hypokalemia occurs when a patient has a serum potassium level of less than
3.5 mEq/L. A number of factors can cause this condition. These include:

• Diarrhea.


• Vomiting.


• Fistulas.


• Nasogastric suctionings.


• Diuretics.


• Hyperaldosteronism.


• Magnesium depletion.

CHAPTER 10 Fluid and Electrolyte Therapy^165