CHAPTER 11 Fluids and Electrolytes^433
PROGNOSIS
As potassium levels rise, the risk of cardiac arrhythmias also increases. An extreme
elevation creates a medical emergency. Correction or management of the underly-
ing cause is necessary to help restore the electrolyte balance.
HALLMARK SIGNS AND SYMPTOMS
- Weakness and dizziness due to neuromuscular changes
- Abdominal distention
- Nausea, vomiting, diarrhea due to change in membrane potential on GI system
- Palpitations due to arrhythmias
- Arrhythmias due to changes in normal cardiac conduction
- Cardiac arrest
INTERPRETING TEST RESULTS
- Potassium level > 5 mEq/L.
- EKG shows peaked T-waves, widened QRS-waves, ventricular asystole, car-
diac arrest.
TREATMENT
The treatment choices will depend on the severity of the potassium elevation.
Decreasing further intake, enhancing renal excretion, and cellular uptake are all
goals of treatment.
- Monitor cardiac rhythm.
- Administer intravenous insulin and glucose to move potassium from extra-
cellular fluid to intracellular fluid. - Administer calcium gluconate intravenously.
- Administer NaHCO 3 to move potassium from extracellular fluid to intracel-
lular fluid. - Administer diuretics to remove potassium from body.
- Administer kayexalate to remove potassium from body via GI tract.
- Monitor electrolyte levels.