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Hypokalaemia (serum K <3.5) (Anaesthetic management (Avoidance of…
Hypokalaemia (serum K <3.5)
Causes
Increased loss
Renal: diuretics
GI: vomiting, diarrhoea
Endocrine: Hyperaldosteronism, Cushings
Inadequate intake
Anorexia
Shift from ECF to ICF
Alkalosis
B2 agonists
Insulin
Anaesthetic concerns
Paralysis and sensitivity to NMBs
Arrhythmias: ECG - U waves, TWI, prolonged PR
Anaesthetic management
Confirm diagnosis
Exclude spuriously low levels e.g. bloods from IV line
Preoperative replacement
Controversial: Chronic hypoK is associated with depletion of total body stores. Safe replacement takes days. PLUS risk of hyperK
Indications for correction
Life threatening (paralysis, arrhythmias)
Profound (very low K)
RFs for arrhythmias (CCF, on digoxin, ECG changes of HypoK)
Routes
Enteral - preferred for non emergent
IV - < 20mmol/hr as associated with pain and thrombophlebitis
Avoidance of further drops in K
Insulin, glucose
B agonists
Bicarb
Diuretics
Resp Alkalosis
Muscle Relaxation
Hyperpolarization cell membrane - reduce effect of depolarising and increases effect of NDMBs