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Hypokalemia

We can remember the assessment, interventions, and considerations of hypokalemia by this scene of the hippo-banana who got stopped at the border, and after a failed bribery attempt was arrested and tortured! Hypokalemia is defined as a serum potassium of less than 3.5 mEq/L, represented here by the less-than (3) tree pointing to the (.5) hand, which can lead to a variety of clinical manifestations. In the setting of severe potassium deficit with values less than 2.5 mEq/L, muscle weakness can result, often exhibiting a pattern affecting the lower extremities first with progression to the trunk and upper extremities, shown here by the weak-drooping-muscle. Low potassium can also lead to a variety of arrhythmias and other EKG changes, depicted by the broken arrhythmia-drum, including flattening or inversion of the T wave, ST depression, and PR interval prolongation. Additionally, hypokalemic patients may display U waves, shown in this Picmonic as the U-wave, which results from prolonged repolarization of ventricular Purkinje fibers. Insufficient potassium may also cause gastrointestinal (GI) manifestations such as an ileus, represented by the eels, which is secondary to slowed motility and presents clinically with nausea, vomiting, and abdominal distention. When assessing deep tendon reflexes, patients with diminished levels of potassium can exhibit hyporeflexia, decreased and weak reflex responses that are seen here as the hippo-reflex-hammer, related to skeletal muscle dysfunction from this electrolyte imbalance. Severe hypokalemia may even result in flaccid paralysis. Hypokalemia can be treated by infusing IV potassium salts at 5-10 mEq/hr, shown as the IV banana infuser with the (5) hand to the (10) tin. However, several caveats exist regarding IV administration of potassium. In particular, never push IV potassium since rapid infusion can cause cardiac arrest; always dilute potassium preparations to at least 1 mEq per 10 ml concentration, and do not exceed 20 mEq/hr during infusion, because IV potassium is necrotic to veins at rising concentrations. Additionally, potassium can be given orally but should be given with food to reduce GI irritation, pictured here as hippo orally eating food. Finally, it is important to monitor the respiratory status of severely hypokalemic patients, recalled here by the lungs monitor, since the associated muscle weakness may lead to respiratory acidosis and further respiratory compromise if unaddressed.So, to recap, remember that hypokalemia is defined by a serum potassium of less than 3.5 mEq/L and causes muscle weakness, arrhythmias, U waves, GI abnormalities including ileus formation, and hyporeflexia. Interventions include infusing potassium at 5-10 mEq/hr with specific precautions due to its delicate infusion restrictions or giving oral supplementation with food to avoid GI irritation. Lastly, always remember to monitor respiratory status in hypokalemic patients.

educational

story

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Potassium

Intern Content - Potassium

Potassium-K (Hyperkalemia, Hypokalemia)

Assessment

less than 3 tree pointing to 5 hand.png

< 3.5 mEq/L

Which of the following lab values is considered the cut off value associated with hypokalemia?

weak drooping muscle.png

Muscle Weakness

Which of the following is most likely a finding associated with hypokalemia?

broken arrhythmia drum.png

Arrhythmia

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U Wave

Which of the following is most likely a clinical finding associated with hypokalemia?

U Wave EKG

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Ileus

Which of the following is most commonly a finding associated with hypokalemia?

hippo reflex hammer.png

Hyporeflexia

Interventions

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IV K+ Infusion at 5-10 mEq/hr

Which of the following best describes the proper repletion methods for hypokalemia?

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Give Orally with Food

What instructions should be given regarding oral potassium supplements?

Nursing Considerations

Which of the following is most likely a consideration associated with hypokalemia?

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Monitor Respiratory Status

Which of the following is an important consideration when treating a patient with severe hypokalemia?

Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition

First Aid for the USMLE Step 1 2016

First Aid for the USMLE Step 1 2017

First Aid for the USMLE Step 2 CK, 9th Ed

Hockenberry, Wong's Nursing Care of Infants and Children, 10th Ed.

Master The Boards USMLE Step 2 CK, 3E

Medical-Surgical Nursing, 10th Ed, Lewis, Dirksen, Heitkemper, & Bucher

Medical-Surgical Nursing, 9th Ed, Lewis, Dirksen, Heitkemper, & Bucher

NP - Certification Examination and Practice Preparation 4th Edition, Fitzgerald

PANCE Prep Pearls: 1st Ed, 2014

Pharmacology and the Nursing Process 8e, Lilley, Rainforth Collins, Snyder, 2017

STEP-UP to USMLE Step 2 CK, 4th Ed

We added the fact "Ileus" per student request and remastered both audios.

This Picmonic was edited to clarify the assessment findings of arrhythmia found in hypokalemia.

Hippo-banana was trying to cross the border, but was stopped by the less-than (3) tree pointing to his (.5) hand, because 5 fingers means “stop.” This hippo fit the description of most banana smugglers, but upon inspection, he had weak-drooping-muscles, and didn't have enough bananas to bribe the guard. This poor hippo was wrongfully detained and tortured. They played a broken arrhythmia-drum at all hours of the night, and waterboarded him with U-waves. Even worse, the water was tainted with eels! All this torture happened all while having his own kind, another hippo, beat him with a reflex-hammer. Soon, the state department realized they had the wrong guy, so they tried to cover up their mistake by replenishing him using an IV banana infuser with a (5) hand to a (10) tin. They treated him like royalty, feeding the finest foods. To top it off, they even gave him a health checkup, monitoring his lungs, before he was returned to freedom, while the border patrol pretended like nothing ever happened.

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