- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Part 10.1 Physiology
- Part 10.2 Electrolyte disturbance
- Chapter 250 Disorders of sodium in the critically ill
- Chapter 251 Disorders of potassium in the critically ill
- Chapter 252 Disorders of magnesium in the critically ill
- Chapter 253 Disorders of calcium in the critically ill
- Chapter 254 Disorders of phosphate in the critically ill
- Part 10.3 Metabolic acidosis and alkalosis
- Part 10.4 Blood glucose control
- Part 10.5 Endocrine disorders
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 1193) Disorders of potassium in the critically ill
- Chapter:
- (p. 1193) Disorders of potassium in the critically ill
- Author(s):
Matthew C. Frise
and Jonathan B. Salmon
- DOI:
- 10.1093/med/9780199600830.003.0251
Plasma potassium levels are maintained in health between 3.5 and 5.0 mmol/L, and reflect total body potassium only in stable states at normal pH. Most true hyperkalaemia results from renal insufficiency. The goals of therapy are myocardial protection and return of plasma potassium to a safe level. Measures are commonly initiated above 5.5 mmol/L; above 6.5 mmol/L, aggressive measures should be adopted and calcium salts given if there are cardiac dysrhythmias or QRS-broadening. Glucose-insulin infusions and beta-2-agonists promote potassium shifts into cells. Diuretics and sodium bicarbonate may be helpful, but persistent hyperkalaemia is an indication for renal replacement therapy. Hypokalaemia may lead to dangerous arrhythmias, skeletal muscle weakness, ileus, and reduced vascular smooth muscle contractility. Rapid replacement should only be undertaken for severe hypokalaemia or in the context of arrhythmias. Once the extracellular deficit is corrected, there will usually be a continuing need for potassium supplementation to replenish intracellular stores.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Part 10.1 Physiology
- Part 10.2 Electrolyte disturbance
- Chapter 250 Disorders of sodium in the critically ill
- Chapter 251 Disorders of potassium in the critically ill
- Chapter 252 Disorders of magnesium in the critically ill
- Chapter 253 Disorders of calcium in the critically ill
- Chapter 254 Disorders of phosphate in the critically ill
- Part 10.3 Metabolic acidosis and alkalosis
- Part 10.4 Blood glucose control
- Part 10.5 Endocrine disorders
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care