TPN &Hypokalemia Essays - Medicine, Potassium,

TPN Hypokalemia Alys Latimer, Layla Mohamed, and Sandra Zheng what IS tpn? Total Parenteral Nutrition (TPN): Infusion of intravenous nutrition (macro- and micro- nutrients) Those with contraindications to oral dietary approach Specialized mixtures of amino acids, dextrose, lipid emulsions, electrolytes, vitamins and minerals Infused centrally into internal jugular or subclavian veins INDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disorders ADVERSE COMPLICATIONS: infections, post-op wound complications, immune compromise, fluid/electrolyte imbalance, GI bleeding, etc. (Arya et al., 2013) What is hypokalemia? Hypokalemia: Normal Findings: 3.5 5.0 mEq/L Critical Values: 2.5 mEq/L Potassium (K+), important part of protein synthesis and maintenance of normal oncotic pressure and cellular electrical neutrality (Pagana Pagana, 2013) Signs and Symptoms of Hypokalemia Typically not present until Potassium levels are less than 3.0 mEq/L Signs and symptoms of hypokalemia are typically related to cardiac, skeletal, and smooth muscle weakness CARDIOVASCULAR: flattened T-wave and prominent U-wave, ST segment depression, conduction abnormalities, dysrhythmias, worsening hypertension, sudden death KIDNEY: polyuria, hypokalemic nephropathy, increased risk of nephrolithiasis, and chloride-depletion metabolic alkalosis CNS/NEUROMUSCULOSKELETAL: fatigue, malaise, hyporeflexia, weakness, cramps, paralysis, myalgia, and rhabdomyolysis GI TRACT: Constipation, vomiting, prolonged gastric emptying, paralytic ileus, anorexia, worsening hepatic encephalopathy GU TRACT: hypotonic bladder PULMONARY: respiratory acidosis, respiratory failure ENDOCRINE: insulin resistance and impairment in insulin release (Asmar et al., 2012; Elgart, 2004; Pagana Pagana, 2013) How to treat hypokalemia? Treatment Options: GOAL: identifying definitive cause of hypokalemia, prevent the development of life-threatening consequences, and correct any potassium deficit which avoiding hyperkalemia MILD MODERATE HYPOKALEMIA (3.0 3.5 MEQ/L): Treat underlying disorder if possible Treat with 60 80 mEq/d of KCl via PO in divided doses Reassess serum potassium concentration after replacement therapy and adjust accordingly SEVERE HYPOKALEMIA ( 3.0 MEQ/L): Preferred: 40 mEq/d of KCl via PO q3-4h TID Reassess serum potassium concentration after replacement therapy and adjust accordingly If necessary: 10 20 mEq/h of KCl via IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicity Continuous cardiac monitoring is mandatory Reassess serum potassium concentration q2-4h (ensure that serum potassium concentration is 3.5 mEq/L) (Asmar et al., 2012) Thank you References: Asmar, A., Mohandas, R., Wingo, C.S. (2012). A physiologic-based approach to the treatment of a patient with hypokalemia. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 60(3), 492 497. doi: 10.1053/j.ajkd.2012.01.031 Arya, I. N., Shah, B., Arya, S., Dronavalli, S., Karthikenyan, N. (2013). A review of literature on modern parenteral nutrition. International Journal of Medical Science and Public Health, 2(4), 801 806. doi: 10.5455/jimsph.2013.030920131 Elgart, H. N. (2004). Assessment of fluids and electrolytes. AACN Clinical Issues, 15(4). 607-621. Retrieved from: https://learn.humber.ca/bbcswebdav/pid-4534008-dt-content-rid 24071933_1/courses/1528.201750/Assessment%20of%20Fluids%20and.pdf Pagana, K. D., Pagana, T. J. (2013). Mosbys Canadian manual of diagnostic and laboratory tests (First Canadian ed.). Toronto, ON: Elsevier Canada