*Mineral Deficiencies - Electrolyte Disturbances, Genes, Diet and Disease Interface*

*3.2.4 Treatment*

*Electrolytes in the ICU*

*DOI: http://dx.doi.org/10.5772/intechopen.96957*

[33–36].

• Goals of treatment are to reduce further potassium loss, replenish potassium stores, evaluate potential toxicities and treatment of the underlying cause

• Due to the intracellular nature of potassium deficit means that intravascular potassium must be administered slowly, and time is required for potassium to enter the cells. Rapid administration may cause serum levels to be elevated even though there is a total body deficit leading to serum hyperkalemia.

• When treating hypokalemia, the goal potassium is >3.5 mEq/L (mmol/L). Traditionally, potassium goal >4 (mmol/L) was used to reduce the risk of arrythmias however larger studies have shown that the safest potassium level in myocardial ischemia is 3.5-4.5 (mmol/L) with evidence of higher/lower levels correlate with worse outcomes. In the specific case of DKA, with the absence of renal dysfunction, target potassium is >5.3 mEq/L (mmol/L).

• Enteral potassium repletion is preferred compared to IV route. Enteral

• Potassium chloride is the most commonly used formulation and are especially useful with metabolic alkalosis (increases serum chloride). Slow release formulations are suboptimal if immediate effect is desired however better tolerated. Another formulation is potassium citrate which may be useful in non-anion gap metabolic acidosis (the citrate will be converted into

• IV potassium can be used when there is lack of gut access/function, severe hypokalemia in need of emergent treatment or profound shock with severe hypokalemia. The rate of administration is 10 mEq/hour through a peripheral line or 20 mEq/hour through a central line. When IV repletion is >20 mEq/

• Magnesium should be repleted as well because failure to treat this will make it difficult to fix hypokalemia. In patients with ongoing gastric losses, initiation

• Calcium circulates in different forms. Within the plasma, 40% of calcium is bound to albumin while 15% is bound to citrate, sulfate or phosphate while 45% exists as physiologically ionized (or free) calcium. Total serum calcium is frequently misleading since it can vary based on albumin concentration and

• Plasma phosphorus exists as organic and inorganic forms. The inorganic forms are completely ionized circulating in the plasma. 99% of phosphate is present

• Only a small portion of total body calcium and phosphate is located in the plasma and it is the ionized calcium and inorganic phosphate that is regulated

of proton pump inhibitor may minimize electrolyte derangements.

potassium is cheaper, safer and does not irritate veins.

hour then continuous cardiac monitoring is suggested.

bicarbonate, thereby improving the acidosis).

**4. Calcium and phosphate balance**

state of hydration [37].

within cells.

by hormones.

**149**

**Figure 7.** *Etiologies of hypokalemia.*

4.Other findings include QT prolongation, ventricular extrasystoles, ventricular arrythmias.

EKG 2. EKG pattern showing changes in hypokalemia.
