Serum potassium is extreemly low. Unlike Sodium, potassium in an intracellular ion. Serum levels do not reflect the total potassium loss in the body. Presence of acidosis means the intracellular potassium is further low as acisdosis only draws potassium out of the cells. As a rough estimate if the serum potassium falls from 3.5 mEq to 2.5 mEq, there is approx 100 mEq loss of total body potassium, from 2.5 mEq to 1.5 meq 200 mEq of total body potassium is lost.
The following are the rules regarding hypokalemia management:
1. As far as possible correct potassium orally than IV
2. when used as IV the concentrarions in the fluid exceeding 40 mEq/l should be strictly given under ECG monitoring.
3. NEVER GIVE BOLUS POTASSIUM - IT WILL KILL THE BABY
4. The rate of infusion should be 0.3 mEq/kg/hr, life threatening hypokalemia like in the present case one may give upto 1 mEq/kg/hr and may go upto 200 meq/l concentration but under strict ECG monitoring
5.There is no formula to calculate the potassium replacement as it is an intracellular ion. Approximately 3 mEq/kr for deficit and 3 mEq/l for maintanence.
6. Oral potassium liquids give 21 meq/15 ml and IV gives 2 mEq/ml
In this child respiratory paralysis is impending, short term ventilation along with potassium correction should be rewarding
Click here for Complete Discussion on Severe Diarrhea with Acidosis and Life threatening Hypokalemia Celiac Crisis |
