Pediatric emergency medicine trisk 2859 2859
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Total body potassium depletion is present in patients with diabetic
ketoacidosis (DKA) despite having normal or elevated serum
potassium levels.
Hyperkalemia should be confirmed to rule out
pseudohyperkalemia due to a hemolyzed sample.
Severe hyperkalemia may lead to cardiac arrhythmias, and initial
treatment is aimed at stabilizing the myocardium with IV calcium.
Subsequent treatment of hyperkalemia involves enhancing
intracellular movement of potassium, followed by removal of
excess potassium from the body.
Hypokalemia
Hypokalemia is defined as a measured serum potassium concentration
below 3.5 mEq/L. Hypokalemia may result from total body deficit,
transcellular shift of potassium to the intracellular space, or a combination
of both processes. There are numerous causes of hypokalemia including
renal loss, extrarenal loss, and increased cellular uptake, which are outlined
in Table 100.7 . The common causes of hypokalemia seen in pediatric EDs
are those due to gastrointestinal loss, diuretic use, and DKA. Metabolic
alkalosis will also lead to hypokalemia due to transcellular shift of
potassium to the intracellular space. For every 0.1 unit rise in blood pH,
serum potassium would be expected to decrease by approximately 0.4 to 0.6
mEq/L.
