Potassium Imbalances: Causes and Manifestations

    • Nursing diagnosis
      • Risk for electrolyte imbalance related to excess potassium loss
      • Risk for activity intolerance related to muscle weakness
      • Risk for injury related to muscle weakness and hyporeflexia
      • Potential complication: dysrhythmias
    • Nursing implementation
      • KCl supplements orally or IV
      • Always dilute IV KCl
      • NEVER give KCl via IV push or as a bolus
      • Should not exceed 10 mEq/hr.
      • Use an infusion pump

Potassium Imbalances: Causes and Manifestations

Hyperkalemia (K+ >5.0 mEq/L [mmol/L])

Hypokalemia (K+ <3.5 mEq/L [mmol/L])


Excessive Potassium Intake

Excessive Potassium Loss

  • Excessive or rapid parenteral administration
  • GI losses: diarrhea, vomiting, fistulas, NG suction, ileostomy drainage
  • Potassium-containing drugs (e.g., potassium penicillin)
  • Renal losses: diuretics, hyperaldosteronism, magnesium depletion
  • Potassium-containing salt substitute
  • Skin losses: diaphoresis
  • Dialysis

Shift of Potassium Out of Cells

Shift of Potassium into Cells

  • Acidosis
  • Increased insulin release (e.g., IV dextrose load)
  • Tissue catabolism (e.g., fever, crush injury, sepsis, burns)
  • Insulin therapy (e.g., with diabetic ketoacidosis)
  • Intense exercise
  • Alkalosis
  • Tumor lysis syndrome
  • Increased Epinephrine (e.g., stress)

Failure to Eliminate Potassium

Lack of Potassium Intake

  • Renal disease
  • Starvation
  • Adrenal insufficiency
  • Diet low in potassium
  • Medications: Angiotensin II receptor blockers, ACE inhibitors, heparin, potassium-sparing diuretics, NSAIDs
  • Failure to include potassium in parenteral fluids if NPO