Adult Medical Emergency Handbook - Scottish Intensive Care Society

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TREATMENT
Oral
• Sando K 2-3 tablets oral bd, or tds. Avoid Slow K, especially in the
elderly as it can cause oesophageal erosions and ulcers.
• Add a potassium sparing diuretic if diuretic induced.
• Monitor potassium levels daily and review dose regularly.
Intravenous
NEVER administer stat or undiluted.
• Maximum concentration is 40 mmol/L usually over 4hrs.
• Higher concentrations (e.g. 80 mmol/L) may be given centrally,
but the rate must not exceed 20 mmol/hr (with continuous ECG
monitoring).
• Caution: monitor serum potassium levels to ensure hyperkalaemia
does not occur, especially in patients with renal impairment.
• Use pre-prepared bags to minimise risk of error (wherever
possible).
• Serum potassium concentration is a poor reflection of total body
potassium (frequently much lower). Seemingly large quantities
may be required e.g. in DKA.
• If difficulty replacing potassium is experienced, check serum
magnesium. May be low, especially in alcoholics, and patients on
diuretics.
• Hypomagnesaemia impairs potassium retention by the kidney.
• Weight loss
• Pigmentation
• Abdominal pain
• Vomiting, diarrhoea
• Fatigue
• Postural hypotension
• Shock
ADDISON’S DISEASE
SYMPTOMS AND SIGNS
214 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11