Answer Happy

Patient Care Skills Lab IV-Sterile Products Substance Abuse Background One of the most common types of substance abuse is alcohol use disorder. Alcohol use disorders such as a cohol intoxication and alcohol withdrawals are disruptive patterns of alcohol use. Alcohol withdrawal develops after a sudden cessation or reduction of alcohol use in patients with a history of heavy drinking. The onset and duration vary among different patients. Symptoms of alcohol withdrawal syndrome can range from minor symptoms such as insomnia, tremors, mild anxiety, palpitations and headache to severe symptoms such as segures, hallucination and delirium. Part of the general care of treatment for alcohol withdrawal, especially when the patient is vomiting, is the replacement of electrolytes and nutrients such as potassium, magnesium, folic acid and thiamine. Potassium plays an important role in many metabolic functions including the maintenance of electrical action potential across the cell membrane, cellular metabolism and growth protein and glycogen synthesis as well as normal blood pressure. Most of the body's potassium is intracellular and its gradient is maintained by the Na/KATPase pump on the cell membrane. The body must maintain the potassium level in the blood within a narrow rage. A serum potassium level that is too high (hyperkalemia) or too low hypokalemia) can have serious consequences, such as arrhythmia or even cardiac arrest. Hypokalemia is common in patients hospitalized for alcohol withdrawal. The cause of hypokalemia in alcoholism is usually multifactorial, which includes inadequate potassium intake and potassium loss secondary to vomiting. It is essential to correct potassium imbalances to prevent life-threatening consequences. Below are the different levels of potassium imbalances and some of the signs and symptoms • Hyperkalemia: Mild: 5.5-6.0 mEq/L Moderate: 6.1-6.9 mEq/L Severe: >7 mEq/L Signs and symptoms: muscle weakness or paralysis; abnormal cardiac conduction with peake and narrowed T waves O o Hypokalemia: Mild: 3.0-3.5 mEq/L Moderate: 2.5 -2.9 mEq/L Severe: <2.5 mEq/L o Signs and symptoms: lower extremity muscle weakness that can progress to respiratory muscles (respiratory failure) and Gl muscles (paralyticileus, N/V, constipation); EKG change with flattened T waves, cardiac arrhythmias including bradycardia, heart black and Vfib. 1P
Patient Care Skills Lab IV-Sterile Products . Electrolyte Replacement: Potassium Pharmacokinetic Parameters . Absorption: Well absorbed from upper GI tract . Distribution (Vd): Enters cell via active transport from extracellular fluid Metabolism: Not known . Excretion: Primarily urine; skin and feces (small amounts); most intestinal potassium will be absorbed. Dosing Monitoring Current Serum Potassium Level Central Line Peripheral Line 3.6-3.9 mEq/L 20 mEq IV over 2 HR x 1 No additional action. 10 mEq IV over 1 HR x 2 3.4-3.5 mEq/L 10 mEq IV over 1 HR x 3 No additional action. 20 mEq IV over 2 HR x 1 AND 10 mEq IV over 1 HR x 1 3.1-3.3 mEq/L 20 mEq IV over 2 HR x 2 10 mEq IV over 1 HR x 4. Recheck serum potassium level 2 hours after infusion complete 10 mEq IV over 1 HR x 5 2.6-3.0 mEq/L 20 mEq IV over 2 HR x 2 AND 10 mEq IV over 1 HR x 1 Recheck serum potassium level 2 hours after infusion complete 2.3-2.5 mEq/L 20 mEq IV over 2 HR x 3 10 mEq IV over 1 HR x 6 Recheck serum potassium level 2 hours after infusion complete <2.3 mEq/L Call Physician AND 20 mEq IV over 2 HR x 3 Call Physician AND 10 mEq IV over 1 HR x 6 Recheck serum potassium level 2 hours: after infusion complete Admin
Patient Care Skills Lab IV-Sterile Products Administration Oral: should be taken with meals and a full glass of water or other liquid to minimize the risk of Gl irritation. o Use parental potassium if: severe depletion (<2.5 mEq/L), NPO or cannot tolerate PO or EKG changes. (nausea/vomiting/diarrhea), • Parenteral: potassium must be diluted prior to parenteral administrations. For IV infusion, do not administer IV push.. . Clinical experts recommend that the maximum concentration for peripheral infusion is 10 mEq per 100 ml. The maximum rate of administration for peripheral infusion is 10 mEq/hour. • With central line administration, higher concentrations and more rapid rates of infusion may be used. Concentrations of 20-40 mEq per 100ml at a maximum rate of 20 mEq/hour via central line have been safely administered. In emergency situations, maximum rate may be increased to 40 mEq/hour. Compatibility . Compatible and preferred: NS, % NS • Compatible but NOT preferred: DSW • Standard concentrations: 10 mEq/50ml, 10 mEq/100ml, 20 mEq/50ml, and 20 mEq/100ml Monitoring Parameters • Normal serum potassium level: 3.6-5.0 mEq/L . Careful monitoring of physiologic effects of severe hypokalemia and hyperkalemia is essential Additionally, it's important to monitor of serum potassium every two to four hours to ascertain the response to therapy. Adverse Reactions Pain and phlebitis can occur when IV potassium is infused via peripheral lines. This primarily occurs at rates above 10 mEq/hour but can be seen at lower rates. If pain occurs, infusion rate or potassium concentration should be reduced. 3