Great inaugural post, thank you. I noticed at the end he said something like "with this EKG you would consider starting Magnesium while awaiting the serum K and Magnesium to come back." He didn't say empirically start K. Would you or have you empirically started K just based on EKG findings?
So I tried looking everywhere for the answer to your question and unfortunately I hit a wall. During my literature search, I could not find any articles on the importance to empirically treat hypokalemia. However, I did find articles that report the association between hypokalemia and fatal arrhythmias (v. fib and v. tach) that can lead to AMI or sudden cardiac deaths. It appears that the risk is 5 times greater than compared to those with potassium > 4.6. Most of the patients they looked at have a history of CAD or CHF. Since, oral potassium replacements of 40-60 mEq/L only increase the potassium level only 1-1.5 mEq/L, I can not see the harm of giving patients with history of CAD or CHF on diuretics with symptoms of hypokalemia and correlating ECG changes oral supplements. There is a recommendation that patients who have CAD and CHF to have a potassium level of at least 4. Hope this helps. Cheers.
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ReplyDeleteGreat inaugural post, thank you. I noticed at the end he said something like "with this EKG you would consider starting Magnesium while awaiting the serum K and Magnesium to come back." He didn't say empirically start K. Would you or have you empirically started K just based on EKG findings?
ReplyDeleteSo I tried looking everywhere for the answer to your question and unfortunately I hit a wall. During my literature search, I could not find any articles on the importance to empirically treat hypokalemia. However, I did find articles that report the association between hypokalemia and fatal arrhythmias (v. fib and v. tach) that can lead to AMI or sudden cardiac deaths. It appears that the risk is 5 times greater than compared to those with potassium > 4.6. Most of the patients they looked at have a history of CAD or CHF. Since, oral potassium replacements of 40-60 mEq/L only increase the potassium level only 1-1.5 mEq/L, I can not see the harm of giving patients with history of CAD or CHF on diuretics with symptoms of hypokalemia and correlating ECG changes oral supplements. There is a recommendation that patients who have CAD and CHF to have a potassium level of at least 4. Hope this helps. Cheers.
ReplyDeleteReferences:
1. http://emj.bmj.com/content/19/1/74.full.pdf+html
2. http://crashingpatient.com/medical-surgical/electrolyte-disorders/potassium-disorders.htm/
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016067/pdf/ecc15e096.pdf
4. http://www.nejm.org/doi/pdf/10.1056/NEJM199808133390707