Commence ECG monitoring
Daily requirement is 1 to 2 mEq/Kg/day
Levels of Serum potassiun and ECG changes:
6 mEq/L tall, peaked T waves
7 mEq/L flat or absent p wave, wide qrs complex, bradycardia
>7.5 mEq/L ventricular arrhythmias, sine wave pattern
Starship guidelines are good on this but cannot be followed fully as concerns insulin infusiom with 25% DW, because it has to be given via central line only.
Follow instead the algorithm of Children Hospital Lahore, where 10 % DW is used. We may give upto 12.5%DW only via peripheral iv line so as to prevent the risk of phlebitis.
Factitious hyperkalemia:
- In-vitro Hemolysis: The most common cause, where red blood cells rupture during collection or processing, releasing their high internal potassium into the serum.
- Delayed Processing: If blood sits too long before being separated in a centrifuge, potassium naturally leaks out of the cells.
- Thrombocytosis
- Leukocytosis
- Specimens not stored between 15 to 25 degC
- Sample collection proximal to potassium containing infusions
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