Goal K level with hypokalemic pt in stable V-tach?

[Disinence2]

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Hey! Question for you all. I've been searching for hours now and can't seem to find any evidence-based medicine recommendations for the goal K level for a hypokalemic patient with an arrhythmia.

Hypothetical example. Pt in stable V-tach, K is 2.1. You suspect they are in a K depleted state. Aside from ACLS, when do you stop giving K? When they get to 3.5, 4.0, 4.5? Anyone know if this has been studied in non-MI patients?

Thanks!

 

[deleted65604]

You are overthinking this one. An ER doctor has much bigger fish to fry than whether to correct potassium or not and to what level. Make it better than what it was when they came and you've done your job as an ER doctor. I've rarely re-checked a potassium level in the ER unless I thought it was erroneous.

There are some studies that are never going to be done because they would take to much time, money and effort to answer a not-so-relevant question.

 

[Aesculapius]

It takes a long time to correct potassium anyway, unless you want to give someone a lethal injection...

 

[Hamhock]

Yeah - I doubt such a study is possible given how rare it is to have a patient in stable VTach with hypokalemia.

Get the potassium into the normal range (higher end of normal may be better) and don't forget calcium and magnesium.

A related question that I think is interesting: How are people getting potassium in quickly? How fast/how much is the limit? (through central access)

HH

 

[WilcoWorld]

Agree with above - this patient meeds magnesium in addition to that K+

 

[Arcan57]

Agree with above - this patient meeds magnesium in addition to that K+

I'm almost certain there is no useful literature on this, but in training I got it pounded into me that with arrhythmias you get the K>4.0 and the Mg >2.0.

 

[emergiQ]

It takes a long time to correct potassium anyway, unless you want to give someone a lethal injection...

Respectfully --

You can correct K+ quite quickly.... it is just that it might revert to the previous level if the underlying malady is not addressed.

In the setting of an arrhythmia, replete with both iv K+ and oral (if possible). And the Mg2+ as a previous poster noted. Nursing gets nervous if rates are greater than 10 /hr, but in life-threatening situations, I've run it at up to 40/hour. I usually settle for 20/hr to keep the peace. I also give 40 down an NG or orally at the same time.

"Life threatening" = in active arrhythmia or hypotension for me, not necessarily a particular number. (We treat patients in beds, not numbers on monitors).

 

[EMFreakz]

What K do you guys typically admit for assuming only symptom is generalized weakness, nonspecific stuff, etc?

 

[WilcoWorld]

If they're symptomatic I'll pull the admit trigger for under 3. If they're just there for vomiting, and I think it's a spurious value, and they're able to tolerate oral K, then I'l sometimes discharge people in the high 2's.

 

[Disinence2]

Thanks everyone!