ABIM - Hypokalemia Management

Here are key facts for ABIM from the Hypokalemia Management tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

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1. Laboratory diagnostic threshold: K+ < 3.5 mEq/L 2. Severity stratification:

• Mild/Moderate: K+ 3.0-3.4 mEq/L
• Severe/Symptomatic: K+ < 3 mEq/L

1. Pathophysiologic mechanisms:

• Gastrointestinal losses
• Renal losses
• Transcellular shifts (redistribution into cells)
• Inadequate intake

1. Neuromuscular manifestations: Cramps, weakness, rhabdomyolysis 2. Cardiovascular presentation: Premature beats, arrhythmias 3. Characteristic ECG abnormalities: U waves, flattened T waves

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1. Parenteral replacement strategy: 20 to 60 mEq KCl in saline 2. Administration rate guidelines: Not exceeding 10-20 mEq/hr to prevent peripheral vein irritation 3. Monitoring protocol: Close observation with ECG monitoring for arrhythmias 1. Oral replacement regimen: K+ supplements – 10-20 mEq, 2-4× daily (maximum 80 mEq/day) 2. Dietary intervention: Increase intake of K+-rich foods 1. Target serum level: Maintain K+ between 3.5-5 mEq/L 2. Safety monitoring: Adjust treatment to avoid hyperkalemia and arrhythmias 1. Addressing underlying pathophysiology:

• Targeted management of gastrointestinal losses
• Modification of diuretic therapy
• Consideration of renal function during replacement planning

2. Advanced management considerations:

• Evaluation and correction of magnesium deficiency
• Pharmacologic intervention with potassium-sparing diuretics (e.g., amiloride) in renal losses
• Individualized approach based on comorbidities and clinical status

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Below is information essential for ABIM certification beyond what's explicitly contained in the tutorial. 1. Transtubular potassium gradient (TTKG): Calculation and interpretation in differential diagnosis 2. Acid-base disorder assessment: Impact on potassium homeostasis and treatment approach 3. Fractional excretion of potassium (FEK): Role in distinguishing renal from non-renal causes 4. Aldosterone-renin ratio: Evaluation in suspected endocrine etiologies 1. Diuretic-induced hypokalemia: Management algorithm and prevention strategies 2. Renal tubular acidosis: Differential diagnosis and tailored management 3. Bartter and Gitelman syndromes: Diagnostic criteria and chronic management 4. Hypokalemic periodic paralysis: Acute management and long-term prevention 1. Central vs. peripheral venous administration: Concentration limits and monitoring requirements 2. Concurrent electrolyte abnormalities: Management priorities and sequence 3. Potassium supplementation in liver disease: Dosing considerations with portal hypertension 4. Refractory hypokalemia: Systematic approach to difficult cases 1. Hospital-acquired hypokalemia: Prevention strategies and quality improvement 2. Risk-adjusted monitoring protocols: Based on medications and comorbidities 3. Medication reconciliation: Prevention of iatrogenic causes 4. Transitional care: From inpatient to outpatient management protocols