PANCE - Hypokalemia Management

Here are key facts for PANCE 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. Definitive laboratory criteria: K+ < 3.5 mEq/L 2. Clinical severity classification:

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

1. Primary causes requiring investigation:

• Gastrointestinal losses
• Renal losses
• Redistribution into cells
• Inadequate intake

1. Musculoskeletal presentation: Cramps, weakness, rhabdomyolysis 2. Cardiovascular findings: Premature beats, arrhythmias 3. Diagnostic ECG changes: U waves, flattened T waves

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1. Emergency replacement protocol: 20 to 60 mEq KCl in saline 2. Administration safety parameters: Rate not to exceed 10-20 mEq/hr to prevent peripheral vein irritation 3. Monitoring requirements: Close observation with ECG monitoring for arrhythmias 1. Outpatient replacement regimen: K+ supplements – 10-20 mEq, 2-4× daily (maximum 80 mEq/day) 2. Patient education focus: Increase intake of K+-rich foods 1. Therapeutic targets:

• Maintain K+ between 3.5-5 mEq/L
• Adjust treatment to avoid hyperkalemia and arrhythmias

2. Comprehensive approach:

• Address underlying causes: Gastrointestinal losses, diuretic therapy
• Consider renal function during replacement planning
• Check for and correct magnesium deficiency
• Consider potassium-sparing diuretics in renal losses
• Individualize treatment based on comorbidities and clinical status

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Below is clinical information essential for PA practice beyond what's explicitly contained in the tutorial. 1. Focused history elements: Medication review, GI symptoms, diet evaluation, exercise patterns 2. Physical examination pearls: Assessing muscle strength, deep tendon reflexes, cardiac auscultation 3. Risk stratification: Identifying patients at risk for dangerous arrhythmias 4. Point-of-care decision making: When to treat emergently vs. outpatient management 1. Primary care management: Chronic monitoring protocols and referral criteria 2. Emergency department protocols: Triage and initial management guidelines 3. Team-based care: Coordination with dietitians, pharmacists, and specialists 4. Documentation requirements: Medical necessity for replacement therapy 1. Medication counseling: Administration timing, side effects, and adherence strategies 2. Dietary guidance: Specific food recommendations and meal planning 3. Self-monitoring: Signs and symptoms requiring medical attention 4. Medication interactions: OTCs, supplements, and prescription medications affecting potassium 1. Cost-effective management: Formulation selection and insurance considerations 2. Follow-up protocols: Timing of repeat laboratory testing 3. Telemedicine applications: Remote monitoring strategies 4. Preventive care: Patient education materials and screening recommendations