TPN Hypokalemia Essay Example For Students

TPN Hypokalemia Essay Alys Latimer, Layla Mohamed, and Sandra Zhengwhat IS tpn?Total Parenteral Nutrition (TPN):Infusion of intravenous nutrition (macro- and micro- nutrients)Those with contraindications to oral dietary approachSpecialized mixtures of amino acids, dextrose, lipid emulsions, electrolytes, vitamins and mineralsInfused centrally into internal jugular or subclavian veinsINDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disordersADVERSE COMPLICATIONS: infections, post-op wound complications, immune compromise, fluid/electrolyte imbalance, GI bleeding, etc. (Arya et al., 2013)What is hypokalemia?Hypokalemia:Normal Findings: 3.5 5.0 mEq/LCritical Values: 2.5 mEq/LPotassium (K+), important part of protein synthesis and maintenance of normal oncotic pressure and cellular electrical neutrality(Pagana Pagana, 2013)Signs and Symptoms of HypokalemiaTypically not present until Potassium levels are less than 3.0 mEq/LSigns and symptoms of hypokalemia are typically related to cardiac, skeletal, and smooth muscle weaknessCARDIOVASCULAR: flattened T-wave and prominent U-wave, ST segment depression, conduction abnormalities, dysrhythmias, worsening hypertension, sudden deathKIDNEY: polyuria, hypokalemic nephropathy, increased risk of nephrolithiasis, and chloride-depletion metabolic alkalosisCNS/NEUROMUSCULOSKELETAL: fatigue, malaise, hyporeflexia, weakness, cramps, paralysis, myalgia, and rhabdomyolysisGI TRACT: Constipation, vomiting, prolonged gastric emptying, paralytic ileus, anorexia, worsening hepatic encephalopathyGU TRACT: hypotonic bladd erPULMONARY: respiratory acidosis, respiratory failure ENDOCRINE: insulin resistance and impairment in insulin release(Asmar et al., 2012; Elgart, 2004; Pagana Pagana, 2013)How to treat hypokalemia?Treatment Options:GOAL: identifying definitive cause of hypokalemia, prevent the development of life-threatening consequences, and correct any potassium deficit which avoiding hyperkalemiaMILD MODERATE HYPOKALEMIA (3.0 3.5 MEQ/L):Treat underlying disorder if possibleTreat with 60 80 mEq/d of KCl via PO in divided doses Reassess serum potassium concentration after replacement therapy and adjust accordinglySEVERE HYPOKALEMIA ( 3.0 MEQ/L):Preferred: 40 mEq/d of KCl via PO q3-4h TIDReassess serum potassium concentration after replacement therapy and adjust accordinglyIf necessary: 10 20 mEq/h of KCl via IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicityContinuous cardiac monitoring is mandatory Reassess serum potassium concentration q2-4h (ensure that serum potassium concentration is 3.5 mEq/L)(Asmar et al., 2012)Thank you References:Asmar, A., Mohandas, R., Wingo, C.S. (2012). A physiologic-based approach to the treatment of apatient with hypokalemia. American Journal of Kidney Diseases: The Official Journal of the NationalKidney Foundation, 60(3), 492 497. doi: 10.1053/j.ajkd.2012.01.031Arya, I. N., Shah, B., Arya, S., Dronavalli, S., Karthikenyan, N. (2013). A review of literature on modernparenteral nutrition. International Journal of Medical Science and Public Health, 2(4), 801 806.doi: 10.5455/jimsph.2013.030920131Elgart, H. N. (2004). Assessment of fluids and electrolytes. AACN Clinical Issues, 15(4). 607-621.Retrieved from: https://learn.humber.ca/bbcswebdav/pid-4534008-dt-content-rid24071933_1/courses/1528.201750/Assessment%20of%20Fluids%20and.pdfPagana, K. D., Pagana, T. J. (2013). Mosbys Canadian manual of diagnostic and laboratory tests (FirstCanadian ed.). Toronto, ON: Elsevier Canada