2. Potassium supplementation should be based on blood potassium level. Patients with blood potassium of 3.5 ~ 4 mmol/L don't need extra potassium supplement, just encourage them to eat more foods containing more potassium, such as fresh vegetables, fruit juice, meat and so on. When the blood potassium is 3.0 ~ 3.5 mmol/L, it is necessary to decide whether to supplement potassium according to the specific situation of patients. If the patient suffers from arrhythmia, congestive heart failure, heart failure being treated with digitalis, ischemic heart disease and a history of myocardial infarction in the past, potassium should be supplemented. In general, patients in good condition can only be encouraged to eat foods containing more potassium or take potassium preparations orally. If the blood potassium is lower than 3.0mmol/L, potassium should be supplemented.
For mild symptoms, only oral potassium supplementation is needed, and 10% potassium chloride is preferred. 1g potassium chloride can provide 13.4mmol potassium. 10 ~ 20 ml each time, taken in batches. Potassium chloride (Budaxiu) (enteric potassium chloride preparation) can be used in patients with chronic potassium deficiency to reduce the stimulation of potassium chloride on gastrointestinal tract. Potassium chloride is suitable for all patients with hypokalemia, which can increase the loss of bicarbonate in urine to eliminate compensatory alkalosis, except metabolic acidosis. Metabolic acidosis patients choose potassium bicarbonate or potassium citrate. Potassium chloride tastes bitter, and tablets are easy to cause bleeding and stenosis of intestinal ulcer. They can be taken in cold water or orange juice, which is more acceptable to patients. Can not tolerate oral potassium chloride, potassium bicarbonate or potassium citrate can be used instead. Each tablet of heavy potassium carbonate can provide 25mmol of potassium, 1 tablet/time, 3 times/d. Taking 80mmol of potassium every day with the above three potassium preparations can increase the blood potassium level from 3.2mmol/L to 4 mmol/L. The content of potassium citrate is only 69% of that of potassium chloride, so the dosage should be greater than that of potassium chloride.
Blood potassium should be monitored during oral potassium preparation. Generally, blood potassium rises after 72 hours of oral administration. If the blood potassium does not increase after 96 hours, magnesium deficiency should be suspected. When Mg2 is deficient, Na+-K+-ATPase is not activated, and renal tubular cells cannot pump in K+and pump out intracellular Na+. In this case, blood magnesium should be determined. If the blood magnesium is lower than 0.5mmol/L[ 1mEq/L (normal value 1.7 ~ 2.8 meq/L)], 2ml of 50% magnesium sulfate should be injected intramuscularly, twice on the second day and once on the third day/kloc-0. You can also take 10% magnesium sulfate orally, 3g/ time, every 6 hours 1 time, 4 times in total.
Severe patients (including arrhythmia, ventricular tachycardia, severe cardiomyopathy and familial periodic paralysis) should be given intravenous drip of potassium preparation, and potassium chloride is also commonly used. 100 millimole (100 milliequivalent/liter) of potassium can be added to 1000 ml/hour of 5% brine, and 10 millimole (100 milliequivalent/liter) of potassium can be supplemented. It is safe to drip potassium at a speed of 20 ~ 40 mmol/h (20 ~ 40 meq/h), but blood potassium monitoring or electrocardiogram monitoring should be carried out during the dripping speed. For patients with acidosis or without hypochloremia, 20 ml of 31.5% potassium glutamate solution should be added to 5% glucose solution, and intravenous drip slowly. Potassium chloride should not be used at this time (see above).
Problems needing attention in the process of intravenous potassium supplementation
(1) The daily urine output is more than 700ml, or the hourly urine output is 30ml, which should be closely monitored during potassium supplementation.
② The potassium concentration of potassium supplement solution is generally 0.3% potassium chloride, and the daily potassium supplement amount is generally 3 ~ 8g. In the case of good renal function, those with severe potassium deficiency can supplement 240mmol of potassium every day.
③ Dropping speed: Based on the principle of slow static dripping. Potassium chloride is generally supplemented per hour 1g, and 2g can be supplemented per hour in severe cases.
④ Intracellular potassium deficiency recovered slowly. After stopping intravenous potassium supplementation, oral potassium preparation 1 week should be continued to completely correct intracellular potassium deficiency.
⑤ When the curative effect of intravenous potassium supplementation is not good and hypokalemia is difficult to be completely corrected, the blood magnesium concentration should be checked. In the case of magnesium deficiency, hypokalemia is difficult to correct, and blood potassium will soon return to normal level after magnesium supplementation.
⑥ When hypokalemia is combined with hypocalcemia, twitching may occur when potassium is supplemented, and calcium should be supplemented at this time.
3. Correct the causes of hypokalemia caused by metabolic disorder of water and other electrolytes, many of which can cause the loss of water and other electrolytes such as sodium and magnesium at the same time, so it is necessary to check them in time and deal with them actively once found. As mentioned above, if hypokalemia is caused by magnesium deficiency, potassium supplementation alone is ineffective if magnesium is not supplemented.