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- Severe hypokalemia may precipitate profound and life-threatening cardiac complications including arrhythmia and asystole.
- Classical teaching is that in cardiac arrest with non-shockable rhythms the management include to identify and treat the H’s & T’s which include hyper and hypokalemia.
- Potassium chloride is the therapy of choice, however, the dose and administration of potassium during cardiac arrest is controversial and limited to case series and case reports.
- Hypokalemia results from one or more of the following: decreased dietary intake, shift into cells, or increased net loss from the body.
- The most common causes of low serum potassium include gastrointestinal loss (diarrhea, laxatives), renal loss (hyperaldosteronism, potassium-losing diuretics, carbenicillin, sodium penicillin, amphotericin B), intracellular shift (alkalosis or a rise in pH), and malnutrition.
- Symptoms of hypokalemia include weakness, fatigue, paralysis, respiratory difficulty, muscle breakdown (rhabdomyolysis), constipation, paralytic ileus, and leg cramps.
- Hypokalemia is suggested by changes in the ECG, including:
- U waves
- T-wave flattening
- ST-segment changes
- Arrhythmias (especially if the patient is taking digoxin)
- Pulseless electrical activity (PEA) or asystole
Overview of Evidence
|Author, year||Design/ sample size||Case & Intervention||Outcome|
|Elmahrouk, 2020||Case report||
|Liu, 2020||Case report||
|Jouffroy, 2014||Case report||
|Abdulaziz, 2012||Case report||
|Philips, 2008||Case report||
|Bannister, 1977||Case report||
|AHA ACLS Guidelines||“If cardiac arrest from hypokalemia is imminent (ie, malignant ventricular arrhythmias), rapid replacement of potassium is required. Give an initial infusion of 2 mEq/min, followed by another 10 mEq IV over 5 to 10 minutes.”|
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