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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 76, Electrolyte Homeostasis.

KEY CONCEPTS

KEY CONCEPTS

  • imagePotassium regulates many biochemical processes in the body and is a key cation for electrical action potentials across cellular membranes.

  • imageThe kidney is the primary route of potassium elimination.

  • imageIn patients with concomitant hypokalemia and hypomagnesemia, it is imperative to correct the hypomagnesemia before the hypokalemia.

  • imagePotassium chloride is the preferred potassium supplement for the most common causes of hypokalemia.

  • imageHyperkalemia is a common occurrence in patients with acute kidney injury or chronic kidney disease.

  • imageHypomagnesemia is commonly caused by excessive gastrointestinal or renal magnesium wasting.

  • imageHypermagnesemia is predominantly observed in patients with acute or chronic kidney disease.

  • imageSevere hypermagnesemia may affect the neuromuscular and cardiovascular systems.

PATIENT CARE PROCESS

Patient Care Process for the Management of Potassium and Magnesium Disorders

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Collect

  • Patient characteristics (eg, age, race, sex)

  • Patient history (past medical, family, social—dietary habits)

  • Current medications including over-the-counter medications, herbals, dietary supplements

  • Subjective data

    • Musculoskeletal and neuromuscular review of systems

    • Intake (food and fluid) and output (urine and stool)

  • Objective data

    • BP, heart rate (HR), height, weight

    • Labs (eg, basic metabolic panel, calcium, magnesium, phosphorus)

    • Other diagnostic tests when indicated (eg, ECG, urinalysis, urine electrolytes)

Assess

  • Presence of symptoms of an electrolyte disorder

  • Presence of ECG changes (see Fig. 68-1)

  • Severity of electrolyte disorder (eg, change from baseline value, timing of development of electrolyte disorder)

  • Kidney function (eg, eGFR, creatinine clearance, presence of chronic kidney disease)

  • Current medications that may contribute to electrolyte disorder (see Tables 68-1, 68-6, and 68-8)

  • Current diet that may contribute to electrolyte disorder (see Tables 68-2 and 68-9)

Plan*

  • Identification of the most likely cause of the electrolyte disorder and discontinuation of offending medication or substance (if applicable)

  • Dietary modifications (see Tables 68-2 and 68-9)

  • Drug therapy regimen including specific medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 68-4, 68-5, and 68-7)

  • Monitoring parameters including efficacy (eg, potassium, magnesium, SCr), safety (medication-specific adverse effects), and need for repeat or additional drug therapy

  • Patient education (eg, purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Referrals to other providers when appropriate (eg, physician, dietician)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Resolution of electrolyte disorder and prevention of further episodes

  • Presence of adverse effects

  • Development/progression of kidney impairment

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other healthcare professionals.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch the video entitled “Hyperkalemia in Primary Care Practice” by the National ...

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