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Hypokalemia and Hyperkalemia
HYPOKALEMIA
Cardiovascular
- Thready, weak, irregular pulse.
- Weak peripheral pulses.
- Orthostatic hypotension.
Respiratory
- Shallow, ineffective respirations that result from profound weakness of the skeletal muscles of respiration.
- Diminished breath sounds.
Neuromuscular
- Anxiety, lethargy, confusion, coma.
- Skeletal muscle weakness, leg cramps.
- Loss of tactile discrimination.
- Paresthesias.
- Deep tendon hyporeflexia.
Gastrointestinal
- Decreased motility, hypoactive to absent bowel, sounds.
- Nsusea, vomiting, constipation, abdominal distension.
- Paralytic ileus
Laboratory findings
- Serum potassium level lower than 3.5 mEq/L (3.5mmol/L)
- Electrocardiogram changes: ST depression ; shallow, flat, or inverted T wave; and prominent U wave.
HYPERKALEMIA
Cardiovascular
- Slow, weak, irregular heart rate.
- Decreased blood pressure.
Respiratory
- Profound weakness of the skeletal muscles leading to respiratory failure.
Neuromuscular
- Early: muscle twitches, cramps, paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
- Late: profound weakness, ascending flaccid paralysis in the arms and legs ( trunk, head, and respiratory muscles become affected when the serum potassium level reaches a lethal level.)
Gastrointestinal
- Increased motility, hyperactive bowel sounds
- Diarrhea
Laboratory findings
- Serum potassium level that exceeds 5.0 mEq/L ( 5.0mmo/L)
- Electrocardiographic changes: Tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals.
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