Perils of Low Potassium Levels During Anesthesia - Nutrition

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Chronic Kidney Disease Q & A | Igor Kagan, MD

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UCLA nephrologistIgor Kagan, MD, talks about about chronic kidney disease and answers to patients’ most common questions. Topics include measuring kidney function and managing the disease. #UCLAMDChat

Video taken from the channel: UCLA Health

Conquering Lab Interpretation: Basic Metabolic Panel & Renal Labs MED-ED

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Presented by Cyndi Zarbano, MSN, RN, CCRN, CMSRN, CLNC, NLCP.
Module 2 of 9.
Module Description.
The basic metabolic panel (BMP) gives a lot of basic clues to glucose level, kidney function, electrolytes and acid-base balance. This module will also discuss how labs can help determine the causes of acute renal failure, how each cause is decided and treatment interventions. Finally, common electrolyte abnormalities and interventions to treat will also be covered..
Module Learning Outcomes.
This module prepares the learner to:
1. Compare and contract prerenal, intrinsic and postobstructive causes of acute renal failure..
2. Calculate the corrected calcium and relate how it differs from a serum calcium level..
3. Classify changes found on the ECG related to hyperand hypokalemia..
Conquering Lab Interpretation includes 6.75 ANCC approved Contact Hours and is available for purchase on MED-ED’s website. To view more about this certification review, please visit https://meded.cvent.com/lab-elearning?refid=YOUTUBE

Keyword Review 2019 | Pharmacology 1 of 3 (Dr. Schell)

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Local anesthetics & NMBs, cocaine intoxication, tumescent liposuction, muscle elaxants, pseudochlinesterase deficiency, anticholinesterase poisoning, botulinum toxin, Lambert-Eaton, neostigmine, codeine, tramadol, biliary pressure, opiods.

Video taken from the channel: University of Kentucky Department of Anesthesiology

Diabetic Ketoacidosis (DKA) Explained Clearly Diabetes Complications

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Understand Diabetic Ketoacidosis (DKA) with this clear explanation from Dr. Seheult of http://www.medcram.com..
This is video 1 of 2 on diabetic ketoacidosis (pathophysiology and signs of diabetic ketoacidosis / DKA):
0:08 DKA stats.
0:47 DKA cellular anatomy.
1:00 mitochondria.
1:48 beta-oxidation.
2:30 insulin function.
3:08 pyruvate.
3:19 diabetes mellitus type 1.
3:26 diabetes mellitus type 2.
4:48 ketone bodies (acetone, acetoacetate, b-hydroxybutyrate).
6:09 carboxylic acid.
6:23 conjugate base (anion gap acidosis).
7:38 beta-oxidation.
8:17 DKA review.
8:57 diabetic ketoacidosis hyperkalemia.
9:37 diabetic ketoacidosis dehydration.
9:50 osmotic diuresis.
10:10 dehydration.
10:27 diabetic ketoacidosis potassium effects.
11:04 diabetic ketoacidosis Cr elevation / renal failure.
11:30 anion gap metabolic acidosis.
12:09 measuring ketone bodies (serum ketones, b-hydroxybutyrate).
Speaker: Roger Seheult, MD.
Clinical and Exam Preparation Instructor.
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine..
MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, internal medicine, usmle prep, dka, and many others. New topics are often added weeklyplease subscribe to help support MedCram and become notified when new videos have been uploaded..
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Recommended Audience: Health care professionals and medical students: including physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, EMT and paramedics, and many others. Review for USMLE, MCAT, PANCE, NCLEX, NAPLEX, NDBE, RN, RT, MD, DO, PA, NP school and board examinations..
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Produced by Kyle Allred PA-C.
Please note: MedCram medical videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your health care provider.

Video taken from the channel: MedCram Medical Lectures Explained CLEARLY

Why is My Patient Hypotensive and Does it Matter? (ASA 2017)

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Intended for healthcare clinicians only..
This symposium will discuss how emerging literature is demonstrating that periods of hypotension in the surgical setting are common and associated with patient risk. Further, significant differences exist in the choice and interpretation of monitoring techniques among anesthesiologists. This program will review clinical evidence describing the risk of intraoperative hypotension (IOH) and discuss the concepts of pressure and flow to guide clinical decision making.

Video taken from the channel: Edwards Lifesciences Clinical Education

Kidney & Bladder Health: How to Lower Potassium Level in the Kidneys

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Kidneys maintain your body’s potassium levels, and high or low levels are equally dangerous. Lower the potassium levels in your kidneys with the help of a practicing nephrologist in this free video..
Expert: Dr. Sean Hashmi.
Contact: www.drseanhashmi.com/.
Bio: Dr. Hashmi obtained a Masters degree in Physiological Science at UCLA and went on to Medical School at the University of California, San Diego..
Filmmaker: Rob Hashemi.
Series Description: When your kidneys and bladder are not in good health there are a number of painful symptoms. Discover how to treat your bladder and kidney symptoms in this free video series presented by a practicing nephrologist.

Video taken from the channel: ehowhealth

Hypokalemia: Treatment

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Hypokalemia: Treatment

Video taken from the channel: Dr. Andras Fazakas

Hypokalemia and Anesthetic Implications. Reductions in serum potassium influence myocardial cell excitability by increasing membrane potential, diastolic depolarization, duration of refractory period and action potential, and decreasing conduction velocity. Disturbances in electrolyte balance typically involve alterations in two or more ca.Doctors give trusted answers on uses, effects, side-effects, and cautions: Dr. Friedlander on risks of low potassium levels during anesthesia: usually around 3.5 is the cut off; most risks with low potassium are associated with the heart rhythm.Potassium levels as low as yours are uncommon, and do present a risk for general anesthesia.

It would not be standard care to give an anesthetic for an elective surgery to a patient with a potassium level as low as 2.6.Physiologic antagonists: 500 mg calcium chloride, or 1 gm calcium gluconate is enough to temporarily stabilize the heart from the effects of hyperkalemia. Shift K+ from plasma back into the cell: intravenous glucose (25 to 50 g dextrose, or 1-2 amps D50) plus 5-10 U regular insulin will reduce serum potassium levels within 10 to 20 minutes, and the effects last 4 to 6 hours, hyperventilation.Another risk is serious damage to the kidneys, that could leave them non-functional. A severe condition known as the hypokalemic nephropathy, could also be caused due to potassium deficiency.

Paralysis. Another life-threatening complication of low levels of potassium is paralysis.Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream.

Potassium helps carry electrical signals to cells in your body. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.If you have hypokalemia, that means you have low levels of potassium in your blood.Potassium is a mineral your body needs to work normally.

It helps muscles to move, cells to get the nutrients.Potassium plays an important role in regulating the contractions of all muscles, including the heart muscle. Very low levels of potassium in the body can lead to irregular heart rhythms, including.Effects of hypokalemia on anesthesiaPoor respiratory function, delayed awakening, prolonged weakness Effects of anesthesia on hypokalemiaHyperventilation can further lower potassium levels as can treatment of hyperglycemia during Colon Bundle and ERAS cases. Use of sympathomimetic drugs during anesthesia can worsen hypokalemia.

General anesthesia is, essentially, a medically induced coma, not sleep.Drugs render a patient unresponsive and unconscious. They are normally administered intravenously (IV) or inhaled.Severe dehydration and dangerously low potassium levels are among the dangers of this condition. It is “non-ketotic” because ketones aren’t usually produced since some insulin is present, preventing their formation.

Dangers of Low Blood Sugar.You will get to see the effects of low potassium levels in the body in form of following symptoms: Myalgia (muscle pain), muscular weakness and cramps. Cardiac arrhythmia i.e. abnormal rate of muscle contractions in the heart.

Unexplained fatigue and weakness.Perioperative (including before,during and after surgery) serum potassium levels are closely associated with postoperative clinical outcomes after gastrointestinal surgery [ 1 ], including the recovery of gastrointestinal function, the risk for acute kidney injury and adverse cardiovascular events, as well as in-hospital mortality [ 2, 3, 4 ].A potassium level higher than 5.5 mmol/L is critically high, and a potassium level over 6 mmol/L can be life-threatening.

Small variations in ranges may be possible depending on the laboratory.Remember that because of the potassium curve, serum levels will be slow to change following hypokalemia – still, if [K+] levels appear refractory, check magnesium because this can be a cause of continued potassium loss [Arch Intern Med 145: 1686, 1985].

List of related literature:

Cardiac arrhythmias, such as premature ventricular contractions, increase the potential risk of cardiac arrest, so the patient’s potassium level is carefully evaluated before the administration of general anesthesia.
fromPharmacology for the Surgical Technologist E-Book by Tiffany Howe, Angela Burton Elsevier Health Sciences, 2019
Cardiac arrhythmias, such as premature ventricular contractions (PVCs), increase the potential risk of cardiac arrest, so the patient’s potassium level is carefully evaluated before the administration of general anesthesia.
fromPharmacology for the Surgical Technologist by Katherine Snyder, Chris Keegan Elsevier Health Sciences, 2016
Serum potassium concentration is unpredictable and should be evaluated, especially if general anesthesia is necessary.
fromFarm Animal Surgery E-Book by Susan L. Fubini, Norm Ducharme Elsevier Health Sciences, 2004
An unintended bolus of IV local anesthetic causes dosedependent consequences ranging from minor side effects (e.g., tinnitus, perioral tingling, mild blood pressure, heart rate changes) to major complications (e.g., seizures, loss of consciousness, severe arrhythmias, cardiovascular collapse).
fromAvery’s Diseases of the Newborn E-Book by Christine A. Gleason, Sherin Devaskar Elsevier Health Sciences, 2011
Also, anesthesia providers prefer to anesthetize patients with renal failure–induced hyperkalemia after dialysis to avoid serum potassium levels above 6.0 mmol/L. A decrease in ionized calcium is a matter of concern, as this condition has the potential to lead to neuromuscular and cardiovascular alterations.
fromThe Advanced Practice Nurse Cardiovascular Clinician by Kelley M. Anderson, PhD, FNP Springer Publishing Company, 2015
Neuromuscular blocking agents (one component of general anesthesia) generally cause a small rise in serum potassium.
fromHandbook of Dialysis Therapy E-Book by Allen R. Nissenson, Richard E. Fine Elsevier Health Sciences, 2007
Hyperkalemia (increased serum potassium level) increases the risk for dysrhythmias, especially with the use of anesthesia.
fromMedical-Surgical Nursing: Patient-Centered Collaborative Care, Single Volume by Donna D. Ignatavicius, M. Linda Workman, PhD, RN, FAAN Elsevier Health Sciences, 2015
Chronic exposure to a high-potassium milieu raises the threshold at which cardiac arrhythmias occur, such that many dialysis patients adapt to serum potassium of greater than 6.0 mmol/l without the clinical consequences, levels that could pose a significant risk if acutely developed.
fromPsychosocial Care of End-Stage Organ Disease and Transplant Patients by Yelizaveta Sher, José R. Maldonado Springer International Publishing, 2018
• No clear threshold has been defined for a level of hypokalemia below which safe conduct of anesthesia is compromised.
fromPharmacology and Physiology for Anesthesia E-Book: Foundations and Clinical Application by Hugh C. Hemmings, Talmage D. Egan Elsevier Health Sciences, 2018
Levels of potassium greater than 6.5 to 7 mmol/L may lead to widening of the QRS complex and peaked T waves that can progress to disorganized ventricular rhythms and severe cardiac dysfunction.
fromPediatric Critical Care E-Book by Bradley P. Fuhrman, Jerry J. Zimmerman Elsevier Health Sciences, 2011