Alys Latimer, Layla Mohamed, and Sandra Zhengwhat IS tpn?Total Parenteral Nutrition (TPN):Infusion of intravenous nutrition (macro- and micro- nutrients)Those with contraindications to oral dietary approachSpecialized mixtures of amino acids, dextrose, lipid emulsions, electrolytes, vitamins and mineralsInfused centrally into internal jugular or subclavian veinsINDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disordersADVERSE COMPLICATIONS: infections, post-op wound complications, immune compromise, fluid/electrolyte imbalance, GI bleeding, etc. (Arya et al.
, 2013)What is hypokalemia?Hypokalemia:Normal Findings: 3. 5 5. 0 mEq/LCritical Values: < 2. 5 mEq/LPotassium (K+), important part of protein synthesis and maintenance of normal oncotic pressure and cellular electrical neutrality(Pagana & Pagana, 2013)Signs and Symptoms of HypokalemiaTypically not present until Potassium levels are less than 3. 0 mEq/LSigns and symptoms of hypokalemia are typically related to cardiac, skeletal, and smooth muscle weaknessCARDIOVASCULAR: flattened T-wave and prominent U-wave, ST segment depression, conduction abnormalities, dysrhythmias, worsening hypertension, sudden deathKIDNEY: polyuria, hypokalemic nephropathy, increased risk of nephrolithiasis, and chloride-depletion metabolic alkalosisCNS/NEUROMUSCULOSKELETAL: fatigue, malaise, hyporeflexia, weakness, cramps, paralysis, myalgia, and rhabdomyolysisGI TRACT: Constipation, vomiting, prolonged gastric emptying, paralytic ileus, anorexia, worsening hepatic encephalopathyGU TRACT: hypotonic bladderPULMONARY: respiratory acidosis, respiratory failure ENDOCRINE: insulin resistance and impairment in insulin release(Asmar et al.
, 2012; Elgart, 2004; Pagana & Pagana, 2013)How to treat hypokalemia?Treatment Options:GOAL: identifying definitive cause of hypokalemia, prevent the development of life-threatening consequences, and correct any potassium deficit which avoiding hyperkalemiaMILD MODERATE HYPOKALEMIA (3. 0 3. 5 MEQ/L):Treat underlying disorder if possibleTreat with 60 80 mEq/d of KCl via PO in divided doses Reassess serum potassium concentration after replacement therapy and adjust accordinglySEVERE HYPOKALEMIA (< 3. 0 MEQ/L):Preferred: 40 mEq/d of KCl via PO q3-4h TIDReassess serum potassium concentration after replacement therapy and adjust accordinglyIf necessary: 10 20 mEq/h of KCl via IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicityContinuous cardiac monitoring is mandatory Reassess serum potassium concentration q2-4h (ensure that serum potassium concentration is > 3. 5 mEq/L)(Asmar et al. , 2012)Thank you References:Asmar, A.
, Mohandas, R. , & Wingo, C. S. (2012). A physiologic-based approach to the treatment of apatient with hypokalemia.
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2012. 01. 031Arya, I. N.
, Shah, B. , Arya, S. , Dronavalli, S. , & Karthikenyan, N.
(2013). A review of literature on modernparenteral nutrition. International Journal of Medical Science and Public Health, 2(4), 801 806. doi: 10.
5455/jimsph. 2013. 030920131Elgart, H. N.
(2004). Assessment of fluids and electrolytes. AACN Clinical Issues, 15(4). 607-621. Retrieved from: https://learn. humber.
ca/bbcswebdav/pid-4534008-dt-content-rid24071933_1/courses/1528. 201750/Assessment%20of%20Fluids%20and. pdfPagana, K. D. , & Pagana, T. J.
(2013). Mosbys Canadian manual of diagnostic and laboratory tests (FirstCanadian ed. ). Toronto, ON: Elsevier Canada
