TPN &Hypokalemia Essay

Alys Latimer, Layla Mohamed, and Sandra Zheng
what IS tpn?
Total Parenteral Nutrition (TPN):
Infusion of intravenous nutrition (macro- and micro- nutrients)
Those with contraindications to oral dietary approach
Specialized mixtures of amino acids, dextrose, lipid emulsions, electrolytes, vitamins and minerals
Infused centrally into internal jugular or subclavian veins
INDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disorders
ADVERSE 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/L
Critical Values: < 2.5 mEq/L
Potassium (K+), important part of protein synthesis and maintenance of normal oncotic pressure and cellular electrical neutrality
(Pagana & Pagana, 2013)
Signs and Symptoms of Hypokalemia
Typically not present until Potassium levels are less than 3.0 mEq/L
Signs and symptoms of hypokalemia are typically related to cardiac, skeletal, and smooth muscle weakness
CARDIOVASCULAR: flattened T-wave and prominent U-wave, ST segment depression, conduction abnormalities, dysrhythmias, worsening hypertension, sudden death
KIDNEY: polyuria, hypokalemic nephropathy, increased risk of nephrolithiasis, and chloride-depletion metabolic alkalosis
CNS/NEUROMUSCULOSKELETAL: fatigue, malaise, hyporeflexia, weakness, cramps, paralysis, myalgia, and rhabdomyolysis
GI TRACT: Constipation, vomiting, prolonged gastric emptying, paralytic ileus, anorexia, worsening hepatic encephalopathy
GU TRACT: hypotonic bladder
PULMONARY: 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 hyperkalemia
MILD MODERATE HYPOKALEMIA (3.0 3.5 MEQ/L):
Treat underlying disorder if possible
Treat with 60 80 mEq/d of KCl via PO in divided doses
Reassess serum potassium concentration after replacement therapy and adjust accordingly
SEVERE HYPOKALEMIA (< 3.0 MEQ/L):
Preferred: 40 mEq/d of KCl via PO q3-4h TID
Reassess serum potassium concentration after replacement therapy and adjust accordingly
If necessary: 10 20 mEq/h of KCl via IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicity
Continuous 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 a
patient with hypokalemia. American Journal of Kidney Diseases: The Official Journal of the National
Kidney Foundation, 60(3), 492 497. doi: 10.1053/j.ajkd.2012.01.031
Arya, 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.2013.030920131
Elgart, 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.pdf
Pagana, K. D., & Pagana, T. J. (2013). Mosbys Canadian manual of diagnostic and laboratory tests (First
Canadian ed.). Toronto, ON: Elsevier Canada

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