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Introduction

  • Severe hypokalemia may precipitate profound and life-threatening cardiac complications including ventricular tachycardia and asystole.
  • Classical teaching is that in cardiac arrest with non-shockable rhythms the management include to identify and treat the H’s & T’s which include hyper and less commonly hypokalemia.
  • Potassium chloride is the therapy of choice, however, the dose and administration of potassium during cardiac arrest is controversial and limited to case series and case reports.

Clinical Detail

    Potassium Chloride

    Dose

    • 10-20 mEq initial dose followed by

    institutional protocol

    Administration

    • Administer at 2 mEq/min followed by

    another 10 mEq IV over 5-10 mins

    PK/PD

    • Onset Immediate

    • Increase in serum potassium is

    variable

    • Renal excretion 85-90%

    • Removed by dialysis.

    Comment

    • Compatible with magnesium sulfate,

    calcium chloride, epinephrine,

    amiodarone, lidocaine, and

    vasopressin

    • Lethal infection dose is ~100+ mEq

    undiluted as IV push x 1-3

    o Being replaced to sedatives

    due to issues with efficacy

    and ethical issues

Evidence

    Author, year

    Design/

    sample size

    Case & Intervention

    Outcome

    Elmahrouk,

    2020

    Case report

    • 46-year-old post CABG with malignant

    ventricular arrhythmia on ECMO and intra-

    aortic balloon pump s/p various

    antiarrhythmic medications.

    • IV KCl 20 mEq boluses

    • s/p KCl, the rhythm changed to sinus rhythm

    • Pt discharged home on a regular rehabilitation program

    Liu, 2020

    Case report

    • Case: 21 yr old with PMHx hyperthyroidism

    with thyrotoxic and K+ 1.5 mEq/dL

    • IV bolus KCl 40 mEq/40 mL via the central

    • ROSC with stable hemodynamic status at 8 minutes post

    KCl after 31 total minutes of CPR

    • Pt was extubated on the next day and was discharged

    without any complication after a total of 5 hospital days

    Jouffroy,

    2014

    Case report

    • 50-year-old male with refractory ventricular

    fibrillation (VF)out-of-hospital cardiac arrest

    (OHCA) s/p ECMO, 20 shocks, and various

    antiarrhythmic medications

    • IV KCl 40 mEq via central line

Conclusions

    Compatible with magnesium sulfate,

    calcium chloride, epinephrine,

    amiodarone, lidocaine, and

    vasopressin

    • Lethal infection dose is ~100+ mEq

    undiluted as IV push x 1-3

    o Being replaced to sedatives

    due to issues with efficacy

    and ethical issues

References

    Pharmacology

    Potassium Chloride

    Dose

    • 10-20 mEq initial dose followed by

    institutional protocol

    Administration

    • Administer at 2 mEq/min followed by

    another 10 mEq IV over 5-10 mins

    PK/PD

    • Onset Immediate

    • Increase in serum potassium is

    variable

    • Renal excretion 85-90%

    • Removed by dialysis.

    Comment

    • Compatible with magnesium sulfate,

    calcium chloride, epinephrine,

    amiodarone, lidocaine, and

    vasopressin

    • Lethal infection dose is ~100+ mEq

    undiluted as IV push x 1-3

    o Being replaced to sedatives

    due to issues with efficacy

    and ethical issues

Tags:hypokalemia cardiac arrest potassium reversible causes

Source PDF

Hypokalemia in cardiac arrest. pharmacy friday Pearls. jlp2 1 page.pdf