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Ubat-ubatan Hypokalemia

Potassium adalah sejenis garam/elektrolit yang sangat penting dalam badan kita terutama untuk fungsi muscle cell (cardiac, skeletal & smooth). Ianya diukur melalui ujian makmal di masukkan dalam kategori 'Renal Profile'. Potassium juga dikenali 'Kalium'. Abbreviation potassium adalah 'K'. Bacaan normal adalah 3.5-5.0 mmol/L. Jadi, hypokalemia ditakrifkan sebagai potassium kurang daripada 3.5 mmol/L. 1 mmol = 1 mEq K+.

Farmakologi:

·         Normally about 80 to 90% of the potassium intake is excreted in the urine, the remainder in the stools and to a small extent, in the perspiration. The kidney does not conserve potassium well so that during fasting, or in patients on a potassium free diet, potassium loss from the body continues resulting in potassium depletion. A deficiency of either potassium or chloride will lead to a deficit of the other.

Apabila melibatkan garam/elektrolit, unit yang digunakan adalah 'milimol @ mmol' bukannya 'gram @ miligram'. Saya bagi contoh :

                a) 1 g Mist@Mixture Potassium Chloride (KCl) adalah bersamaan 13.4 mmol. Kebanyakan             penyediaan larutan air KCl 1 g adalah bersamaan 15 mL.

Berapa banyak mmol K di dalam setiap penyediaan ubat gantian potassium (yang terdapat di fasiliti KKM)?

a) Mixture KCl 1g = 13.4 mmol

b) Tablet KCl 600mg = 8 mmol

c) Injection KCl 1g/10ml = 13.4 mmol

d) Injection Potassium Dihydrogenase Phosphate (KH2PO4) = 10 mmol (digunakan untuk merawat kekurangan Phosphate/PO4)

Apa Yang Bahaya Hypokalemia?

·         symptomatic cardiac arrythmias or conduction disturbances (dengan melihat pada ECG), respiratory muscle weakness, paralaysis

Inj. KCl = High Alert Medication & Must Dilute Before Use!

·         Injection Potassium Chloride (KCl) adalah salah 1 'High Alert Medication'. Pastikan anda menguruskan ubat tersebut dengan betul mengikut protokol yang ada dalam 'Guideline on . Yang paling penting adalah Injection KCl mesti di dilute sebelum digunakan. Maksudnya dilarutkan di dalam dilution yang sesuai sebelum diberikan kepada pesakit, kebiasaannya 1g in 100cc NS over 1 hour @ 1g diluted in 500mL NS/D5% over 2 - 3 hours. Tetapi, kita preferred NS biasanya. Ini kerana 'Sodium chloride 0.9% may be the preferred diluent in critical states, unless contraindicated, due to potential decrease in serum potassium from glucose solutions'.

Kenapa Perlu Dilute & Bagi Secara Infusion Inj. KCl?

·         If potassium is administered too rapidly or if excretion is impaired, potentially fatal hyperkalemia can result; it can develop rapidly and asymptomatically. Therefore careful monitoring of serum potassium concentration and dosage adjustment is recommended. The symptoms and signs of potassium intoxication include paraesthesia of the extremities, flaccid paralysis, listlessness, mental confusion, weakness and heaviness of the legs, fall in blood pressure, cardiac arrhythmias and heart block. Hyperkalaemia may exhibit the following ECG abnormalities: disappearance of the P wave, widening and slurring of the QRS complex, changes in the ST segment, tall-peaked T-waves. Nausea, vomiting, diarrhoea and abdominal discomfort have been reported

·         Too rapid infusion of hypertonic solutions may cause local pain and, rarely, vein irritation.

Adverse Reaction Inj. KCl?

·         febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, hypervolemia, and hyperkalemia.

·         nausea, vomiting, abdominal pain and diarrhea. 

Monitoring Parameter?

·         Sudah tentu Potassium level perlu dipantau sentiasa terutama apabila pesakit diberikan Injection KCl sekurang-kurangnya setiap 24 jam.

Maximum Dose Potassium? *with close K monitoring

·         Usually 200 mmol@mEg/day

·         Can go up to 400 mEq/day

Stability of Inj. KCl?

·         Hanya 24 jam sahaja setelah dilute. Oleh itu, penyediaan melebihi 24 jam perlu dibuang.

NOTES:

1. Administer supplements cautiously in patients with renal impairment and those on potassium sparing diuretics (e.g. spironolactone) or ACE inhibitors (e.g. ramipril).

2. Magnesium deficiency must be replaced to adequately restore potassium.

Disclaimer : Sila rujuk ahli farmasi untuk kepastian. Blog ini hanyalah berkongsian pengalaman yang dilalui oleh penulis.