Potassium replacement should be considered when correcting hyponatremia, especially severe (<120 mEq/L). The rule of thumb is 1 mEq of KCl is approx. equal to 2 mL of 3% saline. KCl solution should be concentrated. We use 20 mEq/50 mL formulation (400 mM vs. 513 mM of 3% saline). Tweet added by Helbert Rondon, MD, MS, FACP, FASN, FNKF @NephroMD

Helbert Rondon, MD, MS, FACP, FASN, FNKF

3 years

Potassium replacement should be considered when correcting hyponatremia, especially severe (<120 mEq/L). The rule of thumb is 1 mEq of KCl is approx. equal to 2 mL of 3% saline. KCl solution should be concentrated. We use 20 mEq/50 mL formulation (400 mM vs. 513 mM of 3% saline).

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Corey Cavanaugh DO

@cavanaugh_do

3 years

@NephroMD Hypokalemia makes me very anxious in severe hyponatremia as the attached case addressed. Do you recommend targeting a lower serum potassium goal in such cases?

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Helbert Rondon, MD, MS, FACP, FASN, FNKF

@NephroMD

3 years

@cavanaugh_do Not necessary. I take my time to correct hypokalemia, especially if asymptomatic, using hypertonic KCl in lieu of 3%, or sometimes even wait until Na comes to a more safer level in 2-digit hyponatremias.

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Yoshitsugu Obi

@Yoshi_Obi

3 years

@NephroMD Great teaching point. Do you place a central line in such cases? Can we use oral KCL instead?

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Helbert Rondon, MD, MS, FACP, FASN, FNKF

@NephroMD

3 years

@Yoshi_Obi No central line needed. You can also use oral but for severe hyponatremia and hypokalemia we are more comfortable using IV.

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Dr. Prashant.C.Dheerendra

@prashantnephro

3 years

@NephroMD Why do you say "considered" rather than "must" ?

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Bill Whittier

@TWhittier_RUSH

3 years

@NephroMD I remember I had a pt with bulimia who had a [Na] 106 and [K] 2.1 and I prevented overcorrection by giving KCl + D5W. No NaCl at all. Went to 112 and 3.8 in 24 hours.

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