How to correct potassium as per pH i.e. in acidosis and alkalosis in ICU; explained by Dr. P.K.Jain

[@vijayalakshmicmsunderaj595]

Pearls like this are priceless. It drums it into your head. A Red flag is raised before you act. The years of immersion in the field. Thank you.

[@drnaseemuddinkalhoro3542]

This is best one. Currently I am working in ICU in KSA. Your channel is a great help for me. Thank you so much sir

[@Archer396]

I panicked when a pt was in hyperkalemia post blood transfusion, my consultant had my back since I was new in ICU! Thank God 🙏

[@chairman-ccef7876]

It is a frightening situation as the hyperkalemia is real and due to RBC breakdown releasing the large intracellular potassium.

[@Archer396]

@@chairman-ccef7876 yes yes

[@lavanyasivakumar3787]

Thank you so much for sharing knowledge

[@drMahroshFalak]

Awesome Sir ❤🇵🇰 Life savings tips with examples are best of all so far. I would like to suggest you to continue such shorts 5 to 10 min clips of common critical cases encountered in ICU are mistakes that must be highlighted in managing them.

[@chairman-ccef7876]

Thank you

[@chandrakantchandak]

We are all privileged to be bestowed with these extremely helpful lessons sir. They are of immense value.. please do continue them. Thank you!❤

[@chairman-ccef7876]

😊 Thank you

[@fatimakadi8887]

Thank you sir !!!

[@mukundrajta2576]

We need more videos and learning like this sir ..... looking forward Thank you sir

[@asmashoaib5964]

Thank you for such beneficial information

[@haha..551]

Excellent information 👍

[@sultanzaffar1017]

Great I really enjoyed your short lecture

[@chamariliyanage9626]

It really worth,Thank you so much sir.

[@hishighnessab5540]

Looking forward for more from you sir. It was very precise and very informative.

[@TheICUChannel]

Glad you liked it

[@meeradewangan5862]

Thankyou sir 🙏 I am nurse this information is give us lot of knowledge 🙏 sir pls also include videos in mix Hindi language, for precise and clear understanding

[@tusharchopawar8255]

Such a minute details but so crucial, very commonly ignored Thank u so much👍👍👍

[@saminkazi4999]

Wonderful explanation

[@TheICUChannel]

Glad you liked it

[@faizdr1723]

Well done sir May Allah grant you long healthy life

[@RaviKumar-ml8ob]

Thank you so much sir, excellent sir

[@hemantingole4033]

Thank you sir

[@LoijingandVsay]

Thank you so much Sir🙏 please continue enlightening us with such priceless pearls

[@TheICUChannel]

Thank you, we will try our best

[@swaroopak8368]

Very useful sir. Thank you so much for giving us such pearls

[@tradingchannell]

Amazing once again❤. Though there alot of blunders is happening when we look around in our area's (in ICU). it's shame when u do something to a patient without having a knowledge about it, I wish to tagg my colleagues those who do arguments on something which they don't know, even though I have recommended this channel to them but they don't have time for it to learn and accept what is right. To be honest i learned alot from this channel andhv been watching since beginning,

[@allahhuakbar7362]

Extremely crucial😊

[@widaltyph491]

Thank you Sir! Kindly make a snippet of IV magnesium correction. Thank you!

[@chairman-ccef7876]

Wonderful recommendation. Will do that soon.😊

[@directajith]

both acidosis and alkalosis can ultimately lead to potassium loss, but the mechanisms and serum potassium levels during these conditions differ. Here's a clear breakdown: 1. In Acidosis: Serum Potassium: Tends to increase initially (hyperkalemia). Hydrogen ions (H⁺) move into cells to buffer excess acidity, and potassium (K⁺) shifts out of cells into the bloodstream. Potassium Loss: Despite the apparent hyperkalemia, total body potassium is depleted due to: Renal potassium losses (e.g., osmotic diuresis in diabetic ketoacidosis, tubular damage). Gastrointestinal losses (e.g., diarrhea in lactic acidosis). End result: Once the acidosis is corrected (e.g., with insulin in DKA), serum potassium can drop significantly, revealing a hypokalemic state. 2. In Alkalosis: Serum Potassium: Tends to decrease (hypokalemia). Hydrogen ions move out of cells into the blood, and potassium shifts into cells to maintain electrochemical balance. Potassium Loss: Alkalosis promotes renal potassium excretion: Increased distal tubular negativity enhances potassium secretion. Aldosterone activity is stimulated, further increasing potassium loss. End result: The combination of intracellular potassium shifts and renal losses leads to hypokalemia. Why Potassium Loss Occurs in Both: In acidosis, total body potassium is lost even if serum potassium appears elevated. In alkalosis, potassium is lost due to cellular shifts and enhanced excretion. Key takeaway: Regardless of the acid-base disturbance, close monitoring of potassium levels is essential, as both conditions can lead to significant total body potassium depletion and complications if untreated.

[@sanjoyghosh2183]

Priceless piece of information Sir

[@jadenbverghese8664]

Brilliant ! Thank you Dr Jain it was helpful.

[@nandan0000s]

Mind blowing concept...... Thank you for your innovative steps We are with you 🙏🏼

[@nandan0000s]

Continue please

[@rachanagupta6628]

Excellent information sir Thanks

[@Dr.Amritkumaryadav]

Very valuable information indeed

[@umeshnagpal1332]

Nice video sir , very knowledgeable. Please sir make a video on hypo/ hypernatremia

[@chairman-ccef7876]

Thanks for the suggestions

[@shubhamtripathi405]

So good sir ....thank you so much ....

[@nishantdeshpande6666]

Thank you for valuable information sir.

[@shilpadesai9962]

Thanks a lot sir Thanks for the wonderful teaching

[@Bunicutaintelectuala]

Thank you for the knowledge!

[@PratyushChaudhuri]

Thank you

[@AumJi13]

How long after correcting for pH, with either Bicarbonate infusion (for acidosis) or fluids (for alkalosis), should we check/re-check the potassium levels? Is it 30mins, 1hr, 2hr... etc... after starting bicarb or fluids? Or more? What is the guideline for this step?

[@chairman-ccef7876]

Excellent question. Transcellular movement occurs in minutes so an hour should be good

[@AumJi13]

@@chairman-ccef7876thank you so much Sir! Much appreciated!

[@abhijitchatterjee7408]

❤️ bows to you.

[@directajith]

Metabolic acidosis typically does not directly lead to hypokalemia but can result in apparent hyperkalemia initially due to potassium shifts. However, total body potassium is often depleted, which can lead to hypokalemia under certain circumstances. Here’s a breakdown: What Happens in Metabolic Acidosis: Potassium Shift to Extracellular Space: In acidosis, hydrogen ions (H⁺) enter cells to buffer the acid. To maintain electrical neutrality, potassium (K⁺) leaves the cells, increasing serum potassium levels (apparent hyperkalemia). Potassium Loss: The body loses potassium through urine or the gastrointestinal tract due to the underlying causes of acidosis, such as: Renal tubular acidosis: Potassium loss in urine. Diabetic ketoacidosis (DKA): Osmotic diuresis leads to significant potassium loss. Effect of Treatment: When acidosis is corrected (e.g., insulin therapy in DKA or bicarbonate administration), potassium shifts back into cells, potentially revealing or exacerbating hypokalemia if total body potassium is already depleted. Situations Leading to Hypokalemia in Metabolic Acidosis: Renal loss of potassium (e.g., in renal tubular acidosis, DKA). Diarrhea or gastrointestinal losses. Correction of acidosis without adequate potassium supplementation. Conclusion: While metabolic acidosis may initially cause hyperkalemia, the total body potassium is often depleted, and hypokalemia can develop, especially during treatment or in prolonged conditions. Monitoring and potassium supplementation are crucial in managing these patients.

[@psthankaraj3887]

Excellent

[@pradeepjoshi969]

Sir,would like to have many more such short videos. please give links for the same

[@Archer396]

Really extra edge! Thanks to the team🎉

[@dr.shivarajvuppin2798]

Thanks for the precious information sir, it would be much more helpful if u share the relevant litrature or links , so tat we can read more about it and can discus in hospitals with seniors

[@chairman-ccef7876]

True. Will keep that in mind. Problem is that there is no single source. Its the amalgamation of 35 years of prolific reading and bedside experience.

[@moulisankar7244]

Thank you so much sir 🙏

[@mahanteshvarute359]

Useful lesson

[@TheICUChannel]

Glad to hear that

[@THEANESTHESIST]

What is low anion gap metabolic acidosis(LAGMA)? is there any term like this in the books?

[@MegaPyrrhus]

Hi Sir, I am a critical care fellow from Pakistan. This pearl is very fascinating and new to me. I didn't find this thing even in Parillo (textbook of CCM) and Washington Manual. Can you please provide the reference of an article or book on this? Your youtube channel has always been helpful to me. Thank you.

[@TheICUChannel]

It’s mentioned in almost every standard textbook . But for sake of reference, quoting uptodate link , www.uptodate.com/contents/potassium-balance-in-acid-base-disorders

[@MegaPyrrhus]

Thank you, Sir.

[@KarthikArjun991991]

Thank you Sir🙏

[@Ignatius7778]

Brilliant 👏 👏. ECG also plays an important role in potassium management

[@chairman-ccef7876]

Yes it does. 😊. But the importance is over emphasised in books.

[@TheICUChannel]

yes ECG is important , because if ECG changes are coming, means its alarming and you need to act on it.

[@chairman-ccef7876]

In my opinion, ECG changes only imply acute K elevation. Nothing more. So serious life threatening hyperkalemia (say in chronic Renal Disease, where the rise is gradual) may occur with NO ECG changes. So if No ECG changes, you have time to correct and I would consider say dialysis. When ECG changes are there, hyperkalemia is acute and medical management becomes an emergency.

[@DrPrabhuSingh]

🎉 thanks Team, esteemed sir❤

[@mikuprateek3886]

Very nice concept sir..

[@TheICUChannel]

Thank u. And yeah, it’s very important

[@chineduekwueme1837]

Lovely video. Thanks

[@anandtiwari52]

Extremely low tolerance for error......a whole book in one sentence......

[@bardaasht007]

Good evening sir Greetings from pune Really very educational video and an eye opener, Can the same principle be applied In case of DKA with T2DM with CKD stage 4-5, with metabolic acidosis , where deranged RFT, hyperkalaemia is very common occurrence. Keen to know the management of such cases

[@ZahidHussain-ht4tw]

Thank you so much sir 👍👍👍

[@rajibhowlader2899]

Today's Learning.. ❤❤❤

[@mohitaggarwal4731]

Thanks sir

[@ranjithkumar-rm8zw]

This applies for only metabolic acid base disorders or also for respiray sir???

[@nikhilsss]

The uptodate article which was quoted mentions the correction is originally based on one study with less than 10 patients with a broad range and this number taken was the mean of that range. Even if that be, the change in pH, for example acidosis, would cause extracellular shift of potassium, rising serum potassium levels. So we are never really worried about the ' intracellular potassium'. The K+ outside (extracellular) is the one causing problems, which we correct routinely. So if potassium is 7 and corrected is 5, wouldn't that give a false sense of security? Or am I missing something entirely?

[@arslanali1432]

Thanks for the video.Really learnt something important Can you kindly tell from where to study these facts.. Any book, article, guidelines Thanks

[@chairman-ccef7876]

Not many books that give such pearls though information drowned in a lot of other information. This site is an excellent source. 😊😊😊

[@annmariesossong4245]

I have never heard this! Where can I read about it more? Do you have a link? Thank you so much for this.

[@TheICUChannel]

Any standard ABG book .

[@kamal7835]

Thanks a lot sir❤

[@nikhiltrivedi1436]

One doubt In DKA when we plan to start Insulin Infusion we see the potassium before it so that potassium is the one that comes in ABG or the corrected one!

[@mohamedabdali6598]

It's just shifting from intra to extr cellular, the number in the serum are still true and the side effects of hyper/hypo kalemia are there? You need to treat both ways

[@kushagarjuneja3300]

Such a crucial detail must say! Dr., just want to ask that we take the corrected K+ into account only for the ICU/ critical patients or for any such as non- critical inpatients and outpatients l? (Perhaps a very stupid question)

[@chairman-ccef7876]

Will apply to anyone, but pH abnormalities more common when a person is critically ill

[@ahmadgumman3390]

How come uptodate tells us to correct the hyperKalemia with insulin😢😢😢I am confused kindly elaborate

[@viswanathselvam2986]

Sir, isn't it the hyperkalemia in acidosis cause arrhythmias? Aren't we be worried about this when the K+ is 6.2meq/l?

[@LearningCriticalCarewithCCEF]

The Hyperkalemia in DKA is just a transcellelar shift that gets rapidly corrected once DKA treatment is started. In the example I gave, the corrected S.K was actually low. So its risky to try and reduce serum K when it is infact low. Does that clarify your doubt?

[@anupamhalder475]

Beautiful

[@KashifKxhan]

Can someone explain in detail how to correct pottasium with PH ?

[@poojanaresh4578]

Sir, then if pt is posted for surgery and no time to correct alkalosis and hypokalemia, can we go ahead without fearing arrythmias??

[@TheICUChannel]

In emergency u have to do your best with ongoing corrections … in elective cases , u need to optimise as much as u can .

[@EDCRITICALCARE]

Considering same example if serum potassium is 8.5 n pH is 6.9, shouldn't we correct potassium level? Corrected potassium will be 5.

[@chairman-ccef7876]

Definitely should be corrected. You answered the question yourself. The corrected K is high now. Justifies cautious correction.

[@drsunilkumarkedia]

Sir 0.1 pH down will increase potassium by 0.7 . Am I right

[@drsunilkumarkedia]

Then in example it will be 0.5*0.7=0.35

[@chairman-ccef7876]

@cuteboy3dbax6year9 you are making a mistake. Your statement is right. Drop in pH by 0.1 increases the k by 0.7 mEw/L. Here it is 5 times 0.1, so increase of K will be 5 x 0.7 = 3.5 mEw/L.

[@chairman-ccef7876]

Typo error. Please read mEq/L

[@adityamaindarge908]

Woww

[@ahmadgumman3390]

Kindly share reference please

[@saumyajitbhaduri1083]

❤❤❤

[@drbhushan146]

🙏🤝

[@jnanamaninanaiah742]

🙏💐

[@dryashd]

It should be 0.5 x 0.7 and not 5 x 0.7

[@srikrishnareddy879]

🙏

[@funnyfun6482]

Pakka

[@chandrashekharrawat1870]

कृतज्ञ हुआ

[@GauravKumar-st1cd]

Books cannot beat experience

[@chairman-ccef7876]

Well said

[@chairman-ccef7876]

So true

[@moiznauman5121]

thank u Sir

[@TheICUChannel]

Welcome

[@amna.ejaz10]

Thank you so much sir

[@shubhamsingh-xk4br]

Thank you so much sir

[@TheICUChannel]

Most welcome