VI.

TREATMENT AND LABORATORY PROCEDURE

During attacks, oral potassium supplementation is preferable to IV supplementation. The latter is reserved for patients who are nauseated or unable to swallow. Potassium chloride is the preferred agent for an acute attack (assuming a normal renal function).[12] A reasonable initial dose for a 60-120 kg man (ie, 0.5-1 mEq/kg) is 60 mEq. Typically, 40-60 mEq of K+ raises the potassium concentration by 1.0-1.5 mEq/L, and 135-160 mEq of K+ raises plasma potassium by 2.5-3.5 mEq/L. Aqueous potassium is favored for quicker results. If there is no response in 30 minutes, an additional 0.3 mEq/kg may be given. This should be repeated up to 100 mEq of potassium. Beyond this, monitoring of serum potassium is warranted prior to further supplementation. Typically, one should not exceed a total dose of 200 mEq in a day. Date of Procedure: December 6, 2013 NORMAL RESULTS 135-145 mmol/l SODIUM 3.5-4.5 mmol/l POTASSIUM 98-107mmol/l CHLORIDE

RESULT 109 mmol/l 2.04 mmol/l 84 mmol/l

SODIUM Decreased levels (hyponatremia) may be caused by: vomiting, diarrhea, gastric suction, excessive perspiration, continuous IV 5% Dextrose/water; low-sodium diet, burns, inflammatory reactions, tissue injury, others. Increased sodium can mean: dehydration, severe vomiting & diarrhea, CHF, Cushing's disease, hepatic failure, highsodium diet, and others. POTASSIUM Cardiac arrhythmias and neurological disturbances are seen with high or low levels of this electrolyte. Hypokalemia can be caused by decreased intake, protracted vomiting, renal loss, cirrhosis and others. Hyperkalemia can be caused by renal failure and other causes. An increased level of blood chloride (called hyperchloremia) usually indicates dehydration, but can also occur with other problems that cause high blood sodium, such as Cushing syndrome or kidney disease. Hyperchloremia also occurs when too much base is lost from the body (producing metabolic acidosis) or when a person hyperventilates (causing respiratory alkalosis). A decreased level of blood chloride (called hypochloremia) occurs with any disorder that causes low blood sodium. Hypochloremia also occurs with congestive heart failure, prolonged vomiting or gastric suction, Addison disease, emphysema or other chronic lung diseases (causing respiratory acidosis), and with loss of acid from the body (called metabolic alkalosis).

CHLORIDE

VII. REFERENCE http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001355/ http://en.wikipedia.org/wiki/Thyroid http://www.uptodate.com/contents/hypokalemic-periodic-paralysis http://mda.org/disease/inherited-and-endocrine-myopathies/periodic-paralyses

PHYSICAL ASSESSMENT Date of assessment: December 7, 2013

SYSTEM a. General/ Overall Health Status ROS Wala naman akong masakit na nararamdaman. PE awake, coherent, oriented to time, place and person PNSS 1L + 60 mEq/L KCl x 12 hours inserted at left metacarpal vein, infusing well stated chronologic age

occasion and weather comfortable with age purposeful in his interaction with others symmetric with movement Speech is clear vital signs: BP = 110/70mmHg, PR = 63 bpm, RR = 16 cpm, and Temp = 36 oC

b. Integument

SKIN Inspection -) pallor -) edema Palpation

on upper extremities -) dry and rough skin HAIR AND SCALP Inspection and Palpation -) flakes on scalp evenly distributed - ) hair loss NAILS AND NAILBED Inspection and Palpation -) brittle, dry -) dirty and untrimmed fingernails seconds Inspection body size -) lesions and swelling Inspection body size -) lesions and swelling Palpation symmetric skull, appropriately related to body size) -) tenderness and crepitation

c. Head

IX. DRUG RATIONALE

KALIUM DURULE Oral 1 to 2 mEq/kg/day orally in equally divided doses using ageappropriate oral dosage formulations. Do not crush, chew, break, or suck on an extended-release tablet or capsule. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Sucking on a potassium tablet can irritate your mouth or throat. Do not stop taking this medicine without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse. Overdose symptoms may include heavy feeling in your arms or legs, confusion, weak or shallow breathing, slow or uneven heartbeat, seizure (convulsions), or feeling like you might pass out.

PENICILLIN G
IM 100,000 units q6 Pediatric doses are generally determined on a weight basis and should be calculated for each patient individually. When Penicillin G Potassium Injection, USP is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Penicillin G Potassium Injection, USP or other antibacterial drugs in the future.

VIII. COURSE IN THE WARD

December 6, 2013 Patient was admitted to 5 West due to difficulty of walking. Administered Pen-g (100,000 IM IU TIV q6) Serum K laboratory of 2.04 mmol/l Instructed to low salt, low fat and high K diet Administered IVF D5NM (M) 635 6 FOR 8hrs Doctors orders: Monitor vital signs every 2 hrs. and record Input and output every shift and record December 7, 2013 Repeated serum K laboratory with a result of 2.04mmol/l Continued medications: Pen-g Monitored vital signs every two hours. Monitored input and output. Administered 1L PNSS + 40 MEQS KCl @ 79cc/hr Observed for signs of respiratory distress and arrhythmia. December 8, 2013 Repeated serum K laboratory with a result of 2.13 mmol/l Continued medications: Pen-g Continued present IVF. Monitored vital signs every four hours. Monitored input and output. December 9, 2013 Administered Kalium durule BID Repeated serum K laboratory with a result of 2.75 mmol/l Monitored vital signs every four hours. Monitored input and output. Continued present IVF. Monitored for presence of body weakness. December 10, 2013 Repeated serum K laboratory with a result of 3.45 mmol/l Maintained low salt, low fat diet. Shifted IVF to heplock. Monitored vital signs every four hours. Monitored input and output. 11:05am doctor ordered MGH

HYPOKALEMIC PERIODIC PARALYSIS

SUBMITTED BY: MELISSA D. DAVID SUBMITTED TO: MELANIE S. CAMBEL, RN, MAN