Congestive heart failure electrolyte replacement

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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

• ACE inhibitors reduce potassium excretion, but most patients with good renal function require potassium supplementation during daily therapy with the diuretics such as furosemide (Lasix) despite of ACE inhibitors therapy.
• Dietary supplementation is rarely adequate.
• Hypokalemia can aggravate arrhythmias and precipitate muscle cramps.
• Potassium levels >6 (particularly when occurs rapidly) can be associated with reduced myocardial contractility.
• Patients are actually at higher risk of hyperkalemia and hypokalemia. The goal is to maintain a potassium between 3.8 and 4.5 mEq.
• Unless the hypokalemia is very severe and at life-threatening level, potassium should be replaced by oral administration.
• Potassium should not be administered intravenously at a rate that exceeds 10 mEq per hour.
• Patients who use diuretics usually require approximately 20-60 mEq/day of oral potassium.
• Extra potassium should be given after the patient has noted diuresis or weight change. If patient has lost more than two pounds, the electrolyte's level should be checked every three days.

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