Hydroelectrolytic syndromes in neuroanesthesia and neurocritical care

Table 3 Potassium disorders correction

Disorder	Treatment category	Agent	Dose/Route	Notes
Hypokalemia	Oral repletion	Potassium chloride	20-40 mEq per dose, 2-3 times/day	High bioavailability; GI side effects at higher doses
	IV repletion (peripheral)	Potassium chloride in D5W or NS	10 mEq in 100 mL, infused ≤ 10 mEq/hour	Must dilute to minimize phlebitis
	IV repletion (central)	Potassium chloride in D5W or NS	20 mEq in 100 mL, infused ≤ 20 mEq/hour (up to 40 mEq/hour in arrest)	ICU monitoring; higher rates only in life-threatening situations
Hyperkalemia	Membrane stabilization	Calcium gluconate (10% solution)	1 g IV over 5-10 minutes	Repeat every 5-10 minutes if ECG changes persist; central line preferred
	Intracellular shift	Insulin + dextrose	10 U regular insulin IV + 25 g dextrose	Lowers K+ in 10-20 minutes; monitor blood glucose
	Intracellular shift	Salbutamol (β2-agonist)	10-20 mg nebulized or 5-10 μg IV	Onset about 30 min; watch for tachycardia
	Intracellular shift	Sodium bicarbonate	50 mEq IV	Particularly if metabolic acidosis present
	Renal elimination	Furosemide	20-40 mg IV	Requires adequate renal function and volume status
	Dialytic removal	Hemodialysis or CRRT	-	Definitive in severe or refractory cases
	Gastrointestinal binding	SPS	15-30 g PO or PR	Erratic onset, GI side effects, risk of colonic necrosis
	Gastrointestinal binding	SZC	10 g PO	Onset about 1 h; better tolerated than SPS

GI: Gastrointestinal; D5W: 5% dextrose in water; NS: Normal saline; ICU: Intensive care unit; ECG: Electrocardiogram; CRRT: Continuous renal replacement therapy; SPS: Sodium polystyrene sulfonate; PO: By mouth; PR: Per rectum; SZC: Sodium zirconium cyclosilicate; IV: Intravenous.