Hypokalemia in pregnancy

Editorial Team / Admin · Sep 29, 2005

What happens to a baby at 34 weeks when mom's K+ gets down to 1.6? I had a pt with pancreatitis the other day whose K+ dropped that low and I wondered what kind of effect that would have on the baby. Feeling really uneasy about this pt . . . just wanting some input. We got her up to 2.6 yesterday, but still not high enough . . .

Hello, Rae,:balloons:

Goodness. 1.6? Did mom have any cardiac s/s? Why was she so low? Severe dehydration?

The fetus can take many brutal insults in utero. I have had mom code with 2/10 H and H from hypovolemia and (fetus) survive unscathed. I am sure this fetus will be unaffected if the hypokalemic episode is reversed and the uderlying cause is treated/corrected.

RaeT,RN · Sep 29, 2005

Hello, Rae,:balloons:
Goodness. 1.6? Did mom have any cardiac s/s? Why was she so low? Severe dehydration?
The fetus can take many brutal insults in utero. I have had mom code with 2/10 H and H from hypovolemia and (fetus) survive unscathed. I am sure this fetus will be unaffected if the hypokalemic episode is reversed and the uderlying cause is treated/corrected.

She had had like 4 or 5 loose stools the day before, but not severe diarrhea, and some vomiting. I have never seen K+ that low, not even in The Units when I was in nursing school. We are not equiped for tele in our rooms (only in recovery), so we got her an EKG, which showed some PVC's and something about the S-T segment I can't remember. I was sure she was going to code on me. Fortunately she did not. The thing I thought was so odd was that with her first pregnancy she said she had "potassium issues" (also said she had uncontrollable N/V). A cardiologist followed her afterwards and the issue eventually resolved itself. Her prenatal record offered us no clues. Have you heard of anything like this before?

RaeT,RN · Sep 29, 2005

I just called the floor (I am off today) to check on this pt because I had this nauseating moment when I realized that mom was tachycardic at 130-140 and I remembered baby running about the same. Then I remembered her saying the baby was not moving around much. . . :uhoh21: She went into labor this am and delivered a healthy little boy 7lbs9oz, Apgars 7 and 9, who went to the regular nursery. They were just transfering her to a telemetry bed when I called. Those HR's should have been a red flag to me at the time and I should've looked into that further. I am lucky that baby is ok. :chair:

Editorial Team / Admin · Sep 29, 2005

She had had like 4 or 5 loose stools the day before, but not severe diarrhea, and some vomiting. I have never seen K+ that low, not even in The Units when I was in nursing school. We are not equiped for tele in our rooms (only in recovery), so we got her an EKG, which showed some PVC's and something about the S-T segment I can't remember. I was sure she was going to code on me. Fortunately she did not. The thing I thought was so odd was that with her first pregnancy she said she had "potassium issues" (also said she had uncontrollable N/V). A cardiologist followed her afterwards and the issue eventually resolved itself. Her prenatal record offered us no clues. Have you heard of anything like this before?

Hello again,

Yes, I have had several occasions with the gravida and renal issues. Especially pheochromocytoma, hyperaldosteronism, renal artery stenosis. These will usually have many B/P elevations and severe, severe hypokalemia. But, I have never had anyone with pancreatitis and a K+ level that low who was not dehydrated from N&V and/or septic.

Yes, I have seen the K+ at 1.5, the lowest and was precode. But, it was not in a pregnancy.

I wonder if she had hyperemesisgravidarum with the first one? Also, is she alcoholic? That would explain some electrolyte issues. How about her Mg levels?

Interesting.

Editorial Team / Admin · Sep 29, 2005

I just called the floor (I am off today) to check on this pt because I had this nauseating moment when I realized that mom was tachycardic at 130-140 and I remembered baby running about the same. Then I remembered her saying the baby was not moving around much. . . :uhoh21: She went into labor this am and delivered a healthy little boy 7lbs9oz, Apgars 7 and 9, who went to the regular nursery. They were just transfering her to a telemetry bed when I called. Those HR's should have been a red flag to me at the time and I should've looked into that further. I am lucky that baby is ok. :chair:

THe tachycardia was probably from early labor ensuing. The decreased fetal movements were also related to impending labor.

You did just fine, Rae. :) You did not miss anything. :balloons:

RaeT,RN · Sep 30, 2005

I wondered about the hyperemesis in her first preg as well, but its onsest was late in her pregnancy, around 20 weeks, which I felt was odd. She also had PIH, or what they called such, with that pregnancy along with the hypokalemia, which I now wonder if she has some underlying renal condition that gets triggered when she is pregnant. She denied alcohol use, and the docs did not delve into that further. On MRI she had "sludge" in her gallbladder, but no stones, so they decided that the duct may have been blocked just due to pregnancy, which is what brought on the pancreatitis. Her BP was also creeping up when I had her. Ok, her Mag level was normal, but can you explain to me why we would be worried about that? I don't understand that. I would also like to have known what her blood gas was. She was doing this awful see-saw breathing when she was sleeping, too. Kind of scary. Her CO2 was normal on some lab sheet that I read, but I just wondered after loosing all that gastric acid . . . and something tickled my brain from school with Metabolic Alkalosis and hypokalemia going together. . .