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(serum K+ < 3.5 mEq/L)

Clinical Suspicion Symptoms and Signs

• Gastrointestinal losses: vomiting, diarrhea • Related to serum K+ level
N-G suction, fistulae • Mental: confusion, depression, agitation
• Urinary losses: diuretic, polyuria • Muscular: fatigue, hypotonicity, paralysis
• Alkalosis: • Respiratory: apnea
metabolic or respiratory • Cardiac: ectopic beats, PAC, PVC,
intracellular shifts tachycardia
• Mineralocorticoid excess: primary and secondary
aldosteronism, Cushing’s
• Hypertension-hypokalemia syndrome
• Tumors: insulinoma, aldosteronism, Cushing’s
• Metabolic: hyperthyroidism
• Hereditary: familial periodic paralysis

Check EKG
Reflects only the serum K+ level
Diagnostic at about 2.7 mEq/L
T waves: flat, inverted, wide
Q-T interval prolonged
U wave prominent

• Always monitor serum potassium during therapy
• Check serum magnesium and replete


< 3.5 mEq/L 2.0 mEq/L or lower 1.5 mEq/L or lower
• po replacement when possible • With normal kidney function Lethal level of hypokalemia
(40 to 120 meq/day in divided doses) patient’s wt in Kg x 3 mEq • IV KCl 50 mEq/hr
• IV: 40 to 120 mEq/day equals maximum safe dose of maximum rate, 1 or 2 hours
concentration 20-40 mEq/L IV K+ per 24 hours, give 1/2 in first • Intensive Care Unit
Rate - not to exceed 10 mEq/hr 12 hours, eg: • Constant ECG monitoring
Avoid IV glucose solutions, may 70 Kg x 3 mEq = 210 mEq • D/C as soon as “T” waves
lower K+ administer 105 mEq in 12 hrs, 9 K+ become upright
administer 105 mEq over next 12 hrs • Artificial ventilator support
• Repeat serum K+ q 4h, reassess almost always required
• Indwelling IV catheter site away • Indwelling IV catheter
from heart site away from heart
Loop blocker and thiazide diuretic • Avoid rapid intracardiac changes • Avoid rapid intracardiac changes
induced hypokalemia:
• po KCl 30-60 mEq/day
• K+ sparing diuretic combination
• amiloride, spironolactone, triamterine

Most cases require potassium replacement as KCl especially if alkalosis co-exists

In cases of metabolic acidosis, consider using K acetate, gluconate, or citrate (bicarbonate precursors )