HYPOKALEMIA
Definition:
A decrease in the serum potassium concentration below
3.5mEq/L caused by a deficit in total body potassium
stores or abnormal movement of potassium into cells
Etiology
Hypokalemia can be caused by decreased intake of K but
is usually caused by excessive losses of K in the urine or
from the GI tract.
Abnormal gastrointestinal K losses occur in chronic
diarrhea
Other causes of gastrointestinal K losses include clay pica,
vomiting, and gastric suction.
The transcellular shift of K into cells may also cause
hypokalemia.
This can occur in glycogenesis during TPN or enteral
hyperalimentation or after administration of insulin
Symptoms & Signs
Muscular weakness, fatigue, and muscle cramps are
frequent complaints in mild to moderate hypokalemia.
Smooth muscle involvement may result in constipation or
ileus.
Flaccid paralysis, hyporeflexia, hypercapnia (respiratory
failure-hypoventilation), tetany, and rhabdomyolysis may
be seen with severe hypokalemia (< 2.5meq/L).
Other muscular dysfunction includes muscle cramping,
fasciculations, and hypotension
Laboratory Findings
The ECG shows decreased amplitude and broadening of T
waves, prominent U waves, premature ventricular
contractions, and depressed ST segments.
Treatment
If hypokalemia develops, K supplementation is indicated
and the diuretic should be discontinued if possible.
Addition of triamterene 100 mg/day or spironolactone 25
mg qid may be useful in occasional patients who become
hypokalemic with diuretic therapy
When deficits and hypokalemia are more severe (plasma
K < 3 mEq/L) or when continued therapy with K-depleting
agents is necessary, KCl can be given po (10% potassium
chloride)
Potassium repletion must be performed cautiously
(usually at a rate of 10–20 mEq/hr) since the absolute
deficit is unpredictable.
The plasma [K+] and the ECG must be monitored during
rapid repletion (10–20 mEq/hr) to avoid hyperkalemic
complications.
