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Causes of hypokalemia in adults

David B Mount, MD
Section Editor
Richard H Sterns, MD
Deputy Editor
John P Forman, MD, MSc


Hypokalemia is a common clinical problem. Potassium enters the body via oral intake or intravenous infusion, is largely stored in the cells, and then excreted in the urine. Thus, decreased intake, increased translocation into the cells, or, most often, increased losses in the urine, gastrointestinal tract, or sweat can lead to a reduction in the serum potassium concentration (table 1).

This topic will review the major causes of hypokalemia. The evaluation and treatment of hypokalemia are discussed separately. (See "Evaluation of the adult patient with hypokalemia" and "Clinical manifestations and treatment of hypokalemia in adults".)


Potassium intake is normally 40 to 120 meq per day, most of which is then excreted in the urine. The kidney is able to lower potassium excretion to a minimum of 5 to 25 meq per day in the presence of potassium depletion [1]. Thus, decreased intake alone rarely causes significant hypokalemia. This was demonstrated in a study of normal individuals in whom lowering potassium intake to 20 meq per day was associated with a reduction in serum potassium from 4.1 meq/L at baseline to 3.5 meq/L [2].

However, a low potassium intake can contribute to the severity of potassium depletion when another cause of hypokalemia is superimposed, such as diuretic therapy.


More than 98 percent of total body potassium is intracellular, chiefly in muscle [3,4]. The normal distribution of potassium between cells and the extracellular fluid is primarily maintained by the Na-K-ATPase pump in the cell membrane [3,4]. Increased activity of the Na-K-ATPase pump and/or alterations in other potassium transport pathways can result in transient hypokalemia due to increased potassium entry into cells.

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Literature review current through: Nov 2017. | This topic last updated: Jan 05, 2016.
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