Clinical manifestations and treatment of hypokalemia in adults
- David B Mount, MD
David B Mount, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Section Editors
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy [1-3]. (See "Causes of hypokalemia in adults".)
Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a significant deficit in body potassium. It is also warranted for acute therapy in disorders such as hypokalemic or thyrotoxic periodic paralysis in which the hypokalemia is due to redistribution of potassium into the cells, often in association with significant symptoms. Potassium is given cautiously in redistributive hypokalemia since the hypokalemia is transient and the administration of potassium can lead to rebound hyperkalemia when the underlying process is corrected and potassium moves back out of the cells. The recommended regimens for acute therapy in this disorder are presented elsewhere. (See "Hypokalemic periodic paralysis", section on 'Acute treatment' and "Thyrotoxic periodic paralysis", section on 'Acute treatment'.)
Optimal therapy in patients with hypokalemia due to potassium loss is dependent upon the severity of the potassium deficit. In addition, somewhat different considerations are required to minimize continued urinary losses due to diuretic therapy, or less often, to primary hyperaldosteronism.
The clinical manifestations and treatment of hypokalemia will be reviewed here. The causes of and evaluation of patients with hypokalemia are discussed separately. (See "Causes of hypokalemia in adults" and "Evaluation of the adult patient with hypokalemia".)
MANIFESTATIONS OF HYPOKALEMIA
The severity of the manifestations of hypokalemia tends to be proportionate to the degree and duration of the reduction in serum potassium. Symptoms generally do not become manifest until the serum potassium is below 3.0 meq/L, unless the serum potassium falls rapidly or the patient has a potentiating factor, such as a predisposition to arrhythmia due to the use of digitalis. Symptoms usually resolve with correction of the hypokalemia.
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- MANIFESTATIONS OF HYPOKALEMIA
- Severe muscle weakness or rhabdomyolysis
- Cardiac arrhythmias and ECG abnormalities
- Renal abnormalities
- Glucose intolerance
- PATHOGENESIS OF SYMPTOMS
- DIAGNOSIS AND EVALUATION
- General issues
- - Hypomagnesemia and redistributive hypokalemia
- Estimation of the potassium deficit
- - Uncontrolled diabetes
- Potassium preparations
- - Intravenous therapy
- Ongoing losses and the steady state
- Potassium-sparing diuretics
- Mild to moderate hypokalemia
- Severe or symptomatic hypokalemia
- - Intravenous potassium repletion
- Adverse effects of intravenous potassium
- Recommended approach
- Careful monitoring
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