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Clinical manifestations and treatment of hypokalemia in adults

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


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".)


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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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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