Hypokalemia

• 55 y/o male
• CC: chronic diarrhea
• Farmer in La Trinidad, Benguet
• Noted progressive weakness for the past
weeks
Blood Test
Na 140 meq/L
Cl 110 meq/L
K 2.0 meq/L
 Hypokalemia
• Urine potassium: 15 meq/L
Arterial Blood Gas
pH 7.28
pCO2 39 mmHg
HCO3 16
Diagnostic approach to hypokalemia
Diagnostic approach to hypokalemia
Diagnostic approach to hypokalemia
Diagnostic approach to hypokalemia
Diagnostic approach to hypokalemia
 Significance of Urinary K levels
• This can be established after eliminating
decreased intake and intracellular shift as
potential causes of hypokalemia
• Appropriate response to K+ depletion is to
excrete less than 15 mmol/d of K+ in the urine,
due to increased reabsorption and decreased
distal excretion
• This is exemplified by the diagnostic approach
shown previously
 Adverse medical implications
• More severe hypokalemia may lead to progressive
weakness, hypoventilation (due to respiratory
involvement involvement, and even complete
paralysis
• Impaired muscle metabolism and blunted hyperemic
response to exercise leads to rhabomyolysis
• Leads to prolonged PR interval, decreased voltage
and widening of the QRS complex, with increased
risk of ventricular arrhythmia
 Symptoms of Hypokalemia
• Palpitations
• Skeletal muscle weakness or cramping
• Paralysis, paresthesias
• Constipation4
• Nausea or vomiting
• Abdominal cramping
• Polyuria, nocturia, or polydipsia
• Psychosis, delirium, or hallucinations
• Depression
 Signs of Hypokalemia
• Signs of ileus • Hypoventilation,
respiratory distress
• Hypotension • Respiratory failure
• Ventricular arrhythmias • Lethargy or other mental
• Cardiac arrest status changes
• • Decreased muscle
Bradycardia or strength, fasciculations,
tachycardia or tetany
• Premature atrial or • Decreased tendon
ventricular beats reflexes
• Cushingoid appearance
(eg, edema)
 Treatment
• ECG monitoring
• Establish IV access
• Assess respiratory status
• Infuse potassium chloride, since his serum potassium is
< 2.5 meq/L, in other cases oral is the preferred route
for potassium repletion because it is easy to administer,
safe, inexpensive, and readily absorbed from the GI
tract
• Check serum Mg levels since it is difficult to restore K if
the former is low