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Hypokalemia

Updated : February 15, 2024





Background

Hypokalemia is one of the most typical electrolyte disorders found in medical care. Although most cases are minor, hypokalemia is much more common than hyperkalemia. Although there is a small range, 3.5 mmol/L is considered to be an appropriate lowest value for normal blood potassium.

Severity is classified as light when the serum level of potassium is between 3 and 3.4 mmol/L, medium when it is between 2.5 and 3 mmol/L, and extreme when it is below 2.5 mmol/L.

Values derived from serum and plasma may not be the same. So, it’s crucial to understand the source of the sampling. Due to processing lags and/or the impact of clotting, serum levels are often somewhat higher than plasma concentrations.

Epidemiology

Generally speaking, cardiac illness, renal failure, shock, and malnutrition diagnoses are linked to hypokalemia. Additional factors that trigger hypokalemia include hypothermia and excessive production of blood cells (such as leukemia). Certain patient groups are more prone to developing hypokalemia than others.

For instance, medication therapy for mentally ill patients puts them at risk for hypokalemia. Hospitalized individuals frequently suffer hypokalemia, especially kids, those with fevers, and people who are seriously ill. Additionally, acute hypokalemia coupled with severe malnutrition and diarrhea is known to raise the likelihood of mortality in children in underdeveloped nations.

Anatomy

Pathophysiology

Potassium is mostly found intracellularly because it is the highest abundant cation and is involved in various cellular functions, including cell control. Small amounts of potassium are present in extracellular space. As a result, potassium levels in the body as a whole cannot be accurately determined by plasma or serum levels. Acute cellular changes between the intracellular and extracellular fluid compartments, renal excretion, and, to a smaller extent, intestinal losses all work together to maintain potassium homeostasis.

Reduced potassium consumption, transcellular changes (enhanced intracellular absorption), or high potassium loss can all lead to hypokalemia (skin, GI, and renal deficits). Because the kidneys can effectively reduce efflux, a reduction in potassium consumption seldom causes hypokalemia. If there are additional factors, including hunger or the use of diuretics, lower intake may nevertheless contribute to hypokalemia. Alkalemia, aldosterone, beta-adrenergic stimulation, xanthines, and insulin, including caffeine, encourage the uptake of potassium into cells.

Most hypokalemia cases are the result of renal or GI losses. Excessive mineralocorticoid-receptor activation, such as that seen with primary aldosteronism and primary hyperreninism, is linked to kidney potassium depletion. Kidney potassium depletion can also be brought on by increased transport of sodium and non-absorbable cations to the distal nephron (diuretic treatment, magnesium deficit, hereditary disorders). Hypokalemia is frequently caused by Gastrointestinal losses, with chronic or severe diarrhea seeming to be the most frequent extrarenal trigger.

Etiology

Hypokalemia can have a number of etiologies. Those etiologies fall under the following headings:

Reduced potassium consumption

Cellular transitions (enhanced intracellular consumption)

A greater loss of potassium (skin, GI, and kidney deficit)

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

salbutamol 

Nebulizer solution:10 to 20 mg through nebulization for 10 minutes



potassium bicarbonate/potassium citrate 

Prevention: take 10 to 80 mEq daily orally once a day
Treatment: 40 to 100 mEq daily dissolved in minimum 4 ounces of cold water orally divided two to four times daily
Renal Impairment
Close observation is necessary when administering to patients with chronic kidney disease or any condition that impaired the excretion of potassium
Hepatic Impairment
Dose modification not required
Dose Considerations
In case of hypokalemia caused by diuretics, it is advisable to reduce the diuretic dosage
Reducing the gastrointestinal irritation is possible through appropriate dilution



potassium chloride 

mild to moderate
Tablets or capsules: 40 to 100 mEq orally daily in divided doses and do not take more than 25 mEq at a time to decrease gastrointestinal discomfort
Liquid: 40 to 100 mEq orally daily in 2 to 5 divided doses and do not take more than 40 mEq/dose also do not exceed 200 mEq/24 hours
Alternatively, 10 to 20 mEq orally two to four times a day
Severe hypokalemia
40 mEq orally three to four times a day
Hypokalemia Prophylaxis
20 to 40 mEq orally daily
Dosing considerations
Varies as per doses
Intravenous intermittent infusions
10 mEq of potassium chloride boosts serum potassium levels by roughly 0.1 mEq/L
Dosing based on serum potassium
For 2.5 to 3.5 mEq/L: not more than 10 mEq/hr infusion rate
Concentration not to exceed 40 mEq/L and dose not more than 200 mEq dose for 24 hours
Dosing Modifications
Hepatic impairment
Patients with liver damage should generally begin treatment with a lower dosage range
Renal impairment
Individuals with renal dysfunction should typically initiate medication at the lower dose range



potassium bicarbonate 

Take dose of 40 to 100 mEq orally one time in a day



 

potassium chloride 

Mild to moderate
>1 month: 2 to 5 mEq/kg orally in divided doses; not to surpass 1 to 2 mEq/kg as a single dose or 20 mEq/kg whichever is smaller that should take into consideration for intravenous administration
Severe
0.5 to 1 mEq/kg/dose: not more than 40 mEq/dose and check serum concentrations in 1 to 2 hours



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK482465/

Hypokalemia

Updated : February 15, 2024




Hypokalemia is one of the most typical electrolyte disorders found in medical care. Although most cases are minor, hypokalemia is much more common than hyperkalemia. Although there is a small range, 3.5 mmol/L is considered to be an appropriate lowest value for normal blood potassium.

Severity is classified as light when the serum level of potassium is between 3 and 3.4 mmol/L, medium when it is between 2.5 and 3 mmol/L, and extreme when it is below 2.5 mmol/L.

Values derived from serum and plasma may not be the same. So, it’s crucial to understand the source of the sampling. Due to processing lags and/or the impact of clotting, serum levels are often somewhat higher than plasma concentrations.

Generally speaking, cardiac illness, renal failure, shock, and malnutrition diagnoses are linked to hypokalemia. Additional factors that trigger hypokalemia include hypothermia and excessive production of blood cells (such as leukemia). Certain patient groups are more prone to developing hypokalemia than others.

For instance, medication therapy for mentally ill patients puts them at risk for hypokalemia. Hospitalized individuals frequently suffer hypokalemia, especially kids, those with fevers, and people who are seriously ill. Additionally, acute hypokalemia coupled with severe malnutrition and diarrhea is known to raise the likelihood of mortality in children in underdeveloped nations.

Potassium is mostly found intracellularly because it is the highest abundant cation and is involved in various cellular functions, including cell control. Small amounts of potassium are present in extracellular space. As a result, potassium levels in the body as a whole cannot be accurately determined by plasma or serum levels. Acute cellular changes between the intracellular and extracellular fluid compartments, renal excretion, and, to a smaller extent, intestinal losses all work together to maintain potassium homeostasis.

Reduced potassium consumption, transcellular changes (enhanced intracellular absorption), or high potassium loss can all lead to hypokalemia (skin, GI, and renal deficits). Because the kidneys can effectively reduce efflux, a reduction in potassium consumption seldom causes hypokalemia. If there are additional factors, including hunger or the use of diuretics, lower intake may nevertheless contribute to hypokalemia. Alkalemia, aldosterone, beta-adrenergic stimulation, xanthines, and insulin, including caffeine, encourage the uptake of potassium into cells.

Most hypokalemia cases are the result of renal or GI losses. Excessive mineralocorticoid-receptor activation, such as that seen with primary aldosteronism and primary hyperreninism, is linked to kidney potassium depletion. Kidney potassium depletion can also be brought on by increased transport of sodium and non-absorbable cations to the distal nephron (diuretic treatment, magnesium deficit, hereditary disorders). Hypokalemia is frequently caused by Gastrointestinal losses, with chronic or severe diarrhea seeming to be the most frequent extrarenal trigger.

Hypokalemia can have a number of etiologies. Those etiologies fall under the following headings:

Reduced potassium consumption

Cellular transitions (enhanced intracellular consumption)

A greater loss of potassium (skin, GI, and kidney deficit)

salbutamol 

Nebulizer solution:10 to 20 mg through nebulization for 10 minutes



potassium bicarbonate/potassium citrate 

Prevention: take 10 to 80 mEq daily orally once a day
Treatment: 40 to 100 mEq daily dissolved in minimum 4 ounces of cold water orally divided two to four times daily
Renal Impairment
Close observation is necessary when administering to patients with chronic kidney disease or any condition that impaired the excretion of potassium
Hepatic Impairment
Dose modification not required
Dose Considerations
In case of hypokalemia caused by diuretics, it is advisable to reduce the diuretic dosage
Reducing the gastrointestinal irritation is possible through appropriate dilution



potassium chloride 

mild to moderate
Tablets or capsules: 40 to 100 mEq orally daily in divided doses and do not take more than 25 mEq at a time to decrease gastrointestinal discomfort
Liquid: 40 to 100 mEq orally daily in 2 to 5 divided doses and do not take more than 40 mEq/dose also do not exceed 200 mEq/24 hours
Alternatively, 10 to 20 mEq orally two to four times a day
Severe hypokalemia
40 mEq orally three to four times a day
Hypokalemia Prophylaxis
20 to 40 mEq orally daily
Dosing considerations
Varies as per doses
Intravenous intermittent infusions
10 mEq of potassium chloride boosts serum potassium levels by roughly 0.1 mEq/L
Dosing based on serum potassium
For 2.5 to 3.5 mEq/L: not more than 10 mEq/hr infusion rate
Concentration not to exceed 40 mEq/L and dose not more than 200 mEq dose for 24 hours
Dosing Modifications
Hepatic impairment
Patients with liver damage should generally begin treatment with a lower dosage range
Renal impairment
Individuals with renal dysfunction should typically initiate medication at the lower dose range



potassium bicarbonate 

Take dose of 40 to 100 mEq orally one time in a day



potassium chloride 

Mild to moderate
>1 month: 2 to 5 mEq/kg orally in divided doses; not to surpass 1 to 2 mEq/kg as a single dose or 20 mEq/kg whichever is smaller that should take into consideration for intravenous administration
Severe
0.5 to 1 mEq/kg/dose: not more than 40 mEq/dose and check serum concentrations in 1 to 2 hours



https://www.ncbi.nlm.nih.gov/books/NBK482465/

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