Hypokalemia: Difference between revisions

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== Definition/Description  ==
== Definition/Description  ==
One of the most common electrolyte disturbances seen in clinical practice is hypokalemia. Hypokalemia is known as a electrolyte imbalance that is lower than normal level of potassium in your bloodstream.<ref name=":0">Castro D, Sharma S. [https://www.ncbi.nlm.nih.gov/books/NBK482465/ Hypokalemia]. 2018 Available: https://www.ncbi.nlm.nih.gov/books/NBK482465/<nowiki/>(accessed 18.9.2021)</ref>


Hypokalemia is known as a electrolyte imbalance that is lower than normal level of potassium in your bloodstream. A normal blood potassium is 3.6 to 5.2 mmol/L. Severe and life threatening hypokalemia level is known as &lt;2.5mmol/L. Since potassium is critical to the proper functioning of nerve and muscle fibers, hypokalemia can require urgent medical attention. <ref name="mayo">Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760</ref>  
* A normal blood potassium is 3.6 to 5.2 mmol/L.  
* Severe and life threatening hypokalemia level is known as &lt;2.5mmol/L. <ref name="mayo">Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760</ref>


== Prevalence  ==
Potassium helps control how our muscles, heart, and digestive system work. Hypokalemia occurs when your body loses too much potassium or does not absorb enough from food<ref>Drugs.com [https://www.drugs.com/cg/hypokalemia.html Hypokalemia] Avaulable: https://www.drugs.com/cg/hypokalemia.html<nowiki/>(accessed 18.9.2021)</ref>.


Hypokalemia&nbsp;is more common in hospitalized patients,&nbsp;up to 15%,&nbsp;as a result of other pathologies. While only 3% of the outpatient population is found to have Hypokalemia.&nbsp;There has been no significant&nbsp;difference in prevalence between gender and race. <ref name="clinical">Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089</ref>  
== Etiology ==
A variety of etiologies can result in hypokalemia. These etiologies can be placed into the following categories:
 
# Decreased potassium intake
# Transcellular shifts (increased intracellular uptake)
# Increased potassium loss (skin, gastrointestinal, and renal losses)<ref name=":0" />
 
== Epidemiology ==
In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia<ref name=":0" />.
 
* Hypokalemia&nbsp;is more common in hospitalized patients,&nbsp;up to 15%,&nbsp;as a result of other pathologies.  
* Only 3% of the outpatient population is found to have Hypokalemia.&nbsp;
* There has been no significant&nbsp;difference in prevalence between gender and race. <ref name="clinical">Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089</ref>  


== Characteristics/Clinical  ==
== Characteristics/Clinical  ==
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*Amphotericin B therapy  
*Amphotericin B therapy  
*Hypothermia <ref name="clinical" />
*Hypothermia <ref name="clinical" />
== Medications    ==
In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously.&nbsp;&nbsp;&nbsp;
Oral preparations of potassium include:
*8m Eq KCl slow release tablets
*20 mEq KCl elixir
*20 mEq KCl powder
*25mEq KCl tablet
If the patient has severe hypokalemia (&lt;2.5mmol/L) up to 40 m Eq/h of IV preparation will be administered. Close follow-up care is necessary with continuous ECG monitoring and serial potassium level cheacks. If higher amounts of potassium is administered, cardiac complication risks may increase. Thus, many insttitutions have set up policies that limit the amount of potassium that can be given per hour. Potassium levels must be measured every 1-3 hours.<ref name="medscape" />
== Diagnostic Tests/Lab Tests/Lab Values  ==
== Diagnostic Tests/Lab Tests/Lab Values  ==


Hypokalemia is commonly found in a blood test, with &lt;3.5mmol/L as mild hypokalemia and &lt;2.5mmol/L as severe hypokalmia.<ref name="mayo" />  
Hypokalemia is commonly found in a blood test, with &lt;3.5mmol/L as mild hypokalemia and &lt;2.5mmol/L as severe hypokalmia.<ref name="mayo" />  


In severe cases, a&nbsp;12-lead electrocardiogram may be necessary if to check&nbsp;for cardiac arrythymias. Findings such as T-wave flattening or prominent U waves will result in hospital admission.<ref name="clinical" />  
In severe cases, a&nbsp;12-lead electrocardiogram may be necessary if to check&nbsp;for cardiac arrythymias. Findings such as T-wave flattening or prominent U waves will result in hospital admission.<ref name="clinical" /> Other tests may include:
 
*arterial blood gas
Other tests may include:  
 
*&nbsp;arterial blood gas  
*basic or comprehensive metabolic panel
*basic or comprehensive metabolic panel


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*thyroxine  
*thyroxine  
*aldosterone levels.<ref name="medline" />
*aldosterone levels.<ref name="medline" />
== Etiology/Causes  ==
Low potassium has many causes with the most common being excessive loss in urine or from the digestive tract. Very seldom it may be caused by&nbsp;not consuming&nbsp;enough potassium in your diet.<ref name="mayo" />&nbsp;
Other causes include excessive sweating or overuse of laxatives, diuretics, and alcoholism.<ref name="mayo" />Certain medications (penicillin, nafcillin, cerbencillin, gentamicin, amphotericin B, foscarnet) are known to be possible causes, as well.Pathologies such as Cushing syndrome, Liddle Syndrome, Barrtter Syndrome and Fanconi Syndrome can all potentially casue low potassium levels.<ref name="medline" />
== Systemic Involvement  ==
== Systemic Involvement  ==


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== Medical Management (current best evidence)  ==
== Management ==
 
The overarching goals of therapy for hypokalemia are to prevent or treat life-threatening complications, replace the potassium deficit, and to diagnose and correct the underlying cause.<ref name=":0" />
Severe hypokalmeia levels that cause ECG changes such as T-wave flattening or prominent U waves require hospital admission. Mild hypokalemia (&lt;3.5mmol/L) can&nbsp;be treated by taking potassium supplements by mouth, while severe cases (&lt;2.5mmol/L)&nbsp;may need to receive potassium intravenously. Potassium supplements usually corrects the problem, however if hypokalemia is not addressed it may lead to serious heart problems that can be fatal.&nbsp;&nbsp;<ref name="clinical" />  


== Physical Therapy Management (current best evidence) ==
Management of the underlying disease or contributing factors constitutes the cornerstone of therapeutic approach. Potassium should be gradually replaced, preferably by oral administration if clinically feasible. In cases of severe/symptomatic hypokalemia and cardiac complications, i.v. administration with continuous ECG monitoring is recommended. In some patients, such as in endocrine related hypokalemia cases, multidisciplinary diagnostic and therapeutic approach is needed.<ref>Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/ Hypokalemia: a clinical update. Endocrine connections]. 2018 Apr 1;7(4):R135-46. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/ (accessed 18.9.2021)</ref>


Potassium levels &lt; 3.2 mEq/L&nbsp;is contraindicated for physical therapy intervention due to the potential for arrhythmia . Due to muscle weakness and cramping, exercise is not effective during the state of hypokalemia. Patients should be monitored for potassium levels in order to determine the appropriate time to participate in Physical Therapy.<ref name="Goodman">Goodman CC. Fuller KS. In K Falk editor. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009. pp.150, 157, 187-189, 480, 558, 927, 1243, 1640-1641</ref>
== Physical Therapy Management ==
Hypokalemia is not managed primarily by a physical therapist. Physical therapists should be mindful of common signs of symptoms of hypokalemia when working with patients.


Thus, hypokalemia is not managed primarily by a physical therapist. Physical therapists should be mindful of common signs of symptoms of hypokalemia when working with patients.  
* Potassium levels &lt; 3.2 mEq/L&nbsp;is contraindicated for physical therapy intervention due to the potential for arrhythmia . Due to muscle weakness and cramping, exercise is not effective during the state of hypokalemia.  
* Patients should be monitored for potassium levels in order to determine the appropriate time to participate in Physical Therapy.<ref name="Goodman">Goodman CC. Fuller KS. In K Falk editor. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009. pp.150, 157, 187-189, 480, 558, 927, 1243, 1640-1641</ref>


== Differential Diagnosis  ==
== Differential Diagnosis  ==


*&nbsp;Emesis
* Bartter syndrome
*Nasogastric suctioning
* Hyperthyroidism and thyrotoxicosis
*Pyloric stenosis
* Hypocalcemia
*Diarrhea&nbsp;
* Hypochloremic alkalosis
*Malabsorption
* Hypomagnesemia
*Villous adenoma&nbsp;
* Iatrogenic Cushing syndrome
*Renal losses
* Metabolic alkalosis<br>
*Electrolyte abnormalities&nbsp;
*Hypomagnesemia  
*Endocrine abnormalities
*Cushing disease or syndrome  
*Congenital adrenal hyperplasia&nbsp;
*Hyperaldosteronism&nbsp;
*High renin states
*Increased mineralocorticoid –&nbsp; chewing tobacco, licorice&nbsp;
*Intrinsic renal abnormalities
*Bartter’s Syndrome
*Gitelman’s Syndrome&nbsp;
*Renal tubular acidosis, types I or II <ref name="pediatrics">Alessandro D. Alessandro M. What is the differential diagnosis of hypokalemia? [Internet] 2006 February 6. [cited 2013 April 4] Available from:http://www.pediatriceducation.org/2006/02/06/what-is-the-differential-diagnosis-of-hypokalemia/</ref><br>
 
== Case Reports/ Case Studies  ==
 
[[Hypokalemia Case Study|Hypokalemia Case Study]]
 
<br> ''The syndrome of refractory watery diarrhea and hypokalemia in patients with a non-insulin—secreting islet cell tumor ☆: A further case study and review of the literature&nbsp; ''http://www.sciencedirect.com/science/article/pii/0002934362901882<br>--Summary: Surgical removal of islet cell adenoma results in a decrease of severe diarrhea and a reduced risk of hypokalemia.
 
<br>
 
''Hypokalemic nephropathy in anorexia nervosa ''http://connection.ebscohost.com/c/case-studies/67145420/hypokalemic-nephropathy-anorexia-nervosa
 
--summary: 25 year old female that has a history of multiple hospital admissions due to hypokalemia caused by chronic purging.
 
== Resources  ==
 
http://www.mayoclinic.com/health/low-potassium/MY00760<br>  


== References  ==
== References  ==

Revision as of 06:33, 18 September 2021

Original Editors - Kara Lawless from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Kara Lawless, Elaine Lonnemann, Lucinda hampton, Admin, Kim Jackson, Wendy Walker and WikiSysop  


[1]

Definition/Description[edit | edit source]

One of the most common electrolyte disturbances seen in clinical practice is hypokalemia. Hypokalemia is known as a electrolyte imbalance that is lower than normal level of potassium in your bloodstream.[2]

  • A normal blood potassium is 3.6 to 5.2 mmol/L.
  • Severe and life threatening hypokalemia level is known as <2.5mmol/L. [3]

Potassium helps control how our muscles, heart, and digestive system work. Hypokalemia occurs when your body loses too much potassium or does not absorb enough from food[4].

Etiology[edit | edit source]

A variety of etiologies can result in hypokalemia. These etiologies can be placed into the following categories:

  1. Decreased potassium intake
  2. Transcellular shifts (increased intracellular uptake)
  3. Increased potassium loss (skin, gastrointestinal, and renal losses)[2]

Epidemiology[edit | edit source]

In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia[2].

  • Hypokalemia is more common in hospitalized patients, up to 15%, as a result of other pathologies.
  • Only 3% of the outpatient population is found to have Hypokalemia. 
  • There has been no significant difference in prevalence between gender and race. [5]

Characteristics/Clinical[edit | edit source]

An individual with Hypokalemia may exhibit signs of the following:

  • Abnormal heart rhythyms
  • Constipation
  • Fatigue
  • Muscle Damage
  • Muscle Weakness or spasms
  • Paralysis[3]
  • Nausea and vomiting
  • Polyuria, nocturia or polydipsia
  • Altered mental status
  • Signs of Ileus
  • Hypotension
  • Cardia arrest
  • Bradycardia or Tachycardia
  • Premature atrial or ventricular beats
  • Hypoventilation/Respiratory distress
  • Respiratory failure
  • Lethargy
  • Edema (Cushingoid appearance)[6]

Associated Co-morbidities[edit | edit source]

Hypokalemia may present as a result of:

  • Chronic Kidney Failure
  • Diabetic Ketoacidosis
  • Diarrhea/Vomiting
  • Excessive Sweating
  • Excessive use of laxatives
  • Prescription Diuretic Pills
  • Primary Aldosteronism [3]
  • Liddle Syndrome
  • Cushing Syndrome
  • Bartter Syndrome
  • Fanconi Syndrome
  • Bulimia [7]
  • Eating large amounts of licorice, herbal teas or chewing tobacco
  • Magnesium Deficiency
  • Glue Sniffing
  • Alcoholism (poor appetite and/or vomiting)
  • Amphotericin B therapy
  • Hypothermia [5]

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

Hypokalemia is commonly found in a blood test, with <3.5mmol/L as mild hypokalemia and <2.5mmol/L as severe hypokalmia.[3]

In severe cases, a 12-lead electrocardiogram may be necessary if to check for cardiac arrythymias. Findings such as T-wave flattening or prominent U waves will result in hospital admission.[5] Other tests may include:

  • arterial blood gas
  • basic or comprehensive metabolic panel

Blood tests will also be administered to check the following:

  • glucose
  • magnesium
  • calcium
  • sodium
  • phosphorus
  • thyroxine
  • aldosterone levels.[7]

Systemic Involvement[edit | edit source]

Systems Affected
Systems Impairments
Cardiovascular Cardiac Arrythmias, Hypotension, Premature Artrial or Ventricular Contractions, Bradycardia/Tachycardia/3
Pulmonary Respiratory Failure or complete paralysis in cases <2.5mmol/L
Musculoskeletal

Muscle weakness, cramping or paralysis.

Genitourinary Polyuria or sexual dysfunction.[3]

Management[edit | edit source]

The overarching goals of therapy for hypokalemia are to prevent or treat life-threatening complications, replace the potassium deficit, and to diagnose and correct the underlying cause.[2]

Management of the underlying disease or contributing factors constitutes the cornerstone of therapeutic approach. Potassium should be gradually replaced, preferably by oral administration if clinically feasible. In cases of severe/symptomatic hypokalemia and cardiac complications, i.v. administration with continuous ECG monitoring is recommended. In some patients, such as in endocrine related hypokalemia cases, multidisciplinary diagnostic and therapeutic approach is needed.[8]

Physical Therapy Management[edit | edit source]

Hypokalemia is not managed primarily by a physical therapist. Physical therapists should be mindful of common signs of symptoms of hypokalemia when working with patients.

  • Potassium levels < 3.2 mEq/L is contraindicated for physical therapy intervention due to the potential for arrhythmia . Due to muscle weakness and cramping, exercise is not effective during the state of hypokalemia.
  • Patients should be monitored for potassium levels in order to determine the appropriate time to participate in Physical Therapy.[9]

Differential Diagnosis[edit | edit source]

  • Bartter syndrome
  • Hyperthyroidism and thyrotoxicosis
  • Hypocalcemia
  • Hypochloremic alkalosis
  • Hypomagnesemia
  • Iatrogenic Cushing syndrome
  • Metabolic alkalosis

References[edit | edit source]

  1. ↑ Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html
  2. ↑ 2.0 2.1 2.2 2.3 Castro D, Sharma S. Hypokalemia. 2018 Available: https://www.ncbi.nlm.nih.gov/books/NBK482465/(accessed 18.9.2021)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760
  4. ↑ Drugs.com Hypokalemia Avaulable: https://www.drugs.com/cg/hypokalemia.html(accessed 18.9.2021)
  5. ↑ 5.0 5.1 5.2 Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089
  6. ↑ Garth D.,Schraga E.Hypokalemia in emergency medicine.[homepage on the Internert]2012 April 13 [cited 2013 March 27] Available from: http://emedicine.medscape.com/article/767448-overview
  7. ↑ 7.0 7.1 Hypokalemia [Internet]. 2013 March 22 [cited 2013 March 27] Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm
  8. ↑ Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocrine connections. 2018 Apr 1;7(4):R135-46. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/ (accessed 18.9.2021)
  9. ↑ Goodman CC. Fuller KS. In K Falk editor. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009. pp.150, 157, 187-189, 480, 558, 927, 1243, 1640-1641

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