Hypokalemia

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

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Definition/Description

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Prevalence

Hypokalemia is more common in hospitalized patients, up to 15%, as a result of other pathologies. While only 3% of the outpatient population is found to have Hypokalemia. No difference has been shown between gender and race.

Characteristics/Clinical

An individual with Hypokalemis may exhibit signs of the following:

• Abnormal heart rhythyms
• Constipation
• Fatigue
• Muscle Damage
• Muscle Weakness or spasms
• Paralysis
• 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)

Associated Co-morbidities

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
• Liddle Syndrome
• Cushing Syndrome
• Bartter Syndrome
• Fanconi Syndrome
• Bulimia

Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from: https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089

Hypokalemia [Internet]. 2013 March 22 [cited 2013 March 27] Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm

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

Low postassium (hypokalemia)[Internet] 2011 August 17 [cited 2013 March 27] Available from: http://www.mayoclinic.com/health/low-potassium/MY00760

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• Eating large amounts of licorice, herbal teas or chewing tobacco
• Magnesium Deficiency
• Glue Sniffing
• Alcoholism (poor appetite and/or vomiting)
• Amphotericin B therapy
• Hypothermia/1

Medications

In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously./2 Oral preparations of potassium include 8m Eq KCl slow release tablets, 20 mEq KClelixir, 20 mEq KCl powder, 25mEq KCl tablet./3

Diagnostic Tests/Lab Tests/Lab Values

Hypokalemia is commonly found in a blood test, with <3.5mmol/L as mild hypokalemia and <2.5mmol/L as severe hypokalmia.*4 A 12-lead electrocardiogram may be necessary if severe to check from cardiac arrythymias. Other tests may include: arterial blood gas, Basic or comprehensive metabolic panel, as well as, blood tests to check glucose magnesium, calcium, sodium, phosphorus, thyroxine, and aldosterone levels.*1

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 not consuming enough potassium in your diet. Other causes include excessive sweating or use of laxatives.*4

Certain medications (penicillin, nafcillin, cerbencillin, gentamicin, amphotericin B, foscarnet) are known to be possible causes.

Other diseases such as Cushing syndrome, Liddle Syndrome, Barrtter Syndrome and Fanconi Syndrome can all potentially casue low potassium levels. *2

Systemic Involvement

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.

Medical Management (current best evidence)

Severe hypokalmeia levels that cause ECG changes such as T-wave flattening or prominent U waves require hospital admission. Mild hypokalemia (<3.5mmol/L) can eb treated by taking potassium supplements by mouth, while severe cases (<2.5mmol/L) 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.

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Physical Therapy Management (current best evidence)

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.

Hyperkalemia is not managed primarily by a physical therapist.

Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

Hyperthyroidism may mimic paralysis and other characteristics of hypokalemia.

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Hypomagnesemia is also a differential diagnosis, however, magnesium levels are unreliable and typically do not change management./3

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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