Hypokalemia: Difference between revisions
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'''Original Editors '''- Kara Lawless [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | '''Original Editors '''- Kara Lawless [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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<ref name="clincal key">Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html</ref> | |||
== Definition/Description == | == Definition/Description == | ||
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 <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> | 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 <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> | ||
== Prevalence<br> == | == Prevalence<br> == | ||
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. There has been no significant 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> | 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. There has been no significant 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 == | ||
| Line 48: | Line 49: | ||
*Excessive use of laxatives | *Excessive use of laxatives | ||
*Prescription Diuretic Pills | *Prescription Diuretic Pills | ||
*Primary Aldosteronism <ref name="mayo" /> | *Primary Aldosteronism <ref name="mayo" /> | ||
*Liddle Syndrome | *Liddle Syndrome | ||
*Cushing Syndrome | *Cushing Syndrome | ||
| Line 61: | Line 62: | ||
*Hypothermia <ref name="clinical" /> | *Hypothermia <ref name="clinical" /> | ||
== Medications <br> == | == Medications <br> == | ||
In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously. | In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously. | ||
| Line 72: | Line 73: | ||
*25mEq KCl tablet | *25mEq KCl tablet | ||
If the patient has severe hypokalemia (<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" /> | If the patient has severe hypokalemia (<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 == | ||
| Line 78: | Line 79: | ||
Hypokalemia is commonly found in a blood test, with <3.5mmol/L as mild hypokalemia and <2.5mmol/L as severe hypokalmia.<ref name="mayo" /> | Hypokalemia is commonly found in a blood test, with <3.5mmol/L as mild hypokalemia and <2.5mmol/L as severe hypokalmia.<ref name="mayo" /> | ||
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.<ref name="clinical" /> | 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.<ref name="clinical" /> | ||
Other tests may include: | Other tests may include: | ||
* arterial blood gas | * arterial blood gas | ||
*basic or comprehensive metabolic panel | *basic or comprehensive metabolic panel | ||
| Line 88: | Line 89: | ||
*glucose | *glucose | ||
*magnesium | *magnesium | ||
*calcium | *calcium | ||
*sodium | *sodium | ||
*phosphorus | *phosphorus | ||
*thyroxine | *thyroxine | ||
*aldosterone levels.<ref name="medline" /> | *aldosterone levels.<ref name="medline" /> | ||
| Line 99: | Line 100: | ||
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.<ref name="mayo" /> | 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.<ref name="mayo" /> | ||
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" /> | 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 == | ||
| Line 126: | Line 127: | ||
== Medical Management (current best evidence) == | == 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 be 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. <ref name="clinical" /> | 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 be 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. <ref name="clinical" /> | ||
== Physical Therapy Management (current best evidence) == | == Physical Therapy Management (current best evidence) == | ||
| Line 132: | Line 133: | ||
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.<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> | 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.<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> | ||
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. | 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. | ||
== Alternative/Holistic Management (current best evidence) == | == Alternative/Holistic Management (current best evidence) == | ||
| Line 157: | Line 158: | ||
* Emesis | * Emesis | ||
*Nasogastric suctioning | *Nasogastric suctioning | ||
*Pyloric stenosis | *Pyloric stenosis | ||
*Diarrhea | *Diarrhea | ||
*Malabsorption | *Malabsorption | ||
*Villous adenoma | *Villous adenoma | ||
*Renal losses | *Renal losses | ||
*Electrolyte abnormalities | *Electrolyte abnormalities | ||
*Hypomagnesemia | *Hypomagnesemia | ||
*Endocrine abnormalities | *Endocrine abnormalities | ||
*Cushing disease or syndrome | *Cushing disease or syndrome | ||
*Congenital adrenal hyperplasia | *Congenital adrenal hyperplasia | ||
*Hyperaldosteronism | *Hyperaldosteronism | ||
*High renin states | *High renin states | ||
*Increased mineralocorticoid – chewing tobacco, licorice | *Increased mineralocorticoid – chewing tobacco, licorice | ||
*Intrinsic renal abnormalities | *Intrinsic renal abnormalities | ||
*Bartter’s Syndrome | *Bartter’s Syndrome | ||
*Gitelman’s Syndrome | *Gitelman’s Syndrome | ||
*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> | *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 == | == Case Reports/ Case Studies == | ||
''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 ''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. | ''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 ''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 | ''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. | --summary: 25 year old female that has a history of multiple hospital admissions due to hypokalemia caused by chronic purging. | ||
== Resources <br> == | == Resources <br> == | ||
http://www.mayoclinic.com/health/low-potassium/MY00760 | http://www.mayoclinic.com/health/low-potassium/MY00760 | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1NGmwZeh8JwVIzrKgHG1LrDm0izTr7ViJiDkSYAY2BW5hiXsx0|charset=UTF-8|short|max=10</rss> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1NGmwZeh8JwVIzrKgHG1LrDm0izTr7ViJiDkSYAY2BW5hiXsx0|charset=UTF-8|short|max=10</rss> | ||
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<br> | <br> | ||
== References == | == References == | ||
Revision as of 19:10, 25 April 2013
Original Editors - Kara Lawless from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
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 <2.5mmol/L. Since potassium is critical to the proper functioning of nerve and muscle fibers, hypokalemia can require urgent medical attention. [2]
Prevalence
[edit | edit source]
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. There has been no significant difference in prevalence between gender and race. [3]
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[2]
- 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)[4]
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 [2]
- Liddle Syndrome
- Cushing Syndrome
- Bartter Syndrome
- Fanconi Syndrome
- Bulimia [5]
- Eating large amounts of licorice, herbal teas or chewing tobacco
- Magnesium Deficiency
- Glue Sniffing
- Alcoholism (poor appetite and/or vomiting)
- Amphotericin B therapy
- Hypothermia [3]
Medications
[edit | edit source]
In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously.
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 (<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.[4]
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.[2]
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.[3]
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.[5]
Etiology/Causes[edit | edit source]
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.[2]
Other causes include excessive sweating or overuse of laxatives, diuretics, and alcoholism.[2]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.[5]
Systemic Involvement[edit | edit source]
| 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.[2] |
Medical Management (current best evidence)[edit | edit source]
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 be 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. [3]
Physical Therapy Management (current best evidence)[edit | edit source]
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.[6]
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.
Alternative/Holistic Management (current best evidence)[edit | edit source]
Consuming foods high in potassium may help avoid the risk of hypokalemia. These foods include:
- avocados
- bananas
- bran
- carrots
- kiwi
- lima beans
- milk
- molasses
- peanut butter
- seaweed
- spinach
- tomatoes
- oranges
- wheat germ [5]
Differential Diagnosis[edit | edit source]
- Emesis
- Nasogastric suctioning
- Pyloric stenosis
- Diarrhea
- Malabsorption
- Villous adenoma
- Renal losses
- Electrolyte abnormalities
- Hypomagnesemia
- Endocrine abnormalities
- Cushing disease or syndrome
- Congenital adrenal hyperplasia
- Hyperaldosteronism
- High renin states
- Increased mineralocorticoid – chewing tobacco, licorice
- Intrinsic renal abnormalities
- Bartter’s Syndrome
- Gitelman’s Syndrome
- Renal tubular acidosis, types I or II [7]
Case Reports/ Case Studies[edit | edit source]
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 http://www.sciencedirect.com/science/article/pii/0002934362901882
--Summary: Surgical removal of islet cell adenoma results in a decrease of severe diarrhea and a reduced risk of hypokalemia.
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
[edit | edit source]
http://www.mayoclinic.com/health/low-potassium/MY00760
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1NGmwZeh8JwVIzrKgHG1LrDm0izTr7ViJiDkSYAY2BW5hiXsx0|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
- ↑ Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760
- ↑ 3.0 3.1 3.2 3.3 Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089
- ↑ 4.0 4.1 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
- ↑ 5.0 5.1 5.2 5.3 Hypokalemia [Internet]. 2013 March 22 [cited 2013 March 27] Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm
- ↑ 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
- ↑ 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/
see adding references tutorial.
