Hypokalaemia is defined as a serum potassium level <3.5 mmol/L (<3.5 mEq/L). Moderate hypokalaemia is defined as serum potassium levels of 2.5 to 3 mmol/L (2.5 to 3 mEq/L) and severe hypokalaemia defined as a serum potassium level <2.5 mmol/L (<2.5 mEq/L). The ratio of intracellular to extracellular potassium determines, in part, the cellular membrane potential. Therefore small changes in the extracellular potassium level can have large effects on the function of the cardiovascular and neuromuscular systems.
Hypokalaemia is most commonly due to urinary or GI losses. A fall in serum potassium from 4 to 3 mmol/L (4 to 3 mEq/L) represents an approximate loss of 200 to 400 mmol (200 to 400 mEq) of potassium. However, these estimates do not always apply to patients with transcellular potassium redistribution. Clinical manifestations of hypokalaemia are typically seen only if the serum potassium is <3.0 mmol/L (<3.0 mEq/L).
Common acute manifestations are muscle weakness and ECG changes. More prolonged and profound hypokalaemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias.
The rapidity and method of potassium repletion depends on the:
severity of hypokalaemia
presence of associated conditions
presence or absence of signs and symptoms
expectation of continued losses.
Obtaining an ECG is recommended for all patients with hypokalaemia. Frequent monitoring of the serum potassium concentration is also recommended to ensure appropriate repletion and to avoid hyperkalaemia.
- Severe diarrhoea
- Laxative and bowel cleansing agent use
- Bulimia nervosa
- Anorexia nervosa
- Diabetic ketoacidosis
- Hyperosmolar hyperglycaemic state
- Primary aldosteronism
- Exercising in a hot climate
- Stress response in critical illness
- Villous adenoma
- Ileal loop/conduit with ureteric implants
- Dialysis or plasmapheresis
- Apparent mineralocorticoid excess
- Cushing's syndrome
- Hypokalaemic periodic paralysis
- Central diabetes insipidus (DI)
- Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency
- Renal tubular acidosis (RTA)
- Bartter's syndrome
- Gitelman's syndrome
- Liddle's syndrome
- Renal disease associated with Sjögren's syndrome
- Renal disease associated with lupus nephropathy
- Eczema involving a large surface area
- Psoriasis involving a large surface area
- Cystic fibrosis (CF)
- Primary (often psychogenic) polydipsia
- SFE/SFHTA/AFCE consensus on primary aldosteronism, part 1: Epidemiology of PA, who should be screened for sporadic PA?
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