Difference between revisions of "Hypokalemia"

(Intracellular Shift)
(External Links)
 
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*Central nervous system
 
*Central nervous system
 
**[[Weakness]]  
 
**[[Weakness]]  
**[[Cramps]]  
+
**[[myalgia|Cramps]]  
**[[Hyporeflexia]]
+
**Hyporeflexia  
 
*Gastrointestinal
 
*Gastrointestinal
 
**[[Ileus]]  
 
**[[Ileus]]  
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**[[Metabolic alkalosis]]
 
**[[Metabolic alkalosis]]
 
*Cardiovascular
 
*Cardiovascular
**PACs/PVCs  
+
**[[PACs]]/[[PVCs]]
**[[ACLS: Bradycardia|Bradycardia]] or atrial/junctional tachycardia  
+
**[[ACLS: Bradycardia|Bradycardia]] or [[atrial tachycardia|atrial]]/[[junctional tachycardia]]
 
**[[AV block]]  
 
**[[AV block]]  
 
**[[Tachycardia (wide)|Ventricular tachycardia]], [[Adult pulseless arrest|Ventricular fibrillation]]
 
**[[Tachycardia (wide)|Ventricular tachycardia]], [[Adult pulseless arrest|Ventricular fibrillation]]
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*Alkalosis (each 0.10 rise in pH causes 0.5 decrease)
 
*Alkalosis (each 0.10 rise in pH causes 0.5 decrease)
 
*[[Insulin]]
 
*[[Insulin]]
*B-agonist
+
*[[Beta agonists]]
 
*[[Hypokalemic periodic paralysis]]
 
*[[Hypokalemic periodic paralysis]]
  
 
===Decreased intake===
 
===Decreased intake===
 
*Special diets or those low in potassium
 
*Special diets or those low in potassium
*Chronic alcohol abuse
+
*Chronic [[alcohol Abuse|alcohol abuse]]
 +
 
 
===Increased loss===
 
===Increased loss===
 
*GI
 
*GI
**Vomiting, diarrhea, fistula
+
**[[Vomiting]], [[diarrhea]], fistula
 
*Renal
 
*Renal
**Diuretics
+
**[[Diuretics]]
**Hyperaldo
+
**Hyperaldosteronism
 
**Exercise
 
**Exercise
 
**[[Hypercalcemia]]
 
**[[Hypercalcemia]]
 
**[[Hypomagnesemia]]
 
**[[Hypomagnesemia]]
 +
 
===Drugs===
 
===Drugs===
 
*[[Penicillins]]
 
*[[Penicillins]]
 
*[[Lithium toxicity|Lithium]]
 
*[[Lithium toxicity|Lithium]]
 
*L-dopa
 
*L-dopa
*[[Theophylline]], methlxanthines
+
*[[Theophylline]], methylxanthines (e.g. [[caffeine]]
 
*[[Insulin]]
 
*[[Insulin]]
 
*Barium
 
*Barium
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[[Image:ECG Hypokalemia.jpg]]
 
[[Image:ECG Hypokalemia.jpg]]
 +
  
 
==Management==
 
==Management==
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**KCl tablet (elixir form available but has poor taste)
 
**KCl tablet (elixir form available but has poor taste)
 
**K-Dur (extended release tablet) is large and may be difficult to swallow
 
**K-Dur (extended release tablet) is large and may be difficult to swallow
 +
**If sending patient home can also increase food intake of potassium as an alternative or supplementing potassium tablets. Printable table that can be given to the patient available at this reference: <ref>[https://www.mayoclinic.org/drugs-supplements/potassium-supplement-oral-route-parenteral-route/description/drg-20070753?p=1 Potassium Supplement (Oral Route, Parenteral Route) from Mayo Clinic]</ref>.
 
*Intravenous potassium
 
*Intravenous potassium
 
**Must be given in dilute solutions at slow rate (10meq/hour) to minimize side effects and cardiac toxicity
 
**Must be given in dilute solutions at slow rate (10meq/hour) to minimize side effects and cardiac toxicity
 
**Generally should not give more than 40mEq via IV
 
**Generally should not give more than 40mEq via IV
**Side effects: Local tissue burning, phelbitis, sclerosis
+
**Side effects: Local tissue burning, phlebitis, sclerosis
 
*Also treat [[Hypomagnesemia]] if present
 
*Also treat [[Hypomagnesemia]] if present
 
*Re-check ECG after treatment <ref>Slovis, Corey. "Electrolyte Emergencies". Presentation.</ref>
 
*Re-check ECG after treatment <ref>Slovis, Corey. "Electrolyte Emergencies". Presentation.</ref>
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==Disposition==
 
==Disposition==
 
*Based on underlying cause
 
*Based on underlying cause
 +
*One admission criteria is potassium less than 3.0 meq/L and a QTc that is close to or more than 500 msec. <ref>[https://www.emrap.org/episode/emrap2018august/electrolyte EM:RAP 2018 August Electrolyte Emergencies - Part 1 - All Things Potassium]</ref>
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
 +
*[https://emcrit.org/ibcc/hypokalemia/ IBCC Hypokalemia]
 
*[http://ddxof.com/electrolyte-abnormalities/ DDxOf: Differential Diagnosis of Electrolyte Abnormalities]
 
*[http://ddxof.com/electrolyte-abnormalities/ DDxOf: Differential Diagnosis of Electrolyte Abnormalities]
  

Latest revision as of 10:39, 6 December 2019

Background

Clinical Features

Differential Diagnosis

Differential diagnosis of hypokalemia

Intracellular Shift

Decreased intake

Increased loss

Drugs

Evaluation

ECG Hypokalemia.jpg


Management

  • Potassium repletion (PO or IV)
    • Every 10mEq KCl → serum K ↑ ~0.1mEq/L
    • PO preferred (if symptomatic or level is <2.5, both oral and IV should be given)
  • Oral potassium
    • Inexpensive and rapidly absorbed
    • KCl tablet (elixir form available but has poor taste)
    • K-Dur (extended release tablet) is large and may be difficult to swallow
    • If sending patient home can also increase food intake of potassium as an alternative or supplementing potassium tablets. Printable table that can be given to the patient available at this reference: [1].
  • Intravenous potassium
    • Must be given in dilute solutions at slow rate (10meq/hour) to minimize side effects and cardiac toxicity
    • Generally should not give more than 40mEq via IV
    • Side effects: Local tissue burning, phlebitis, sclerosis
  • Also treat Hypomagnesemia if present
  • Re-check ECG after treatment [2]
  • Hypokalemia in acute or recent myocardial infarction places patients at much higher risk for ventricular fibrillation[3]
    • Previous studies and many professional organizations recommend maintaining K between 4.0 - 5.0 mEq/L in MI patients
    • However, more recent studies suggest 3.5 - 4.5 mEq/L results in the lowest mortality

Disposition

  • Based on underlying cause
  • One admission criteria is potassium less than 3.0 meq/L and a QTc that is close to or more than 500 msec. [4]

See Also

External Links

References

  1. Potassium Supplement (Oral Route, Parenteral Route) from Mayo Clinic
  2. Slovis, Corey. "Electrolyte Emergencies". Presentation.
  3. Goyal A et al. Serum Potassium Levels and Mortality in Acute Myocardial Infarction. JAMA. 2012;307(2):157-164.
  4. EM:RAP 2018 August Electrolyte Emergencies - Part 1 - All Things Potassium