Hypokalemia

Hypokalemia is a condition where the amount of potassium in the patient's blood is lower than normal. Hypokalemia can be defined as a potassium level < 3.5.

Causes of Hypokalemia

The causative agents for every disease are the factors which are responsible for the occurrence of that particular disease in a patient. Similarly, hypokalemia also has certain causative agents or the causes for hypokalemia. They are mentioned below.

  • Diarrhea - It is a condition where the faeces of an individual are discharged frequently from his bowl. During diarrhea, the feaces appear in a liquid form.

  • Antibiotics - The use of certain Antibiotics can prove to be harmful and lead to many harmful effects. Hypokalemia can happen if certain antibiotics are consumed frequently. These antibiotics include nafcillin, penicillin, foscarnet etc.

  • Magnesium deficiency - The deficiency of magnesium is not a good sign for e human health. This deficiency can lead to some disorders or disease formation in the human body. Hypokalemia is one of such disorders.

  • Kidney related diseases - There are certain diseases that show up on the patient's kidneys. That is, these diseases directly affect or harm the kidneys of the patient and later can be a causative agent for hypokalemia. These diseases include 'Cushing syndrome, Fanconi syndrome etc'.

Symptoms of Hypokalemia

The symptoms of any disease are actually its early signs. The symptoms indicate that a certain disorder or disease is about to get developed in your body or has already developed. Each and every kind of disease has certain symptoms that help us to understand what is going on inside the patient's body. The symptoms of Hypokalemia are as follows:

  • Constipation
  • Dysrhythmias(it means abnormalities in heart rhythm)
  • Rhabdomyolysis (Damaging of the bones)
  • Weakness of the muscles
  • Paralysis

Pathophysiology

Hypokalemia arises through either a shift of potassium into cells or by increased losses, usually GI or renal. Its adverse effects result from abnormalities in membrane polarization. This occurs in virtually every organ system in the body.

Diagnosis and Evaluation

Hypokalemia is generally symptomatic below 2.5 with weakness and fatigue. As levels decrease, the most serious manifestations are neurological and cardiac. There is progressive paralysis, hypoventilation and ultimately, cardiac dysrrhythmias, hypocalcemia.

The neurologic findings in hypokalemia are nonspecific; consideration of the differential diagnosis must be made when neuromuscular findings are present. Weakness may be caused by various infectious, vascular, hyperkalemia, traumatic and toxicologic etiologies that require prompt identification.

Consider coexistent conditions that may require other critical actions in the setting of hypokalemia:

ConditionsActions
HypomagnesemiaIV magnesium sulphate (2 g slow IV push)
Digitalis toxicityAdminister digoxin specific Fab fragments
Hyperglycemia/DKAHold insulin administration
Metabolic acidosisHold sodium bicarbonate/alkaline infusions
Drug related:
  • amphotericin B
  • synthetic penicillins
  • aminoglycosides
  • theophylline
  • loop diuretics
Hold these infusions

Laboratory/Studies

  • A STAT 12-lead EKG should be performed looking for PR prolongation, flattened T waves, U waves, ST depression, decreased voltage and ventricular ectopy/ tachydysrrhymias
  • STAT electrolytes should be performed, including Mg, PO4, Ca and albumin and repeated every 1-2 h during potassium repletion
  • Head CT and/or neurological consultation may be indicated if there is uncertainty regarding the etology of neurological signs.
  • Measure digitalis level if its use is known or suspected.

ED Management

  • The patient must be placed on telemetry to monitor for dysrrhythmias
  • Potassium replacement is safest via oral route, where the GI tract serves as a homeostatic regulator of absorption.
  • Intravenous potassium replacement, in those patients with life-threatening levels and signs, should not normally occur faster than 20 mmol/h with a maximum concentration of 40 mmol/L peripherally and 60 mmol/h via central vein—faster rates can be considered only with patient extremis.
  • Mix KCl solutions in saline, not dextrose solutions (increasing glucose may exacerbate hypokalemia).

Preventive measures

To prevent any kind of disease, there are many ways. The thing is one should be aware what preventive measures should be taken. The preventive measures of Hypokalemia are mentioned below.

A rich diet is very necessary in order to stay away from the disorder of Hypokalemia. A rich diet is a diet that consists of the necessary food contents in the exact required amount.

Also food items which are rich in the potassium content are equally important. Food which consists potassium in high amount are as follows:

  • Carrots
  • Kiwi
  • Milk
  • Oranges
  • Tomatoes
  • Peanut Butter
  • Bananas

The Hypokalemia is not a very complex disorder, which means that it can be cured if the patient undergoes the treatment measures at the correct point of time. Also, if proper care is taken, the disease can be overcome without diagnosis.

       
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