Dec 06, 2018 for example, if an individual presents with nausea, vomiting, and hypokalemia, the physician might understandably attribute the hypokalemia to the nausea and vomiting. Hypokalemia can also occur when there is an intracellular shift of the potassium in the body, which stops the correct transmission of potassium between cells. Rate of change since previous sample falls are of increasing significance as they approach 0. Hypokalemia and hyperkalemia are common electrolyte disorders caused by. The evaluation and treatment of hypokalemia are discussed separately. Severe hypokalemia is defined as a level less than 2.
Practical algorithms for the optimal diagnostic, treatment and followup strategy are presented, while an individualized approach is emphasized. The etiology of hypokalemia can be quite difficult to diagnose. Dec 06, 2018 hypokalemia is defined as a condition in which the serum potassium level is less than 3. Wasd abc of intravenous fluids, electrolyte disorders and aki management in adults management of hypokalaemia 5 hypokalaemia hok is a serum potassium concentration sk,3.
Males and females are affected equally, although some studies suggest females are affected more by diureticinduced hypokalemia. A physiologicbased approach to the treatment of a patient. Potassium helps control how your muscles, heart, and digestive system work. In some cases, however, the diagnosis is not readily apparent. A random urine potassiumcreatinine ratio kc less than 1. As a matter of fact, many organ systems are involved in the regulation of potassium level and any derangement to their normal function can cause hypokalemia. In addition, a manual search of key journals and abstracts from the major. The earliest electrocardiogram ecg change associated with hypokalemia is a decrease in the twave amplitude. Cardiac effects of hypokalemia are usually minimal until serum potassium concentrations are hypokalemia causes sagging of the st segment, depression of the t wave, and elevation of the u wave.
Symptoms depend on degree and duration of hypokalemia. A more practical approach is calculation of the urine potassium to creatinine ratio from a spot urine specimen. She had noticed a gradual increase in symptoms over the past two weeks. Introduction hypokalemia is a common clinical problem, the cause of which can usually be determined from the history as with diuretic use, vomiting, or diarrhea. Dec 09, 20 the clinical manifestations, etiologies, diagnostic evaluation, and treatment of hypokalemia, including states of mineralocorticoid excess. See evaluation of the adult patient with hypokalemia and clinical manifestations and treatment of hypokalemia in adults. Lifethreatening electrolyte abnormalities aha journals. Hypokalemia is treated with oral or intravenous potassium. Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. To illustrate these principles, we discuss our approach to a patient with chronic hypokalemia and hypertension.
The goals of hypokalemia management are to prevent the development of life threatening consequences, to identify the definitive cause of hypokalemia, and to correct any potassium deficit while avoiding hyperkalemia. Disorder of potassium balanceboth hypo and hyperkalemiais a common finding in the icu. Hypokalemia endocrine and metabolic disorders merck. With marked hypokalemia, the t wave becomes progressively smaller and the u wave becomes increasingly larger. Case report a 58yearold female presented to the emergency department with a chief complaint of ongoing fatigue and weakness. A practical and pathophysiologic approach to hypokalemia. Jan 28, 2011 hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. Hypokalemia is when bloods potassium levels are too low. Hypokalemia and hyperkalemia have been estimated to occur in about 21% and 3% of hospitalized.
Transcellular shifts maintenance of potassium in icf is achieved by the action of the 3na2k atpase pump present on cell membranes pumps 3na out for 2k in contributes to generation of resting membrane potential increased activity results in shift of potassium into the cell hypokalaemia. Patients are often asymptomatic, particularly with mild hypokalemia. In the absence of hypertension, coexistent metabolic alkalosis is consistent with surreptitious vomiting, diuretic. Definition hypokalemia is defined as a persistently low levels of serum potassium lower than 3. Absorption of mealderived glucose stimulates insulin secretion with a consequent insulindriven potassium uptake in muscle. In most cases, the cause of hypokalemia is apparent from the history and physical examination. Hypokalemia is generally defined as a serum potassium level of less than 3.
Hypokalaemia is defined as a serum potassium of less than 3. Jan 23, 2017 a blood result indicating hypokalaemia is a reasonably common problem in general practice. This is also an opportunity to teach the general lesson that internal medicine is much more like a game of chess, where every move has to be contemplated with respect to its consequences several moves clinical teaching scripts for inpatient medicine jeff wiese, md. Pdf pathophysiology of vomitinginduced hypokalemia and. Diagnosis of hypokalemia a problemsolving approach to clinical cases farahnak assadi in situations where the cause of hypokalemia is not obvious, measurement of urinary potassium excretion and blood pressure and assessment of acidbase balance are often helpful. However, if after replenishment the patient once again develops hypokalemia without nausea and vomiting, then considering other possible causes of hypokalemia is necessary.
Diagnosis of hypokalemia world health organization. If you continue browsing the site, you agree to the use of cookies on this website. He denied vomiting, diarrhea, palpitation, tremor or excessive sweating. Pathophysiology of vomitinginduced hypokalemia and diagnostic approach.
A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Familial periodic paralysis, andersens syndrome, congenital chloridelosing diarrhea, and cystic fibrosis are genetic causes of hypokalemia with low urine k. The presence of a u wave is not speci c for hypokalemia since it can also be a normal nding. A more practical approach is calculation of the urine potassiumtocreatinine ratio from a. A methodological approach is warranted to manage this problem.
Algorithm of the diagnostic approach to a patient with hypokalemia. Diuretic use and gastrointestinal losses are common. Diagnostic approach to hypokalemia due to renal loss with metabolic alkalosis approach to hypokalemia. Algorithm for the approach to hypokalemia with a high u openi. Request pdf therapeutic approach to hypokalemia for successful potassium replacement, one should consider the optimal potassium preparation, route of. Hypokalemia occurs when your body loses too much potassium or does not absorb enough from food. An accurate diagnosis will help determine the molecular. Types of hyponatremia hypovolumic hyoponatremialowtotal body h20, decreased total body na hypovolumiamost common minerlocortoid deficiency diuretics hypervolumic hyponatremia increased total body h20,total body na normalincrease but can have decrease ecv renal failure chf nephrotic syndrome cirrhosis. A 20yearold woman with fatigue and palpitations cleveland. Apr 29, 2014 approach to hypokalemia ranjita pallavi internal medicine pgy2 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Sep 15, 2015 hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Feb 03, 2020 hypokalemia is a low level of potassium in your blood. To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Since then, he has been receiving potassium supplement, but his serum potassium has remained low or low normal.
To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with. The normal ratio of around 30 of the intracellular ki over the extracellular ke potassium concentration is increased. Therapeutic approach to hypokalemia request pdf researchgate. Drugs, diarrhea, kidney disease, endocrine diseases and many others are potential culprits. A case of medicationinduced hypokalemia recently seen at our hospital is described below. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. For successful potassium replacement, one should consider the optimal potassium preparation, route of administration, and the appropriate speed of administration. Hypokalemia report free download as powerpoint presentation. By far the most common causes of hypokalemia are potassium losses caused by diuretics or gastrointestinal disorders.
Clinical features associated with hypokalaemia include abnormalities of cardiovascular, neurological and metabolic function and may be treated with oral. Hypokalemia affects more than 20% of hospitalized patients. The ecg shows a wide qrs complex merging with the peaked t wave. Ppt hypokalemia powerpoint presentation free to download.
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