Hypokalemia is a condition.

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 06, 2024
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Potassium is one of the essential electrolytes for life. Its physiological functions mainly include maintaining cellular metabolism, regulating osmotic pressure, acid-base balance, and maintaining cell stress functions. The human body intakes about 100 millimoles of potassium each day, of which 90% is excreted through the kidneys, and the remainder is excreted through the gastrointestinal tract. Potassium mainly exists inside cells, with serum potassium accounting for only 2% of the total potassium in the body. The concentration of potassium in serum is between 3.5 to 5.5 mmol/L. If the concentration of serum potassium is below 3.5 mmol/L, it is considered hypokalemia, which is often due to insufficient potassium intake or excessive potassium excretion.

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Written by Wei Shi Liang
Intensive Care Unit
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What medicine should be taken for hypokalemia?

The treatment of hypokalemia primarily involves addressing the underlying disease. Symptomatic treatment should avoid excessive potassium supplementation, which can lead to hyperkalemia. The principle of potassium supplementation is as follows: for mild hypokalemia, such as in patients showing clinical signs, oral potassium can be administered at 40-80 millimoles per day. For patients with severe hypokalemia, or those whose gastrointestinal tract cannot utilize potassium, with potassium levels less than 2.0 millimoles per liter, intravenous potassium can be provided. An initial supplementation rate of 10-20 millimoles per hour is relatively safe. In cases of severe hypokalemia with life-threatening clinical signs, a rapid increase to 40-80 millimoles can be achieved in a short period, but close monitoring is necessary.

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Causes of Hypokalemia

Common causes of hypokalemia include insufficient intake or prolonged inability to eat without intravenous supplementation. In such cases, while intake of potassium decreases, the kidneys continue to excrete potassium, leading to a loss of potassium in the blood. Additionally, increased excretion can cause hypokalemia, including losses from the gastrointestinal tract such as vomiting, diarrhea, and continuous gastrointestinal decompression, which results in a loss of digestive fluids rich in potassium. Potassium loss through the kidneys from prolonged use of potassium-wasting diuretics or during the polyuric phase of acute renal failure can also lead to hypokalemia. Furthermore, the shift of potassium from outside to inside the cells can cause hypokalemia.

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Which department to go to for hypokalemia?

Hypokalemia is defined as having a blood potassium level below 3.5 mmol/L. In hospitals, when treating mild hypokalemia, it is essential to identify and treat the primary disease in the corresponding department, such as endocrinology, internal medicine, or gastroenterology. Additionally, timely oral potassium supplementation is necessary to correct the hypokalemia. If severe hypokalemia occurs clinically, with blood potassium levels less than 2.5 mmol/L, treatment in the intensive care unit is required. It is crucial to establish an intravenous access for potassium supplementation immediately. The rate of potassium supplementation should be slow, and blood potassium levels must be monitored continuously.

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Clinical symptoms of hypokalemia

Hypokalemia has diverse clinical manifestations. The most life-threatening symptoms involve the cardiac conduction system and the neuromuscular system. In mild hypokalemia, the electrocardiogram (ECG) shows flattened T waves or their disappearance, along with the appearance of U waves. Severe hypokalemia can lead to lethal arrhythmias, such as ventricular tachycardia, ventricular fibrillation, or sudden death. In the neuromuscular system, the most prominent symptoms of hypokalemia are in the skeletal muscle, presenting as sluggish paralysis and loss of tone in the smooth muscle, leading to rhabdomyolysis. If respiratory muscles are affected, it may result in respiratory failure. Hypokalemia can also cause insulin resistance and obstruct insulin release, leading to significant glucose tolerance abnormalities. Decreased potassium excretion reduces the kidney's ability to concentrate urine, resulting in polyuria.

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When supplementing potassium for hypokalemia, what should be paid attention to?

When supplementing potassium for hypokalemia, the following should be noted: 1. Closely monitor the blood potassium levels. Supplement 60-80 mmol/L of potassium, or recheck the blood potassium level within 1-4 hours after supplementation. 2. If the rate of potassium supplementation exceeds 10 moles per hour, continuous ECG monitoring should be maintained, closely observe the changes in the ECG, and prevent the occurrence of life-threatening hyperkalemia. 3. The rate of potassium supplementation for patients with regenerative dysfunction should be 50% of that for patients with normal kidney function. 4. The daily amount of potassium supplementation should not exceed 100-200 millimoles. 5. Try not to use peripheral veins for high-concentration potassium supplementation. 6. Use sodium chloride solution to dilute potassium-containing solutions, and it is not recommended to use glucose or low molecular weight dextrorotatory sugar as the carrier.