Causes of Hypokalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 13, 2024
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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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Written by Wei Shi Liang
Intensive Care Unit
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Symptoms of hypokalemia

The clinical manifestations of hypokalemia are diverse, and the most life-threatening involve the cardiac conduction system and neuromuscular system. Mild hypokalemia is characterized on the electrocardiogram by flattened or absent T waves and the appearance of U waves. Severe hypokalemia can lead to fatal arrhythmias, such as ventricular tachycardia, ventricular fibrillation, or sudden death. In the neuromuscular system, the most prominent symptoms of hypokalemia are skeletal muscle relaxation, paralysis, and loss of tone in smooth muscles, leading to rhabdomyolysis. When respiratory muscles are involved, it can lead to respiratory failure. Hypokalemia can also cause insulin resistance or hinder insulin release, leading to significant glucose intolerance. A decrease in potassium excretion results in a reduced ability of the kidneys to concentrate urine, causing polyuria and low specific gravity urine.

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Written by Wei Shi Liang
Intensive Care Unit
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Hypokalemia is a condition.

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
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Why does hypokalemia cause alkalosis?

Hypokalemia can cause metabolic alkalosis because it leads to the intracellular movement of hydrogen ions. In hypokalemia, potassium shifts from the inside to the outside of the cell to compensate for the decreased serum potassium. As an exchange, hydrogen ions from the gastric fluid move into the cells, causing cellular alkalosis and intracellular acidosis. Additionally, due to potassium deficiency in the renal tubular epithelial cells, the potassium-sodium exchange decreases and the sodium-hydrogen exchange increases, leading to enhanced excretion of hydrogen ions and increased reabsorption of bicarbonate ions, resulting in hypokalemia-induced metabolic alkalosis, which needs to be promptly addressed clinically.

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Patients with hypokalemia can have what kind of urine?

When patients have hypokalemia, they often exhibit paradoxical aciduria, which is a typical manifestation of hypokalemia. In hyperkalemia, however, there is paradoxical alkaline urine. When serum potassium ions decrease, the renal tubular epithelium reduces its potassium excretion function and instead increases hydrogen excretion, leading to increased reabsorption of sodium and bicarbonate. This results in metabolic alkalosis, causing an increase in plasma bicarbonate, unlike typical alkalosis where alkaline urine is excreted. However, in the case of hypokalemia, acidic urine is excreted, hence it is called paradoxical aciduria.

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Written by Wei Shi Liang
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How to radically cure hypokalemia?

Hypokalemia must be treated with potassium supplementation while simultaneously addressing the primary condition. For mild hypokalemia, oral potassium can be given in doses of 40 to 80 mmol/day. In cases of severe hypokalemia, where blood potassium is less than 2.0 mmol/L or when life-threatening symptoms are present, intravenous potassium should be administered at a rate of 10 to 20 mmol/L per hour. Regular monitoring of blood potassium levels is necessary, especially in cases of renal dysfunction and cellular uptake impairment. For life-threatening severe hypokalemia, potassium can be administered via central venous lines with close monitoring of blood potassium levels, and the infusion rate can reach up to 40 mmol/L, which can effectively cure hypokalemia.