Clinical manifestations of hypokalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 05, 2024
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The clinical manifestations of hypokalemia are diverse, with the most life-threatening symptoms affecting the cardiac conduction system and the neuromuscular system. Mild hypokalemia on an electrocardiogram presents as flattened T waves and the appearance of U waves, while severe hypokalemia can lead to fatal arrhythmias such as ventricular tachycardia and ventricular fibrillation. In the neuromuscular system, the most prominent symptoms of hypokalemia are skeletal muscle flaccid paralysis and sustained smooth muscle tension, which can involve the respiratory muscles and lead to respiratory failure. Hypokalemia can also cause insulin resistance or hinder insulin release, leading to significant glucose tolerance abnormalities. Reduced potassium excretion decreases the kidney's ability to concentrate urine, resulting in polyuria and urine with low specific gravity.

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Written by Wei Shi Liang
Intensive Care Unit
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Clinical manifestations of hypokalemia

The clinical manifestations of hypokalemia are diverse, with the most life-threatening symptoms affecting the cardiac conduction system and the neuromuscular system. Mild hypokalemia on an electrocardiogram presents as flattened T waves and the appearance of U waves, while severe hypokalemia can lead to fatal arrhythmias such as ventricular tachycardia and ventricular fibrillation. In the neuromuscular system, the most prominent symptoms of hypokalemia are skeletal muscle flaccid paralysis and sustained smooth muscle tension, which can involve the respiratory muscles and lead to respiratory failure. Hypokalemia can also cause insulin resistance or hinder insulin release, leading to significant glucose tolerance abnormalities. Reduced potassium excretion decreases the kidney's ability to concentrate urine, resulting in polyuria and urine with low specific gravity.

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Written by Wei Shi Liang
Intensive Care Unit
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Precautions for intravenous potassium supplementation in patients with hypokalemia

Patients with hypokalemia should closely monitor their blood potassium levels when receiving intravenous potassium supplementation, rechecking potassium levels within 1-4 hours after supplementation. Continuous electrocardiogram monitoring is necessary to closely observe any changes in the electrocardiogram and prevent life-threatening hyperkalemia. In patients with renal impairment, the potassium supplementation should be 50% of that for normal patients, and it is generally considered that the daily potassium supplementation should not exceed 100-200 mmol. For patients with severe hypokalemia, the total daily potassium supplementation can reach 240-400 mmol, but blood potassium levels should be closely monitored to prevent hyperkalemia. Peripheral administration of high-concentration potassium can irritate the vein wall, causing pain and phlebitis. Generally, it is considered that the rate of potassium supplementation through peripheral veins should not exceed 40 mmol/L.

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Written by Wei Shi Liang
Intensive Care Unit
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Hypokalemia belongs to the department of nephrology.

Hypokalemia is seen in various clinical departments and can affect the nervous system, muscles, heart, digestive system, kidneys, as well as carbohydrate metabolism and acid-base balance. If hypokalemia occurs, it is important to first identify the primary disease and treat it specifically in the corresponding department. In cases of severe hypokalemia, patients should be admitted to the intensive care unit. Treatment involves addressing the primary disease and promptly supplementing potassium. Severe hypokalemia, especially if accompanied by arrhythmias or muscle paralysis, requires immediate potassium supplementation. Potassium deficiency within cells recovers slowly; treatment may take four to six days to gradually reach a balance. Additionally, it is important to timely correct other electrolyte imbalances. The specific department to which the patient is admitted mainly depends on the primary disease, but in cases of very severe conditions, potassium supplementation should be managed in the intensive care unit.

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Written by Wang Li Bing
Intensive Care Medicine Department
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How to replenish potassium for hypokalemia

After the occurrence of hypokalemia, we usually adopt oral potassium supplementation or intravenous potassium supplementation. Oral potassium supplementation is the safest method clinically, and patients can also be advised to consume potassium-rich fruits or vegetables, etc. On the other hand, there is intravenous potassium supplementation, which must be decided based on the patient's urine output. Generally, potassium supplementation can be carried out only when the patient's urine output is more than 500 milliliters per day. However, the concentration of potassium must be diluted and not administered undiluted to prevent arrhythmias and so on.

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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.