Causes of hypokalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 15, 2024
00:00
00:00

Potassium is one of the essential electrolytes necessary for life. Its physiological functions mainly include maintaining cellular metabolism, regulating osmotic pressure and acid-base balance, and preserving cell stress response, etc. Daily potassium intake is about 100 millimoles, with 90% excreted through the kidneys and the remainder through the gastrointestinal tract.

Common causes of hypokalemia include reduced intake, such as long-term inability to eat without timely potassium supplementation. Even though potassium intake decreases, the kidneys continue to excrete potassium, leading to potassium loss. The second cause is increased excretion, which includes losses through the gastrointestinal tract and the kidneys, both of which can lead to hypokalemia. The third cause is the movement of potassium from outside to inside the cells, which can occur during metabolic alkalosis or when glucose and insulin are administered, promoting the transfer of potassium ions into the cells, resulting in hypokalemia.

Other Voices

doctor image
home-news-image
Written by Wei Shi Liang
Intensive Care Unit
1min 1sec home-news-image

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.

doctor image
home-news-image
Written by Li Fang Fang
Hematology
33sec home-news-image

How is hypokalemia tested?

Hypokalemia can be diagnosed by drawing 3-5ml of venous blood for biochemical and electrolyte tests. Patients with hypokalemia may experience weakness or even paralysis, hence it is crucial to actively treat by replenishing potassium. During potassium supplementation, it is also important to clarify the underlying cause of the hypokalemia in order to solve the issue from its root. Otherwise, merely supplementing potassium might result in recurring hypokalemia.

doctor image
home-news-image
Written by Gan Jun
Endocrinology
53sec home-news-image

What are the clinical manifestations of hypokalemia?

When patients present with hypokalemia, the first symptoms often include significant muscle weakness and episodic flaccid paralysis. Additionally, there may be a decrease in the stress tolerance of cardiac myocytes, leading to arrhythmias or an increased heart rate. Hypokalemia can also cause damage to the renal tubules, leading to a decline in kidney excretion functions. The most crucial manifestation is endocrine disorder, which can lead to kidney failure. The primary treatment for hypokalemia is potassium supplementation. For mild hypokalemia, it is advisable to consume foods high in potassium, such as oranges, bananas, and other fruits and vegetables. In cases of severe hypokalemia, potassium can be administered intravenously or orally, and blood potassium levels should be dynamically monitored.

doctor image
home-news-image
Written by Wei Shi Liang
Intensive Care Unit
52sec home-news-image

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.

doctor image
home-news-image
Written by Wang Li Bing
Intensive Care Medicine Department
50sec home-news-image

How is hypokalemia diagnosed?

Hypokalemia refers to a blood potassium level below 3.5mmol/L. Clinically, it is mainly diagnosed through electrolyte tests and arterial blood gas analysis, which can confirm whether a patient has low potassium. After developing hypokalemia, patients may experience symptoms such as fatigue and limb weakness. At this point, treatment should include the oral administration of sustained-release potassium chloride tablets or intravenous infusion of potassium chloride, as well as advising the patient to consume potassium-rich vegetables and fruits to correct hypokalemia. Prolonged hypokalemia can lead to arrhythmia and even endanger the patient’s life. (Medications should be used under the guidance of a clinical doctor, according to the specific situation.)