Why is the urine acidic in hypokalemia?

Written by Gan Jun
Endocrinology
Updated on December 24, 2024
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When hypokalemia occurs, the concentration of potassium ions in the extracellular fluid decreases, causing potassium ions to shift from the inside to the outside of the cell. Meanwhile, two sodium ions and one hydrogen ion from the extracellular fluid move into the cell, decreasing the concentration of hydrogen ions outside the cell, thus resulting in metabolic alkalosis. At the same time, due to the reduction of blood potassium, the potassium-sodium exchange in the renal tubules is reduced. The renal tubule cells exchange more hydrogen ions and sodium ions, thus increasing the reabsorption of bicarbonate ions and raising the pH value. This type of metabolic alkalosis increases the number of hydrogen ions inside cells, while the kidney secretes more hydrogen, thereby producing acidic urine, also known as paradoxical aciduria.

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Written by Gan Jun
Endocrinology
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What should I do if hypokalemia suddenly occurs?

Hypokalemia is very common in clinical settings, generally caused by improper diet, insufficient supplementation, or excessive loss. It is recommended that patients first seek further examination at a hospital. If potassium deficiency is confirmed, mild cases can be treated with oral potassium supplements, while moderate to severe cases who experience muscle weakness, flaccid paralysis, and arrhythmias should receive intravenous potassium supplementation in conjunction with oral treatment. It is also important to dynamically monitor electrolyte levels. In daily life, it is important to plan a diet that is rich in vitamins and trace elements, and treat the specific causes of the condition. It is recommended that patients continually monitor their fluid and electrolyte balance, abstain from smoking and limit alcohol consumption, and maintain good daily habits.

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Written by Gan Jun
Endocrinology
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What are the symptoms of hypokalemia?

When the body's blood potassium level falls below 3.5 millimoles per liter, it is called hypokalemia. Hypokalemia can cause adverse symptoms in multiple systems of the body, initially causing weakness and fatigue in the limbs, flaccid paralysis, sluggish and absent tendon reflexes, and in severe cases, respiratory difficulty. At the same time, hypokalemia can lead to a series of central nervous system damages, such as apathy, a blank stare, drowsiness, and confusion; it also causes nausea, poor appetite, abdominal distension, and intestinal paralysis among other adverse gastrointestinal phenomena. Additionally, it can lead to palpitations, and rapid atrial or ventricular arrhythmias, among other adverse phenomena. Therefore, it is crucial to provide timely and proper potassium supplementation and correction of blood potassium levels for patients with hypokalemia.

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Written by Wei Shi Liang
Intensive Care Unit
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Causes and Clinical Manifestations of Hypokalemia

Hypokalemia refers to a condition where blood potassium levels are below 3.5mmol/L. The causes can be due to inadequate intake of potassium, such as prolonged inability to eat without sufficient intravenous supplementation of potassium. It can also result from excessive loss of potassium, through external losses such as vomiting and diarrhea, or through renal losses due to the excessive use of diuretics and certain hormonal imbalances. A third cause involves the shift of potassium into cells, such as during episodes of alkalemia and periodic paralysis. Clinically, mild to moderate hypokalemia is characterized by symptoms like muscle weakness, fatigue, cramps, intestinal obstruction, and some abnormalities in electrocardiograms, including the presence of U waves and flattened T waves. Severe hypokalemia can lead to life-threatening arrhythmias, such as ventricular tachycardia and ventricular fibrillation, which require immediate treatment.

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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
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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.