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Table of contents

Hypokalemia

Definition
Hypokalemia refers to the presence of serum potassium levels < 3.6 mmol/L.
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Pathophysiology
Potassium depletion occurs due to inadequate dietary intake, increased renal excretion (e.g., due to diuretic therapy), or increased gastrointestinal losses in the context of diarrhea.
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Epidemiology
Hypokalemia is the most common electrolyte disorder encountered in clinical practice.
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Disease course
Manifestations of hypokalemia include muscle weakness, ileus, and cardiac arrhythmias. Typical electrocardiographic changes include flat or inverted T waves, ST-segment depression, and prominent U waves.
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Prognosis and risk of recurrence
Severe untreated hypokalemia can lead to rhabdomyolysis and malignant cardiac arrhythmias, such as ventricular tachycardia and VF.
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Key sources
The following summarized guidelines for the evaluation and management of hypokalemia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023; 2015) and the National Council on Potassium in Clinical Practice (NCPCP 2000).
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Guidelines

1.Diagnostic investigations

Measurement of potassium levels
Use serum potassium as the most convenient laboratory test to establish the diagnosis if hypokalemia, recognizing that it is not always an accurate indicator of total body potassium.
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Consider measurement of 24-hour urinary potassium excretion as a more appropriate indicator of total body potassium in patients who are at high risk of complications from hypokalemia, such as those with HF.
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2.Medical management

General principles
Initiate potassium replacement in individuals who are subject to nausea, vomiting, diarrhea, bulimia, or diuretic/laxative abuse.
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Administer potassium supplements are best administered PO in a moderate dosage over a period of days to weeks to achieve full repletion of potassium.
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More topics in this section

  • Oral potassium replacement

  • Intravenous potasium replacement

  • Optimization of patient adherence

3.Inpatient care

Electrocardiogram monitoring: consider electrocardiographic monitoring in patients with severe hypokalemia (serum potassium < 2.5 mmol/L).
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4.Nonpharmacologic interventions

Dietary considerations: initiate potassium replacement therapy in combination with dietary consumption of potassium-rich foods.
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5.Specific circumstances

Patients with diabetes mellitus: monitor potassium levels closely monitored in patients with diabetes mellitus, and initiate potassium replacement therapy when appropriate.
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More topics in this section

  • Patients with hypertension

  • Patients with heart disease

  • Patients with cardiac arrhythmias

  • Patients at risk of stroke