Hypokalemia

Immediate Questions
A. Is the patient symptomatic? Symptoms of
hypokalemia include weakness, nausea,
vomiting and abdominal tenderness. Severe
hypokalemia can depress reflexes and cause
weakness.

B. What medications is the patient taking?

Loop diuretics and amphotericin causes
potassium wasting by direct renal effects.
 Immediate Questions
C. Is there a history of vomiting,
nasogastric suction, diarrhea or renal
problems (such as renal tubular
acidosis)?
 Database

Because potassium is the principle

intracellular action, measured serum
hypokalemia usually represents a significant
loss of body potassium. Thus, serum levels
of 3.0 meg/L (mmol/L) often reflects total
deficits of 100-200 mEq or more. Look for
coexisting hypocalcemia and
hypomagnesemia. Check ABG's, as acid-base
disorders may coexist and obtain an ECG.
Severe hypokalemia can cause blunting of
reflexes, paresthesia and paralysis.
 Plan
A. Aggressive potassium replacement
should be performed only after
adequate renal function has been
documented.
B. Parenteral replacement should be
considered for digoxin toxicity,
significant arrhythmia, and severe
hypokalemia (<3.0 mmol/L). Maximum
concentrations of KCl used in
peripheral veins generally should not
exceed 10 meq/100 cc, due to the
damaging effects of high
concentrations on the veins.
 Plan
C. For lesser degrees of hypokalemia
that require parenteral replacement, 10
to 15 meq/h may be infused
peripherally. The maximum infusion
rate is 10 meq/hour. Check serum
levels frequently (every 2-4 hours
depending on clinical response) to
avoid hyperkalemia. ICU monitoring is
required if arrhythmias are present or
for rapid infusions of KCl.
 Plan
D. Oral replacement include liquids and
tablets. Slow-release pills typically
contain 8, 10 or 20 mEq tablet. Thus, it
will take several days to replete the
potassium depletion. Replacement
doses should be 40-120 meq qd in
divided doses, depending on the
patient's weight and level of
hypokalemia. More than 20 meq in one
dose can cause GI upset.