Disorders of potassium

balance
Zhao Chenghai
Pathophysiology
Outline
Potassium balance
Disorders of potassium balance
Hypokalemia
Hyperkalemia
Potassium balance
Distribution of potassium
Gains and losses of potassium
Mechanisms of regulation
Functions of potassium

Potassium balance
Distribution of potassium
The intracellular concentration of
potassium ranges from 140 to 150
mmol/L.
The extracellular concentration of
potassium (3.5-5.0mmol/L) is
considerable less.

Gains and losses
Food is the main source of potassium
intake.

The kidneys are the main source of
potassium elimination.
Mechanisms of regulation
Renal regulation

Transcellular shift between the
intracellular and extracellular
compartments
Renal regulation
Secretion of potassium by distal and
collecting tubules.
Aldosterone --- a sodium-potassium
exchange system.
Sodium is transported back into blood.
Potassium is secreted into tubular filtrate.

Mineralocorticoid hormone
Plasma potassium levels control aldosterone
secretion by adrenal gland.
Transcellular shifts
Sodium-potassium ATPase
Both insulin and epinephrine increase the activity of
sodium-potassium pump.
(An increase in potassium level stimulates insulin
release. --- a feedback mechanism)
Potassium channels
ECF osmolalityH
2
O leaves cell ICF K
+
K
+
moves out of cell through K
+
channels ECF K
+
Exercise
Potassium-hydrogen exchange to maintain
electrical neutrality
In acidosis
In alkalosis
Functions of potassium
Maintain the osmotic integrity of cells
Osmotic pressure in ICF
Maintain acid-base balance
Through potassium-hydrogen exchange
Contribute to the reactions that take place in
cells
Transform carbohydrates into energy
Convert amino acid to protein
Change glucose into glycogen
Play a critical role in the excitability of
skeletal, cardiac, and smooth muscle.

Resting membrane potential (RMP)
RMP-59.5lg[K
+
]
i
/[K
+
]
e


Excitability of muscle cells can be affected
by the distance between RMP and
threshold potential.
Hypokalemia
Hypokalemia refers to a decrease
in plasma potassium level below
3.5 mmol/L.
Causes of hypokalemia
Inadequate intake
inability to obtain or ingest food
Diet deficient in potassium
Excessive renal, gastrointestinal and skin
losses
Diuretic therapy (thiazide and loop diuretics)
Increased aldosterone level (primary aldosteronism,
stress-cortisol)
burn, sweating increase, vomiting and diarrhea
Transcellular shift
Administration of insulin (to treat diabetic
ketoacidosis)
-adrenergic agonist----albuterol (bronchodilator)
Alkalosis
Manifestations of hypokalemia
Neuromuscular manifestations
Muscle flabbiness, weakness and fatigue
Muscle cramps and tenderness
Paresthesia and paralysis
Impaired kidneys ability to concentrate the
urine
polyuria, urine with low osmolality, polydipsia (ECF
osmolality)
Gastrointestinal manifestations
Anorexia, nausea, vomitting,
Constipation, abdominal distension, paralytic ileus
Cardiovascular manifestations
Arrhythmias, increased sensitivity to digitalis toxicity
Metabolic alkalosis
ECG changes in hypokalemia
Depression of the ST segment
Flattening of the T wave
Appearance of a prominent U wave
Prolongation of PR interval

Treatment of hypokalemia
Increasing the intake of foods high in
potassium content
Oral potassium supplements
Giving potassium intravenously when
rapid replacement is needed.
Only if the renal function is adequate
Hyperkalemia
Hyperkalemia refers to an increase in
plasma levels of potassium in excess
of 5.0mmol/L.
Causes of hyperkalemia
Decreased renal elimination
Decreased renal function-renal failure
Treatment with potassium-sparing diuretics
Decreased aldosterone level
Adrenal insufficiency (addisons disease)
Treatment with ACEI
Angiotensin II receptor blocker
Excessively rapid administration

Movement of potassium from the intracellular
to extracellular compartment
Tissue injury such as burns and crushing injuries
Extreme exercise or seizures
Acidosis
Manifestations of hyperkalemia
Gastrointestinal manifestations
Anorexia, nausea, vomitting, intestinal
cramps, diarrhea
Cardiovascular manifestations
Ventricular fibrillation and cardiac arrest
Neuromuscular manifestations
Paresthesias
Weakness
Muscle cramps
ECG changes in hyperkalemia
Appearance a peaked T wave
Widening of the QRS complex
Prolongation of the PR interval
Disappearance of the P wave

Treatment of hyperkalemia
Decreasing intake or absorption of
potasssium.
Using calcium to antagonize the
potassium.
Using insulin and glucose
Increasing potassium excretion
hemodialysis
peritoneal dialysis
Case1
A 40-year-old man with advanced acquired
immunodeficiency syndrome (AIDS) presents
with an acute chest infection. Investigation
confirm a diagnosis of P.carinii pneumonia.
Although he is treated appropriately, his serum
sodium level is 118mmol/L. Tests of adrenal
function are normal.
What type of disorders happened to this man?
What is the likely cause of this electrolyte
disturbance?

Case 2
A 70-year-old woman who is taking
furosemide (a loop diuretic) for congestive
heart failure complains of weakness, fatigue,
and cramping of the muscles in her legs. Her
serum potassium is 2.0mmol/L, and her
serum sodium is 140mmol/L. She also
complains that she notices a strange heart
beat at times.
What is the likely cause of this womans
symptoms?
What would be the treatment for this woman?
Case 3
A 76-year-old woman was brought to the
hospital because she was lethargic and
refused to drink fluid. Her blood pressure is
100/60 mmHg. Serum sodium level is
170mmol/L, potassium level is 4.3mmol/L.
What kind of electrolyte disturbance
happened to this woman?
What is the cause of this kind of disorder?
What is the most severe outcome of this
disorder?