What medicine should be taken for hypokalemia?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 29, 2024
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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.

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Written by Li Fang Fang
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Hypokalemia is a condition.

Hypokalemia is classified as an electrolyte disorder. When suffering from hypokalemia, patients may experience general weakness and poor appetite. In severe cases, paralysis of the limbs may occur. There are certain causes of hypokalemia, which can be divided into three types. One is reduced intake, the second is excessive loss, and the third is abnormal distribution. Reduced intake mainly refers to patients with poor diets; excessive loss is common in patients with infections, diarrhea, and those who excrete a high amount of potassium in their urine; abnormal distribution refers to potassium moving from the extracellular space into cells, causing hypokalemia.

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Why is the urine acidic in hypokalemia?

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 Wang Li Bing
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How to replenish potassium for hypokalemia

After the occurrence of hypokalemia, we usually adopt oral potassium supplementation or intravenous potassium supplementation. Oral potassium supplementation is the safest method clinically, and patients can also be advised to consume potassium-rich fruits or vegetables, etc. On the other hand, there is intravenous potassium supplementation, which must be decided based on the patient's urine output. Generally, potassium supplementation can be carried out only when the patient's urine output is more than 500 milliliters per day. However, the concentration of potassium must be diluted and not administered undiluted to prevent arrhythmias and so on.

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Written by Wang Li Bing
Intensive Care Medicine Department
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How to supplement potassium for hypokalemia

Hypokalemia generally has two common methods of potassium supplementation. The first is oral potassium supplementation, and the second is intravenous potassium supplementation. Oral potassium supplementation is the safest method, for example, taking potassium chloride sustained-release tablets orally, as well as potassium chloride injection solution orally, and eating more potassium-rich vegetables and fruits. The second method is intravenous potassium supplementation. For intravenous potassium supplementation, it is important to pay attention to the patient's urine output. If the patient's urine output is adequate, intravenous potassium supplementation can be appropriately performed, and the concentration of intravenous potassium supplementation should not exceed 0.3% to prevent arrhythmias caused by hyperkalemia. (Please use medications under the guidance of a doctor.)

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Written by Wei Shi Liang
Intensive Care Unit
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Causes of Hypokalemia

Common causes of hypokalemia include insufficient intake or prolonged inability to eat without intravenous supplementation. In such cases, while intake of potassium decreases, the kidneys continue to excrete potassium, leading to a loss of potassium in the blood. Additionally, increased excretion can cause hypokalemia, including losses from the gastrointestinal tract such as vomiting, diarrhea, and continuous gastrointestinal decompression, which results in a loss of digestive fluids rich in potassium. Potassium loss through the kidneys from prolonged use of potassium-wasting diuretics or during the polyuric phase of acute renal failure can also lead to hypokalemia. Furthermore, the shift of potassium from outside to inside the cells can cause hypokalemia.