Symptoms of hypokalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 05, 2024
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The clinical manifestations of hypokalemia are diverse, and the most life-threatening involve the cardiac conduction system and neuromuscular system. Mild hypokalemia is characterized on the electrocardiogram by flattened or absent T waves and the appearance of U waves. Severe hypokalemia can lead to fatal arrhythmias, such as ventricular tachycardia, ventricular fibrillation, or sudden death. In the neuromuscular system, the most prominent symptoms of hypokalemia are skeletal muscle relaxation, paralysis, and loss of tone in smooth muscles, leading to rhabdomyolysis. When respiratory muscles are involved, it can lead to respiratory failure. Hypokalemia can also cause insulin resistance or hinder insulin release, leading to significant glucose intolerance. A decrease in potassium excretion results in a reduced ability of the kidneys to concentrate urine, causing polyuria and low specific gravity urine.

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Written by Wei Shi Liang
Intensive Care Unit
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Clinical symptoms of hypokalemia

Hypokalemia has diverse clinical manifestations. The most life-threatening symptoms involve the cardiac conduction system and the neuromuscular system. In mild hypokalemia, the electrocardiogram (ECG) shows flattened T waves or their disappearance, along with the appearance of U waves. Severe hypokalemia can lead to lethal arrhythmias, such as ventricular tachycardia, ventricular fibrillation, or sudden death. In the neuromuscular system, the most prominent symptoms of hypokalemia are in the skeletal muscle, presenting as sluggish paralysis and loss of tone in the smooth muscle, leading to rhabdomyolysis. If respiratory muscles are affected, it may result in respiratory failure. Hypokalemia can also cause insulin resistance and obstruct insulin release, leading to significant glucose tolerance abnormalities. Decreased potassium excretion reduces the kidney's ability to concentrate urine, resulting in polyuria.

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Written by Wei Shi Liang
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The impact of hypokalemia on skeletal muscle

In clinical practice, hypokalemia can affect the muscular and nervous conduction systems. The most prominent symptoms of hypokalemia in the neuromuscular system are flaccid paralysis of the skeletal muscles, loss of tension in smooth muscles, and rhabdomyolysis. If the respiratory muscles are involved, it can lead to respiratory failure. Hypokalemia can also lead to insulin resistance, resulting in significantly abnormal glucose tolerance. If hypokalemia occurs clinically, it is crucial to actively treat the primary disease, appropriately supplement potassium, monitor during the supplementation process to avoid hyperkalemia, and closely monitor blood potassium levels with regular reviews.

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Written by Wei Shi Liang
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When supplementing potassium for hypokalemia, what should be paid attention to?

When supplementing potassium for hypokalemia, the following should be noted: 1. Closely monitor the blood potassium levels. Supplement 60-80 mmol/L of potassium, or recheck the blood potassium level within 1-4 hours after supplementation. 2. If the rate of potassium supplementation exceeds 10 moles per hour, continuous ECG monitoring should be maintained, closely observe the changes in the ECG, and prevent the occurrence of life-threatening hyperkalemia. 3. The rate of potassium supplementation for patients with regenerative dysfunction should be 50% of that for patients with normal kidney function. 4. The daily amount of potassium supplementation should not exceed 100-200 millimoles. 5. Try not to use peripheral veins for high-concentration potassium supplementation. 6. Use sodium chloride solution to dilute potassium-containing solutions, and it is not recommended to use glucose or low molecular weight dextrorotatory sugar as the carrier.

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Written by Wei Shi Liang
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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.

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Written by Wei Shi Liang
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How to radically cure hypokalemia?

Hypokalemia must be treated with potassium supplementation while simultaneously addressing the primary condition. For mild hypokalemia, oral potassium can be given in doses of 40 to 80 mmol/day. In cases of severe hypokalemia, where blood potassium is less than 2.0 mmol/L or when life-threatening symptoms are present, intravenous potassium should be administered at a rate of 10 to 20 mmol/L per hour. Regular monitoring of blood potassium levels is necessary, especially in cases of renal dysfunction and cellular uptake impairment. For life-threatening severe hypokalemia, potassium can be administered via central venous lines with close monitoring of blood potassium levels, and the infusion rate can reach up to 40 mmol/L, which can effectively cure hypokalemia.