How to treat hypokalemia?

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 18, 2024
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After the occurrence of hypokalemia, there are generally two methods of potassium supplementation clinically. The first is oral potassium supplementation, which is relatively safe, and one can also eat fruits or vegetables rich in potassium. The second method is intravenous potassium supplementation. The first thing to note with intravenous supplementation is the patient's urination status. If the patient’s urination is normal, potassium chloride can be administered intravenously but must be diluted. In clinical practice, the concentration of intravenous potassium chloride generally does not exceed 0.3%, so we must pay attention to the concentration during potassium supplementation.

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Written by Wei Shi Liang
Intensive Care Unit
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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 Gan Jun
Endocrinology
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What should I do if hypokalemia suddenly occurs?

Hypokalemia is very common in clinical settings, generally caused by improper diet, insufficient supplementation, or excessive loss. It is recommended that patients first seek further examination at a hospital. If potassium deficiency is confirmed, mild cases can be treated with oral potassium supplements, while moderate to severe cases who experience muscle weakness, flaccid paralysis, and arrhythmias should receive intravenous potassium supplementation in conjunction with oral treatment. It is also important to dynamically monitor electrolyte levels. In daily life, it is important to plan a diet that is rich in vitamins and trace elements, and treat the specific causes of the condition. It is recommended that patients continually monitor their fluid and electrolyte balance, abstain from smoking and limit alcohol consumption, and maintain good daily habits.

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Written by Gan Jun
Endocrinology
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What are the symptoms of hypokalemia?

When the body's blood potassium level falls below 3.5 millimoles per liter, it is called hypokalemia. Hypokalemia can cause adverse symptoms in multiple systems of the body, initially causing weakness and fatigue in the limbs, flaccid paralysis, sluggish and absent tendon reflexes, and in severe cases, respiratory difficulty. At the same time, hypokalemia can lead to a series of central nervous system damages, such as apathy, a blank stare, drowsiness, and confusion; it also causes nausea, poor appetite, abdominal distension, and intestinal paralysis among other adverse gastrointestinal phenomena. Additionally, it can lead to palpitations, and rapid atrial or ventricular arrhythmias, among other adverse phenomena. Therefore, it is crucial to provide timely and proper potassium supplementation and correction of blood potassium levels for patients with hypokalemia.

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Written by Gan Jun
Endocrinology
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Patients with hypokalemia can have what kind of urine?

When patients have hypokalemia, they often exhibit paradoxical aciduria, which is a typical manifestation of hypokalemia. In hyperkalemia, however, there is paradoxical alkaline urine. When serum potassium ions decrease, the renal tubular epithelium reduces its potassium excretion function and instead increases hydrogen excretion, leading to increased reabsorption of sodium and bicarbonate. This results in metabolic alkalosis, causing an increase in plasma bicarbonate, unlike typical alkalosis where alkaline urine is excreted. However, in the case of hypokalemia, acidic urine is excreted, hence it is called paradoxical aciduria.

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Written by Wei Shi Liang
Intensive Care Unit
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Causes and Clinical Manifestations of Hypokalemia

Hypokalemia refers to a condition where blood potassium levels are below 3.5mmol/L. The causes can be due to inadequate intake of potassium, such as prolonged inability to eat without sufficient intravenous supplementation of potassium. It can also result from excessive loss of potassium, through external losses such as vomiting and diarrhea, or through renal losses due to the excessive use of diuretics and certain hormonal imbalances. A third cause involves the shift of potassium into cells, such as during episodes of alkalemia and periodic paralysis. Clinically, mild to moderate hypokalemia is characterized by symptoms like muscle weakness, fatigue, cramps, intestinal obstruction, and some abnormalities in electrocardiograms, including the presence of U waves and flattened T waves. Severe hypokalemia can lead to life-threatening arrhythmias, such as ventricular tachycardia and ventricular fibrillation, which require immediate treatment.