What are the symptoms of hypokalemia?

Written by Gan Jun
Endocrinology
Updated on March 07, 2025
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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 Wang Li Bing
Intensive Care Medicine Department
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How to treat hypokalemia?

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 Wang Li Bing
Intensive Care Medicine Department
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The earliest clinical manifestations of hypokalemia

Hypokalemia is also relatively common in clinical settings. If the blood potassium level falls below 3.5 mmol, it indicates that the patient has hypokalemia. Clinically, this can affect related systems. For instance, patients may experience general weakness, nausea, vomiting, loss of appetite, and even disorientation. If the patient remains hypokalemic for an extended period, it can lead to arrhythmias, such as premature atrial and ventricular contractions. Once hypokalemia occurs, it must be actively managed by correcting the low potassium levels. Clinically, this can be done by administering potassium chloride sustained-release tablets via nasogastric feeding, as well as consuming potassium-rich vegetables and fruits.

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Written by Wei Shi Liang
Intensive Care Unit
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Why does hypokalemia cause alkalosis?

Hypokalemia can cause metabolic alkalosis because it leads to the intracellular movement of hydrogen ions. In hypokalemia, potassium shifts from the inside to the outside of the cell to compensate for the decreased serum potassium. As an exchange, hydrogen ions from the gastric fluid move into the cells, causing cellular alkalosis and intracellular acidosis. Additionally, due to potassium deficiency in the renal tubular epithelial cells, the potassium-sodium exchange decreases and the sodium-hydrogen exchange increases, leading to enhanced excretion of hydrogen ions and increased reabsorption of bicarbonate ions, resulting in hypokalemia-induced metabolic alkalosis, which needs to be promptly addressed clinically.

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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 Wei Shi Liang
Intensive Care Unit
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How many days does hypokalemia need to be treated?

In the extracellular fluid of human cells, the concentration of potassium in the blood is 3.5 to 5.5 millimoles per liter. If the potassium level falls below 3.5 millimoles per liter, it is considered hypokalemia. The main causes of hypokalemia are insufficient intake and excessive excretion. The treatment duration for hypokalemia caused by different primary diseases varies. For mild hypokalemia, oral potassium supplements alone can correct the condition, but this generally takes about three to five days. For severe hypokalemia, intravenous potassium should be administered as soon as possible, preferably through a central venous line for fluid administration. At this time, the focus is on treating the underlying disease and timely supplementation of potassium ions. The duration of treatment may be relatively longer, and it is not possible to determine a specific timeframe.