para>May need to correct magnesium depletion
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
- Patients receiving IV therapy should have cardiac monitoring and serum potassium level checked frequently (q4-6h).
- Patients requiring potassium supplements should have serum potassium studied at intervals and magnesium level dictated by clinical judgment and patient compliance (5)[C].
DIET
In patients with mild hypokalemia (potassium, 3.0 to 3.5 mEq/L [3.0 to 3.5 mmol/L]) not caused by GI losses, dietary supplementation may be sufficient; potassium-rich foods include oranges, bananas, cantaloupes, prunes, raisins, dried beans, dried apricots, and squash.
PATIENT EDUCATION
- Instructions for appropriate diet
- If potassium supplementation is necessary, stress the need for compliance.
PROGNOSIS
- Associated with higher morbidity and mortality because of cardiac arrhythmias
- Ease of correction of hypokalemia and need for prolonged treatment rest on the primary cause; if it can be eliminated (e.g., resolution of diarrhea, discontinuation of diuretics, removal of adrenal tumor), hypokalemia can be expected to resolve and no further treatment is indicated.
COMPLICATIONS
- Hyperkalemia can occur during the course of treatment.
- Increased risk of digoxin toxicity
- Increased risk of atrial fibrillation (2,3)[B]
REFERENCES
11 Hanlon JT, Semla TP, Schmader KE. Medication misadventures in older adults: literature from 2013. J Am Geriatr Soc. 2014;62(10):1950-1953.22 Krijthe BP, Heeringa J, Kors JA, et al. Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol. 2013;168(6):5411-5415.33 Tran CT, Bundgaard H, Ladefoged SD, et al. Potassium dynamics are attenuated in hyperkalemia and a determinant of QT adaptation in exercising hemodialysis patients. J Appl Physiol (1985). 2013;115(4):498-504.44 Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2014;38(10):2664-2677.55 Unwin RJ, Luft FC, Shirley DG. Pathophysiology and management of hypokalemia: a clinical perspective. Nat Rev Nephrol. 2011;7(2):75-84.
ADDITIONAL READING
- Arsenault KA, Yusuf AM, Crystal E, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013;(1):CD003611.
- Asmar A, Mohandas R, Wingo CS. A physiologic-based approach to the treatment of a patient with hypokalemia. Am J Kidney Dis. 2012;60(3):492-497.
- Ben Salem C, Hmouda H, Bouraoui K. Drug-induced hypokalaemia. Curr Drug Saf. 2009;4(1):55-61.
- Chan KE, Lazarus JM, Hakim RM. Digoxin associates with mortality in ESRD. J Am Soc Nephrol. 2010;21(9):1550-1559.
- Ernst ME, Moser M. Use of diuretics in patients with hypertension. N Engl J Med. 2009;361(22):2153-2164.
- Facchini M, Sala L, Malfatto G, et al. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol. 2006;106(2):170-176.
- Jones E. Hypokalemia. N Engl J Med. 2004;350(11):1156.
- Osadchii OE. Mechanisms of hypokalemia-induced ventricular arrhythmogenicity. Fundam Clin Pharmacol. 2010;24(5):547-559.
- Palmer BF. A physiologic-based approach to the evaluation of a patient with hypokalemia. Am J Kidney Dis. 2010;56(6):1184-1190.
- Zietse R, Zoutendijk R, Hoorn EJ. Fluid, electrolyte and acid-base disorders associated with antibiotic therapy. Nat Rev Nephrol. 2009;5(4):193-202.
SEE ALSO
- Hyperkalemia
- Algorithm: Hypokalemia
CODES
ICD10
E87.6 Hypokalemia
ICD9
276.8 Hypopotassemia
SNOMED
- 43339004 hypokalemia (disorder)
- 22774003 Hypokalemic alkalosis (disorder)
- 237851007 Hypokalemic acidosis (disorder)
- 237853005 Drug-induced hypokalemia (disorder)
CLINICAL PEARLS
- In patients without heart disease, a low potassium level will rarely cause cardiac disturbances. In an otherwise healthy patient, gentle repletion using oral potassium or an increase in potassium-rich foods should be adequate.
- In patients with cardiac ischemia, heart failure, or left ventricular hypertrophy, even mild to moderate hypokalemia can cause arrhythmias. These patients should receive potassium repletion as well as cardiac monitoring.
- To safely prevent hypokalemia in diabetic and renal insufficiency patients, ensure adequate dietary potassium intake with foods rich in potassium, including spinach, tomatoes, broccoli, squash, potatoes, bananas, cantaloupe, and oranges. Avoid potassium-sparing diuretics, if possible.
- Uncorrected hypomagnesemia can hinder the correction of hypokalemia. Check magnesium levels and replete as necessary.