Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. In addition, a manual search of key journals and abstracts from the major. The ecg shows a wide qrs complex merging with the peaked t wave. Pathophysiology of vomitinginduced hypokalemia and diagnostic approach.
Hypokalemia and hyperkalemia have been estimated to occur in about 21% and 3% of hospitalized. Jan 28, 2011 hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. Therapeutic approach to hypokalemia request pdf researchgate. The goals of hypokalemia management are to prevent the development of life threatening consequences, to identify the definitive cause of hypokalemia, and to correct any potassium deficit while avoiding hyperkalemia. Hypokalemia report free download as powerpoint presentation. Diuretic use and gastrointestinal losses are common. Lifethreatening electrolyte abnormalities aha journals. For successful potassium replacement, one should consider the optimal potassium preparation, route of administration, and the appropriate speed of administration. Familial periodic paralysis, andersens syndrome, congenital chloridelosing diarrhea, and cystic fibrosis are genetic causes of hypokalemia with low urine k. The etiology of hypokalemia can be quite difficult to diagnose. A methodological approach is warranted to manage this problem. Practical algorithms for the optimal diagnostic, treatment and followup strategy are presented, while an individualized approach is emphasized.
An accurate diagnosis will help determine the molecular. He also denied use of over the counter medications or supplements. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Hypokalaemia is defined as a serum potassium of less than 3. Hypokalemia is when bloods potassium levels are too low. Absorption of mealderived glucose stimulates insulin secretion with a consequent insulindriven potassium uptake in muscle. Hypokalemia is generally defined as a serum potassium level of less than 3.
By far the most common causes of hypokalemia are potassium losses caused by diuretics or gastrointestinal disorders. A case of medicationinduced hypokalemia recently seen at our hospital is described below. Approach to hyponatremia authorstream presentation. Diagnosis of hypokalemia world health organization. These abnormalities might be subtle requiring minimal intervention or lifethreatening requiring urgent measures. Hypokalemia can also occur when there is an intracellular shift of the potassium in the body, which stops the correct transmission of potassium between cells.
Cardiac effects of hypokalemia are usually minimal until serum potassium concentrations are hypokalemia causes sagging of the st segment, depression of the t wave, and elevation of the u wave. To illustrate these principles, we discuss our approach to a patient with chronic hypokalemia and hypertension. Clinical features associated with hypokalaemia include abnormalities of cardiovascular, neurological and metabolic function and may be treated with oral. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. The earliest electrocardiogram ecg change associated with hypokalemia is a decrease in the twave amplitude. Case report a 58yearold female presented to the emergency department with a chief complaint of ongoing fatigue and weakness. Request pdf therapeutic approach to hypokalemia for successful potassium replacement, one should consider the optimal potassium preparation, route of. Apr 29, 2014 approach to hypokalemia ranjita pallavi internal medicine pgy2 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypokalemia and hyperkalemia are common electrolyte disorders caused by. With marked hypokalemia, the t wave becomes progressively smaller and the u wave becomes increasingly larger. Wasd abc of intravenous fluids, electrolyte disorders and aki management in adults management of hypokalaemia 5 hypokalaemia hok is a serum potassium concentration sk,3. Transcellular shifts maintenance of potassium in icf is achieved by the action of the 3na2k atpase pump present on cell membranes pumps 3na out for 2k in contributes to generation of resting membrane potential increased activity results in shift of potassium into the cell hypokalaemia. A physiologicbased approach to the treatment of a patient.
Diagnosis of hypokalemia a problemsolving approach to clinical cases farahnak assadi in situations where the cause of hypokalemia is not obvious, measurement of urinary potassium excretion and blood pressure and assessment of acidbase balance are often helpful. A random urine potassiumcreatinine ratio kc less than 1. Diagnostic approach to hypokalemia due to renal loss with metabolic alkalosis approach to hypokalemia. Drugs, diarrhea, kidney disease, endocrine diseases and many others are potential culprits. Hypokalemia is the likely cause of these find ings. If you continue browsing the site, you agree to the use of cookies on this website. The evaluation and treatment of hypokalemia are discussed separately. Dec 09, 20 the clinical manifestations, etiologies, diagnostic evaluation, and treatment of hypokalemia, including states of mineralocorticoid excess. Dec 06, 2018 for example, if an individual presents with nausea, vomiting, and hypokalemia, the physician might understandably attribute the hypokalemia to the nausea and vomiting.
A more practical approach is calculation of the urine potassium to creatinine ratio from a spot urine specimen. Disorder of potassium balanceboth hypo and hyperkalemiais a common finding in the icu. However, if after replenishment the patient once again develops hypokalemia without nausea and vomiting, then considering other possible causes of hypokalemia is necessary. Dec 06, 2018 hypokalemia is defined as a condition in which the serum potassium level is less than 3. Hypokalemia is treated with oral or intravenous potassium. Males and females are affected equally, although some studies suggest females are affected more by diureticinduced hypokalemia. In some cases, however, the diagnosis is not readily apparent. Introduction hypokalemia is a common clinical problem, the cause of which can usually be determined from the history as with diuretic use, vomiting, or diarrhea. Symptoms depend on degree and duration of hypokalemia. Since then, he has been receiving potassium supplement, but his serum potassium has remained low or low normal. Pdf pathophysiology of vomitinginduced hypokalemia and. Rate of change since previous sample falls are of increasing significance as they approach 0. Jan 23, 2017 a blood result indicating hypokalaemia is a reasonably common problem in general practice. In the absence of hypertension, coexistent metabolic alkalosis is consistent with surreptitious vomiting, diuretic.
A 20yearold woman with fatigue and palpitations cleveland. Definition hypokalemia is defined as a persistently low levels of serum potassium lower than 3. Hypokalemia affects more than 20% of hospitalized patients. Hypokalemia endocrine and metabolic disorders merck. Hypokalemia occurs when your body loses too much potassium or does not absorb enough from food. To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. A more practical approach is calculation of the urine potassiumtocreatinine ratio from a. Patients are often asymptomatic, particularly with mild hypokalemia.
Algorithm for the approach to hypokalemia with a high u openi. The normal ratio of around 30 of the intracellular ki over the extracellular ke potassium concentration is increased. In most cases, the cause of hypokalemia is apparent from the history and physical examination. Severe hypokalemia is defined as a level less than 2. Types of hyponatremia hypovolumic hyoponatremialowtotal body h20, decreased total body na hypovolumiamost common minerlocortoid deficiency diuretics hypervolumic hyponatremia increased total body h20,total body na normalincrease but can have decrease ecv renal failure chf nephrotic syndrome cirrhosis. To prevent cardiac conduction dis turbances, intravenous calcium is administered to patients with. Algorithm of the diagnostic approach to a patient with hypokalemia. Sep 15, 2015 hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. She had noticed a gradual increase in symptoms over the past two weeks. This is also an opportunity to teach the general lesson that internal medicine is much more like a game of chess, where every move has to be contemplated with respect to its consequences several moves clinical teaching scripts for inpatient medicine jeff wiese, md. Feb 03, 2020 hypokalemia is a low level of potassium in your blood. He denied vomiting, diarrhea, palpitation, tremor or excessive sweating. Potassium helps control how your muscles, heart, and digestive system work.
Ppt hypokalemia powerpoint presentation free to download. As a matter of fact, many organ systems are involved in the regulation of potassium level and any derangement to their normal function can cause hypokalemia. A practical and pathophysiologic approach to hypokalemia. See evaluation of the adult patient with hypokalemia and clinical manifestations and treatment of hypokalemia in adults.
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