Hypokalemia in Emergency Medicine Clinical Presentation

  • Author: David Garth, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 25, 2012
 

History

The history may be vague. Patients are often asymptomatic, particularly with mild hypokalemia. Symptoms are often due to the underlying cause of the hypokalemia rather than the hypokalemia itself. Hypokalemia should be suggested by a constellation of symptoms that involve the GI, renal, musculoskeletal, cardiac, and nervous systems. The patient's medications should be reviewed to ascertain whether any of them could cause hypokalemia.

Common symptoms include the following:

  • Palpitations
  • Skeletal muscle weakness or cramping
  • Paralysis, paresthesias
  • Constipation[4]
  • Nausea or vomiting
  • Abdominal cramping
  • Polyuria, nocturia, or polydipsia
  • Psychosis, delirium, or hallucinations
  • Depression
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Physical

Findings that are consistent with severe hypokalemia may include the following:

  • Signs of ileus
  • Hypotension
  • Ventricular arrhythmias[5]
  • Cardiac arrest
  • Bradycardia or tachycardia
  • Premature atrial or ventricular beats
  • Hypoventilation, respiratory distress
  • Respiratory failure
  • Lethargy or other mental status changes
  • Decreased muscle strength, fasciculations, or tetany
  • Decreased tendon reflexes
  • Cushingoid appearance (eg, edema)
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Causes

  • Renal losses
    • Renal tubular acidosis
    • Hyperaldosteronism
    • Magnesium depletion
    • Leukemia (mechanism uncertain)
  • GI losses (source may be medical or psychiatric[6] , ie, anorexia or bulimia)
    • Vomiting or nasogastric suctioning
    • Diarrhea
    • Enemas or laxative use
    • Ileal loop
  • Medication effects
    • Diuretics (most common cause)
    • Beta-adrenergic agonists
    • Steroids
    • Theophylline
    • Aminoglycosides
  • Transcellular shift
    • Insulin
    • Alkalosis
  • Malnutrition or decreased dietary intake, parenteral nutrition
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Contributor Information and Disclosures
Author

David Garth, MD  Attending Physician, Department of Emergency Medicine, Mary Washington Hospital

David Garth, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

I would like to thank my wife, Mary. Her patience, love, and reassurance, are my bedrock.

References

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Prominent U waves after T waves in hypokalemia.
 
 
 
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