eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hypokalemia: Follow-up

Author: David Garth, MD, Attending Physician, Department of Emergency Medicine, Mary Washington Hospital
Contributor Information and Disclosures

Updated: Jul 31, 2009

Follow-up

Further Inpatient Care

  • Continue intravenous replacement of potassium as needed.
  • Continue cardiac monitoring in severe hypokalemia.
  • Repeat potassium level measurement every 1-3 hours.
  • Identify the etiology of the hypokalemia.

Further Outpatient Care

  • Repeat potassium level in 2-3 days.

Inpatient & Outpatient Medications

  • Consider switching to potassium-sparing diuretic if diuretic therapy is needed.
  • Take 40 mEq KCI daily for 2-3 days and repeat the potassium level.

Transfer

  • Patients should be transferred only after any cardiac arrhythmias have been treated and the condition has been stabilized.
  • Depending on the level of hypokalemia, an advanced cardiac life support (ACLS) ambulance should be used to allow continuous cardiac monitoring during transport.

Complications

  • Replacing potassium too quickly can cause a rapid rise in the blood potassium level, leading to a relative hyperkalemia with subsequent cardiac complications.
  • If hypokalemia is not corrected easily with replacement therapy, search for other coexistent metabolic abnormalities (eg, hypomagnesemia). Hypokalemia may be refractory to treatment until hypomagnesemia is corrected.
  • Hypokalemia can potentiate digitalis toxicity in patients who are taking digoxin.

Prognosis

  • Hypokalemia usually resolves with appropriate therapy.

Patient Education

  • Diet modification is recommended for those patients who are predisposed to hypokalemia. Increase intake of bananas, tomatoes, oranges, and peaches because they are high in potassium.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Low Potassium.

Miscellaneous

Medicolegal Pitfalls

  • If potassium is replaced too quickly, the rapid rise of the serum potassium level can induce symptomatic hyperkalemia; however, the total body reserves of potassium might still be less than normal.
  • Failure to monitor and repeat potassium levels during replacement therapy
  • Failure to recognize and correct other coexistent metabolic disorders (eg, hypomagnesemia)

Special Concerns

  • Do not overcorrect potassium in patients with periodic hypokalemic paralysis. This condition is a transcellular maldistribution, not a true deficit.
  • Diuretic therapy, diarrhea, and chronic laxative abuse are the most common causes of hypokalemia in elderly patients.
  • In patients with hypokalemia and diabetic ketoacidosis, part of the serum potassium should be administered as potassium phosphate.
 
Acknowledgments

I would like to thank my wife, Mary, for allowing me the time to work on this article.



More on Hypokalemia

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References
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Further Reading

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Keywords

hypokalemia, low potassium, potassium level less than 3.5 mEq/L, potassium homeostasis, palpitations, skeletal muscle weakness, cramping, paralysis, paresthesias, abdominal cramping, ventricular arrhythmias, premature atrial beats, premature ventricular beats, respiratory distress, hypoventilation, respiratory failure, lethargy, fasciculations, tetany, hyperaldosteronism, magnesium depletion, ileal loop, diuretics, alkalosis, decreased tendon reflexes, cushingoid appearance

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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 and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard A Bessen, MD, Professor of Medicine, Department of Emergency Medicine, UCLA 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.

CME Editor

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, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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