Hypokalemia in Emergency Medicine Treatment & Management

  • Author: David Garth, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 2, 2010
 

Prehospital Care

  • Be attentive to the ABCs.
  • If the patient is severely bradycardic or manifesting cardiac arrhythmias, appropriate pharmacologic therapy or cardiac pacing should be considered.
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Emergency Department Care

  • Patients in whom severe hypokalemia is suspected should be placed on a cardiac monitor; establish intravenous access and assess respiratory status.
  • Direct potassium replacement therapy by the symptomatology and the potassium level. Begin therapy after laboratory confirmation of the diagnosis.
  • Patients who have mild or moderate hypokalemia (potassium level of 2.5-3.5 mEq/L) are usually asymptomatic; if these patients have only minor symptoms, they may need only oral potassium replacement therapy. Patients with mild hypokalemia whose underlying cause of hypokalemia can be corrected may not need any potassium replacement, such as those with vomiting successfully treated with antiemetics. If cardiac arrhythmias or significant symptoms are present, then more aggressive therapy is warranted. This treatment is similar to the treatment of severe hypokalemia.
  • If the potassium level is less than 2.5 mEq/L, intravenous potassium should be given. Admission or ED observation is indicated; replacement therapy takes more than a few hours.
  • The serum potassium level is difficult to replenish if the serum magnesium level is also low. Look to replace both.
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Consultations

An internist or a nephrologist should be consulted for admission or follow-up care.

Consider psychiatric consultation in laxative abuse, anorexia, or bulimia cases.[9]

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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.

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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