Pediatric Hypokalemia Clinical Presentation

  • Author: Michael J Verive, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 14, 2011
 

History

  • Hypokalemia due to excessive loss is usually accompanied by a history of GI loss (emesis or diarrhea), urinary output, or sweating. This may be exacerbated by inadequate oral intake.
  • Query about current or recent treatment with medications and herbal products (especially natural licorice), including insulin, albuterol or other beta2-sympathomimetics, corticosteroids, diuretics, laxatives, enemas, or bowel-prep solutions.
  • The patient may have had similar episodes in the past. Familial historical data may include surgery for pituitary or adrenal tumors or acute intermittent episodes of paralysis, with or without association with hyperthyroidism.
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Physical

  • Physical examination findings may frequently be within the reference range. Occasionally, muscle weakness is evident.
  • Cardiac arrhythmias and acute respiratory failure from muscle paralysis are life-threatening complications that require immediate diagnosis.
  • Cardiovascular examination findings may also be within normal limits. Occasionally, tachycardia with irregular beats may be heard. Severe hypokalemia may manifest as bradycardia with cardiovascular collapse.
  • Hypoactive bowel sounds may suggest hypokalemic gastric hypomotility or ileus.
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Causes

  • Hypokalemia may be due to a total body deficit of potassium, which may occur chronically with the following:
    • Prolonged diuretic use
    • Inadequate potassium intake
    • Laxative use
    • Diarrhea (including congenital chloride diarrhea)[4]
    • Hyperhidrosis
    • Hypomagnesemia
    • Renal tubular losses (including Fanconi syndrome,[5] Bartter syndrome, Gitelman syndrome, and others)
    • Dengue syndrome[6]
  • Acute causes of potassium depletion include the following:
    • Diabetic ketoacidosis
    • Severe GI losses from vomiting and diarrhea
    • Dialysis and diuretic therapy
    • Alcohol intoxication/overdose[7]
  • Hypokalemia may also be due to excessive potassium shifts from the extracellular to the intracellular space, as seen with the following:
    • Alkalosis
    • Insulin use
    • Catecholamine use
    • Sympathomimetic use
    • Hypothermia
  • Other recognizable causes of hypokalemia include the following:
    • Renal tubular disorders, such as Bartter syndrome and Gitelman syndrome
    • Type I or classic distal tubular acidosis
    • Periodic hypokalemic paralysis
    • Hyperaldosteronism
    • Celiac disease[8]
  • Other states of mineralocorticoid excess that may cause hypokalemia include the following:
    • Cystic fibrosis with hyperaldosteronism from severe chloride and volume depletion
    • Cushing syndrome
    • Exogenous steroid administration, including fludrocortisone and other mineralocorticoids
    • Excessive licorice consumption[3]
  • Other conditions that may cause hypokalemia include acute myelogenous, monomyeloblastic, or lymphoblastic leukemia.
  • Drugs that may commonly cause hypokalemia include the following:
    • Furosemide, bumetanide, and other loop diuretics
    • Methylxanthines (theophylline, aminophylline, caffeine)
    • Verapamil (with overdose)
    • Amphotericin B, micafungin[9]
    • Quetiapine (particularly in overdose)
    • Ampicillin, carbenicillin, high-dose penicillins[10]
    • Drugs associated with magnesium depletion, such as aminoglycosides, amphotericin B, and cisplatin
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Contributor Information and Disclosures
Author

Michael J Verive, MD  Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children

Michael J Verive, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, Pediatric Sedation, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD  FCCM, Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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Prominent U waves after T waves in hypokalemia.
 
 
 
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