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Pediatric Hypokalemia Clinical Presentation

  • Author: Michael J Verive, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Nov 11, 2015
 

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. A complete and up-to-date medication and supplement list is essential, especially if the patient is taking new medications or may have had medication substitutions.

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
  • Use of sodium bicarbonate, especially during therapeutic alkalinization (commonly used to treat salicylate and cyclic antidepressant overdoses, tumor lysis syndrome, rhabdomyolysis, etc)
  • Use of sodium polystyrene sulfonate to treat transient hyperkalemia
  • 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]
  • Sirolimus [11]
  • 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, FAAP Pediatrician, UP Health System Portage

Michael J Verive, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Society for Pediatric Sedation

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM 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, Wilderness Medical Society

Disclosure: Nothing to disclose.

References
  1. Bevacqua JE. Diabetic ketoacidosis in the pediatric ICU. Crit Care Nurs Clin North Am. 2005 Dec. 17(4):341-7, x. [Medline].

  2. Kumar PS, Deenadayalan M, Janakiraman L, Vijayakumar M. Neonatal Bartter syndrome. Indian Pediatr. 2006 Aug. 43(8):735-7. [Medline].

  3. Johns C. Glycyrrhizic acid toxicity caused by consumption of licorice candy cigars. CJEM. 2009 Jan. 11(1):94-6. [Medline].

  4. Gurakan F, Baysoy G, Wedenoja S, et al. Three cases of a rare disease, congenital chloride diarrhea, summons up the variation in the clinical course and significance of early diagnosis and adequate treatment in the prevention of intellectual disability. Turk J Pediatr. 2011 Mar-Apr. 53(2):194-8. [Medline].

  5. Patra S, Nadri G, Chowdhary H, Pemde HK, Singh V, Chandra J. Nephrogenic diabetes insipidus with idiopathic Fanconi's syndrome in a child who presented as vitamin D resistant rickets. Indian J Endocrinol Metab. 2011 Oct. 15(4):331-3. [Medline]. [Full Text].

  6. Lumpaopong A, Kaewplang P, Watanaveeradej V, Thirakhupt P, Chamnanvanakij S, Srisuwan K, et al. Electrolyte disturbances and abnormal urine analysis in children with dengue infection. Southeast Asian J Trop Med Public Health. 2010 Jan. 41(1):72-6. [Medline].

  7. Bouthoorn SH, van der Ploeg T, van Erkel NE, van der Lely N. Alcohol intoxication among Dutch adolescents: acute medical complications in the years 2000-2010. Clin Pediatr (Phila). 2011 Mar. 50(3):244-51. [Medline].

  8. Bhattacharya M, Kapoor S. Quadriplegia due to Celiac Crisis with Hypokalemia As Initial Presentation of Celiac Disease: A Case Report. J Trop Pediatr. 2011 Apr 27. [Medline].

  9. Emiroglu M. Micafungin use in children. Expert Rev Anti Infect Ther. 2011 Sep. 9(9):821-34. [Medline].

  10. Zaki SA, Lad V. Piperacillin-tazobactam-induced hypokalemia and metabolic alkalosis. Indian J Pharmacol. 2011 Sep. 43(5):609-10. [Medline]. [Full Text].

  11. Buchler M, Caillard S, Barbier S, et al. Sirolimus versus cyclosporine in kidney recipients receiving thymoglobulin, mycophenolate mofetil and a 6-month course of steroids. Am J Transplant. 2007 Nov. 7(11):2522-31. [Medline].

  12. [Guideline] Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation. 2004 Oct 26. 110(17):2721-46. [Medline].

  13. Clayton JA, Rodgers S, Blakey J, Avery A, Hall IP. Thiazide diuretic prescription and electrolyte abnormalities in primary care. Br J Clin Pharmacol. 2006 Jan. 61(1):87-95. [Medline].

  14. Dinleyici EC, Dogruel N, Acikalin MF, Tokar B, Oztelcan B, Ilhan H. An additional child case of an aldosterone-producing adenoma with an atypical presentation of peripheral paralysis due to hypokalemia. J Endocrinol Invest. 2007 Nov. 30(10):870-2. [Medline].

  15. Isbrucker RA, Burdock GA. Risk and safety assessment on the consumption of Licorice root (Glycyrrhiza sp.), its extract and powder as a food ingredient, with emphasis on the pharmacology and toxicology of glycyrrhizin. Regul Toxicol Pharmacol. 2006 Dec. 46(3):167-92. [Medline].

  16. Jospe N, Forbes G. Fluids and electrolytes--clinical aspects. Pediatr Rev. 1996 Nov. 17(11):395-403; quiz 404. [Medline].

  17. Landau D. Potassium handling in health and disease: lessons from inherited tubulopathies. Pediatr Endocrinol Rev. 2004 Dec. 2(2):203-8. [Medline].

  18. Lucas da Silva PS, Iglesias SB, Waisberg J. Hypokalemic rhabdomyolysis in a child due to amphotericin B therapy. Eur J Pediatr. Feb. 166:169-71. [Medline].

  19. Lumpaopong A, Thirakhupt P, Srisuwan K, Chulamokha Y. Rare F311L CFTR gene mutation in a child presented with recurrent electrolyte abnormalities and metabolic alkalosis: case report. J Med Assoc Thai. 2009 May. 92(5):694-8. [Medline].

  20. Mueller PL, Jaimovich DG. Endocrine and metabolic emergencies. Handbook of Pediatric and Neonatal Transport Medicine. 1996. 265-92, 492.

  21. Parr JR, Salama A, Sebire P. A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia. Eur J Pediatr. 2006 May. 165(5):323-5. [Medline].

  22. Rodriguez-Soriano J. Bartter and related syndromes: the puzzle is almost solved. Pediatr Nephrol. 1998 May. 12(4):315-27. [Medline].

  23. Rose BD. Introduction to disorders of potassium balance. Clinical Physiology of Acid-Base and Electrolyte Disorders. 1989. 715-56.

  24. Wiseman K. Index of suspicion. Case 3. Familial periodic paralysis. Pediatr Rev. 1997 Oct. 18(10):357, 359-60. [Medline].

  25. Wood EG, Lynch RE. Fluid and Electrolyte Balance. 1998. 703-22.

  26. Kumar R, Kumar P, Aneja S, Kumar V, Rehan HS. Safety and efficacy of low-osmolarity ORS vs. modified rehydration solution for malnourished children for treatment of children with severe acute malnutrition and diarrhea: a randomized controlled trial. J Trop Pediatr. 2015 Aug 27. [Medline].

  27. Seyberth HW. Pathophysiology and clinical presentations of salt-losing tubulopathies. Pediatr Nephrol. 2015 Jul 16. [Medline].

  28. Hartman S, Merkus P, Maseland M, Roovers L, van Setten P. Hypokalaemia in children with asthma treated with nebulised salbutamol. Arch Dis Child. 2015 Oct. 100(10):970-2. [Medline].

 
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