eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care

Hypokalemia: Follow-up

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

Updated: Sep 21, 2009

Follow-up

Further Inpatient Care

  • After the initial phase of hypokalemia therapy is completed, focus further inpatient care on matching potassium intake to losses, periodic testing of serum potassium levels, and electrocardiographic monitoring for hypokalemia or hyperkalemia due to therapy.
  • Alleviation of aggravating conditions, simplification of medication administration, and patient education form the basis of ongoing patient health and safety.

Further Outpatient Care

  • If the condition is expected to persist beyond inpatient care, patients should receive follow-up medical care for home treatment.
  • Additional medical follow-up must be obtained for associated medical conditions.

Inpatient & Outpatient Medications

  • Other than potassium supplementation as described above, no additional medications are required.
  • If current medications are responsible for hypokalemia, substitution of potassium-sparing alternatives may help reduce degree of hypokalemia and may help minimize requirements for potassium supplementation. 

Transfer

  • Patients with severe or symptomatic hypokalemia require transfer to an ICU for intravenous potassium supplementation and continuous electrocardiographic monitoring.

Deterrence/Prevention

  • Because many medications (particularly loop diuretics, mineralocorticoids, catecholamines, methylxanthines, alkalinizing agents) may be responsible for hypokalemia, eliminating or reducing the doses of these medications may be helpful in preventing or minimizing hypokalemia.

Complications

  • Hyperkalemia due to excessive/rapid potassium replacement
  • Cardiac dysrhythmia
  • Gastric erosions
  • Strictures

Prognosis

  • With adequate control of potassium levels and resolution of any predisposing condition, prognosis is excellent.

Patient Education

  • Patients should be educated in terms of predisposing conditions. The importance and risks involved with potassium supplementation and the warning signs of hypokalemia or overtreatment must be emphasized upon discharge from the hospital.
  • Knowledge of cardiopulmonary resuscitation and education on timely access to emergency medical services may prevent morbidity or mortality.
  • Ongoing communication is essential for reducing the risks and in therapy, especially in patients with chronic conditions associated with hypokalemia.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Low Potassium.

Miscellaneous

Medicolegal Pitfalls

  • Failure to adequately communicate the risks of treatment
  • Failure to appropriately monitor patients receiving potassium supplementation for complications, especially patients with renal failure or patients receiving potassium-sparing diuretics or angiotensin-converting enzyme inhibitors
  • Failure to follow serum potassium and other electrolyte concentrations during or after therapy
  • Treating a patient on the basis of a low serum potassium value that is false because of a sampling or laboratory error (or failing to treat a patient with symptoms of actual hypokalemia because of an elevated serum potassium value that is false because of a sampling or laboratory error)
 


More on Hypokalemia

Overview: Hypokalemia
Differential Diagnoses & Workup: Hypokalemia
Treatment & Medication: Hypokalemia
Follow-up: Hypokalemia
Multimedia: Hypokalemia
References
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References

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Further Reading

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Keywords

hypokalemia, potassium deficiency, vomiting, dialysis, diarrhea, diuretics, alkalosis, insulin, catecholamines, sympathomimetics, hypothermia, renal tube disorders, distal renal tubular acidosis, Bartter syndrome, Gitelman syndrome, periodic hypokalemic paralysis, hyperthyroidism, beta2-adrenergic agents, hyperaldosteronism, cystic fibrosis, Cushing syndrome, exogenous steroid administration, GI hypomotility, GI ileus, cardiac dysrhythmia, QT prolongation, muscle weakness, muscle cramping, hypomagnesemia, hyperhidrosis, diabetic ketoacidosis, acute myelogenous leukemia, monomyeloblastic leukemia, lymphoblastic leukemia

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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, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
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.

 
 
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