eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care
Hypokalemia: Treatment & Medication
Updated: Sep 21, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- The treatment of hypokalemia depends on severity and etiology.
- Unlike hyponatremia, in which the total body sodium deficit can be readily estimated, serum potassium may not accurately reflect total body stores. Indeed, during diabetic ketoacidosis, serum potassium levels are usually initially elevated, even in the face of severe depletion of total body potassium. Correction of acidosis in diabetic ketoacidosis may cause a precipitous drop in serum potassium levels.
- Transient, asymptomatic, or mild hypokalemia may spontaneously resolve or may be treated with enteral potassium supplements.
- Symptomatic or severe hypokalemia should be corrected with a solution of intravenous potassium.
Surgical Care
- Except for excision of tumors leading to hypokalemia, management is nonsurgical.
Consultations
- After resolution, consultation with an endocrinologist, geneticist, or specialist in metabolic disease may be necessary to diagnose and manage predisposing conditions.
- Consultation with a dietitian may be helpful in cases of hypokalemia due to inadequate dietary intake.
Diet
- Dietary modification may be necessary for patients with excessive potassium losses (eg, diuretic or laxative use) or patients with hypokalemia who are at increased risk, such as those receiving digoxin.
- Avoidance of specific foods (eg, licorice) may also be necessary for high-risk individuals.
Activity
- Patients with hypokalemic periodic paralysis may need to modify exercise regimens to avoid periods of strenuous exercise.
- Patients at risk of hypokalemia from sweat losses should have adequate potassium and fluid available during activities likely to result in significant sweating and should be given anticipatory guidance regarding symptoms of hypokalemia.
Medication
Medical therapy is aimed at potassium supplementation by the enteral (ie, oral or through feeding tubes) or parenteral route. Transient, asymptomatic, or mild hypokalemia may resolve spontaneously, or it may be treated using enteral potassium supplements. Symptomatic or severe hypokalemia should be corrected with intravenous potassium preparations.
Potassium supplements
These agents are used to restore body potassium storage. Electrolytes are used to correct disturbances in fluid and electrolyte homoeostasis or acid-base balance and to reestablish osmotic equilibrium of specific ions.
Potassium chloride (also citrate, acetate, bicarbonate, gluconate)
Potassium chloride is the preferred salt for patients with preexisting alkalosis. First choice for IV therapy. Essential for transmission of nerve impulses; contraction of cardiac muscle; and maintenance of intracellular tonicity, skeletal and smooth muscles, and normal renal function. Gradual potassium depletion occurs via renal excretion, through GI loss, or because of low intake. Depletion may result from diuretic therapy, primary or secondary hyperaldosteronism, diabetic ketoacidosis, severe diarrhea, vomiting, or inadequate replacement during prolonged parenteral nutrition.
Adult
IV replacement: 10-40 mEq IV infused over 2-3 h; infusion rate not to exceed 40 mEq/h; may repeat q3-4h prn; modify infusion rate for specific requirements
PO supplementation: 50-100 mEq/d PO divided bid/tid or qd as SR formulation; larger doses may be needed in severe depletion to replenish potassium body storage
Pediatric
Usual dose for potassium replacement: 0.5-1 mEq/kg IV; not to exceed 30-40 mEq/dose
Infusion rate not to exceed 0.3-0.5 mEq/kg/h for noncritical hypokalemia; however, this rate may be inadequate in life-threatening hypokalemia
Infusion rates: >0.5 mEq/kg/h can be delivered but requires ECG monitoring to detect potentially fatal arrhythmia, especially ventricular dysrhythmia, because it can rapidly lead to cardiac arrest
PO supplementation is based on body weight, ranging from 2-4 mEq/kg/d PO in divided doses to avoid gastric distress
Coadministration with drugs that elevate potassium (eg, potassium-sparing diuretics, ACE inhibitors) may cause severe hyperkalemia; hypokalemia may result in digoxin toxicity in patients taking digoxin; caution if discontinuing potassium administration in patients taking digoxin
Undiluted IV administration; hyperkalemia, renal failure, conditions in which potassium retention is present, oliguria or azotemia, crush syndrome, severe hemolytic reactions, anuria, and adrenocortical insufficiency
Acidosis (alkaline forms of potassium such as potassium bicarbonate, citrate, acetate, or gluconate can be used in the face of metabolic acidosis)
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Do not infuse rapidly; high plasma concentrations of potassium may cause death due to cardiac depression, arrhythmias, or arrest; plasma levels do not necessarily reflect tissue levels; monitor potassium replacement therapy whenever possible by means of continuous or serial ECG; IV potassium must be diluted before administration, when a concentration >40 mEq/L is infused, local pain and phlebitis also may follow
Solid potassium supplements can produce or aggravate gastric ulcers and can produce strictures or stenotic lesions; patients with a predisposition to these lesions should use liquid formulations
GI complaints, including nausea, stomach pain, vomiting, and flatulence, are some of the more common adverse drug reactions with the PO preparations
Closely monitor potassium levels to avoid hyperkalemia
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
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
