Pediatric Hypokalemia Treatment & Management

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

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.
  • Treatment of hypokalemia should be directed at the etiology of hypokalemia as well as its correction, as treatment of hypokalemia carries with it a significant risk of iatrogenic hyperkalemia.
  • 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.
  • Whenever practical, treatment of hypokalemia should be performed in a monitored setting with medications and personnel available to intervene in the event that treatment results in symptomatic hyperkalemia.
Next

Surgical Care

  • Except for excision of tumors leading to hypokalemia, management is nonsurgical.
Previous
Next

Consultations

  • After resolution, consultation with subspecialists (including, but not limited to, endocrinologist, nephrologist, pulmonologist, gastroenterologist, 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.
  • Consultation with mental health professionals may be necessary for ongoing treatment of hypokalemia secondary to anorexia and/or bulimia.
Previous
Next

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.
Previous
Next

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

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

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

  4. Gürakan F, Baysoy G, Wedenoja S, Uslu N, Ozen H, Ozaltin F, 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. Mar-Apr 2011;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. Oct 2011;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. Jan 2010;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). Mar 2011;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. Apr 27 2011;[Medline].

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

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

  11. [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. Oct 26 2004;110(17):2721-46. [Medline].

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

  13. 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. Nov 2007;30(10):870-2. [Medline].

  14. 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. Dec 2006;46(3):167-92. [Medline].

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

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

  17. Lucas da Silva PS, Iglesias SB, Waisberg J. Hypokalemic rhabdomyolysis in a child due to amphotericin B therapy. Eur J Pediatr. 2007;166:169-71. [Medline].

  18. 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. May 2009;92(5):694-8. [Medline].

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

  20. 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. May 2006;165(5):323-5. [Medline].

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

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

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

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

Previous
Next
 
Prominent U waves after T waves in hypokalemia.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.