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Pediatric Hypokalemia Workup

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

Laboratory Studies

The following studies are indicated in patients with hypokalemia:

  • Serum electrolyte tests: Screen for concurrent electrolyte abnormalities, which may affect treatment.
  • Blood gas analysis: Assess acid-base status; alkalosis may induce hypokalemia, and treatment of acidosis may worsen existing hypokalemia.
  • Drug screen (serum or urine): Amphetamines and other sympathomimetic stimulants can cause hypokalemia; other drugs that can cause hypokalemia include verapamil (with overdose), theophylline, amphotericin B, aminoglycosides, and cisplatin.
  • Serum adrenocorticotropic hormone (ACTH), cortisol, renin activity, and aldosterone tests: Evaluate for suspected Cushing, Conn, or adrenal hyperplasia syndromes, including 11-beta-hydroxylase deficiency.
  • Simultaneous serum insulin and C-peptide tests: Because hyperinsulinism can cause transient hypokalemia, elevated serum insulin without appropriately elevated C-peptide suggests exogenous insulin administration, which may represent Münchhausen-by-proxy syndrome.
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Imaging Studies

Magnetic resonance imaging

Perform brain magnetic resonance imaging (MRI) if a brain or pituitary tumor is suspected as a cause of hypercortisolism.

Ultrasonography and computed tomography scanning

Perform abdominal ultrasonography or computed tomography (CT) scanning if an adrenal tumor or hyperplasia is suspected.

Electrocardiography

Although ECG changes may be helpful if present, their absence should not be taken as reassurance of normal cardiac conduction.[12] The ECG in hypokalemia may appear normal or may have only subtle findings immediately before clinically significant dysrhythmias.

ECG findings may include the following (see the image below):

  • Ventricular dysrhythmia
  • Prolongation of QT interval
  • ST-segment depression
  • T-wave flattening
  • Appearance of U waves
    Prominent U waves after T waves in hypokalemia. Prominent U waves after T waves in hypokalemia.

During therapy, monitor for changes associated with overcorrection and hyperkalemia, including a prolonged QRS, peaked T waves, bradyarrhythmia, sinus node dysfunction, and asystole.

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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.

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Prominent U waves after T waves in hypokalemia.
 
 
 
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