Hypokalemia in Emergency Medicine Clinical Presentation

Updated: Oct 11, 2018
  • Author: David Garth, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The history may be vague. Patients are often asymptomatic, particularly with mild hypokalemia. Symptoms are often due to the underlying cause of the hypokalemia rather than the hypokalemia itself. Hypokalemia should be suggested by a constellation of symptoms that involve the GI, renal, musculoskeletal, cardiac, and nervous systems. The patient's medications should be reviewed to ascertain whether any of them could cause hypokalemia.

Common symptoms include the following:

  • Palpitations

  • Skeletal muscle weakness or cramping

  • Paralysis, paresthesias

  • Constipation [9]

  • Nausea or vomiting

  • Abdominal cramping

  • Polyuria, nocturia, or polydipsia

  • Psychosis, delirium, or hallucinations

  • Depression



Findings that are consistent with severe hypokalemia may include the following:

  • Signs of ileus

  • Hypotension

  • Ventricular arrhythmias [10]

  • Cardiac arrest

  • Bradycardia or tachycardia

  • Premature atrial or ventricular beats

  • Hypoventilation, respiratory distress

  • Respiratory failure

  • Lethargy or other mental status changes

  • Decreased muscle strength, fasciculations, or tetany

  • Decreased or absent tendon reflexes

  • Cushingoid appearance (eg, edema)



Causes include the following:

  • Renal losses

    • Renal tubular acidosis

    • Hyperaldosteronism

    • Magnesium depletion

    • Leukemia (mechanism uncertain)

  • GI losses (source may be medical or psychiatric, ie, anorexia or bulimia)

    • Vomiting or nasogastric suctioning

    • Diarrhea

    • Enemas or laxative use

    • Ileal loop

  • Medication effects

    • Diuretics (most common cause)

    • Beta-adrenergic agonists

    • Steroids

    • Theophylline

    • Aminoglycosides

  • Transcellular shift

    • Insulin

    • Alkalosis

  • Malnutrition or decreased dietary intake, parenteral nutrition