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Hypokalemia

Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. The condition is also known as potassium deficiency. The prefix hypo- means low (contrast with hyper-, meaning high). The middle kal refers to kalium, which is Latin for potassium. The end portion of the word, -emia, means 'in the blood' (note, however, that hypokalemia is usually indicative of a systemic potassium deficit). more...

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Signs and symptoms

There may be no symptoms at all but severe hypokalemia may cause:

  • Muscle weakness
  • Disturbed heart rhythm (arrhythmias), leading to ectopic beats
  • Serious arrhythmias
  • Increased risk of hyponatraemia with resultant confusion and seizures

Causes

Hypokalemia can result from a variety of medical conditions:

  • Perhaps most obviously, insufficient consumption of potassium (that is, a low-potassium diet) can result in the condition. More commonly, however, hypokalemia occurs due to excessive loss of potassium, often associated with excess water loss, which "flushes" potassium out of the body. Typically, this is a consequence of vomiting and diarrhea.
  • Hypomagnesemia can also cause hypokalemia. This is realized as a possibility when hypokalemia persists despite potassium supplementation.
  • Certain medications can also accelerate the removal of potassium from the body, including loop diuretics, such as furosemide or bumetanide, as well as various laxatives. The antifungal amphotericin B is also associated with hypokalemia. Often doctors and pharmacists will suggest changes in their patients' diets to compensate for the effects of medication. For instance, recommending that a patient eat a (potassium-rich) banana daily; sometimes, doctors will co-prescribe a potassium supplement when a potassium-depleting drug is prescribed.

Pathophysiology

Potassium is essential for many body functions, including muscle and nerve activity. Potassium is the principal intracellular cation, with a concentration of about 145 mEq/L, as compared with a normal value of about 4 mEq/L in extracellular fluid, including blood. More than 98% of the body's potassium is intracellular; measuring it from a blood sample is relatively insensitive, with small fluctuations in the blood corresponding to very large changes in the total bodily reservoir of potassium.

The osmotic gradient of potassium between intracellular and extracellular space is essential for nerve function; in particular, potassium is needed to repolarize the cell membrane to a resting state after an action potential has passed. Decreased potassium levels in the extracellular will cause hyperpolarization of the resting membrane potential. As a result, a greater than normal stimulus is required for depolarization of the membrane in order to initiate an action potential.

Potassium is also essential to the normal muscular function, in both voluntary muscle (e.g. the arms and hands) and involuntary muscle (e.g. the heart and intestines). Severe abnormalities in potassium levels can seriously disrupt cardiac function, even to the point of causing cardiac arrest and death.

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Understanding hypokalemia
From Nursing, 3/1/02

Incredibly Easy!

IN HYPOKALEMIA, the serum potassium level drops below 3.5 mEq/liter. Because the normal range for serum potassium is narrow (3.5 to 5.0 mEq/liter at many labs), a slight decrease has profound consequence.

How does it happen? Remember that the body can't conserve potassium, so inadequate potassium intake and excessive potassium output can upset the balance and cause hypokalemia.

What causes it?

Not enough intake: Inadequate potassium intake causes a drop in the body's overall potassium level.

Too much output: Intestinal fluids contain large amounts of potassium. Severe gastrointestinal fluid losses from suction, lavage, diarrhea, or. prolonged vomiting can deplete the body's potassium supply. Potassium also can be depleted through the kidneys by osmotic diuresis from high urine glucose levels.

Drugs can cause problems: Diuretics (especially thiazide and furosemide), corticosteroids, insulin, cisplatin, and certain antibiotics (gentamicin, carbenicillin, and amphotericin B, for instance) also cause potassium loss.

Excessive insulin secretion, whether endogenous or exogenous, may shift potassium into the cells. Potassium levels also drop when adrenergic drugs such as epinephrine and albuterol are used to treat asthma.

Diseases can wreak havoc too: Disorders associated with hypokalemia are hepatic disease, hyperaldosteronism, acute alcoholism, heart failure, and malabsorption syndrome.

What to look for

Because potassium is vital to many body functions, hypokalemia causes multisystemic signs and symptoms. Assess for the following red flags.

* Neuromuscular alerts: Skeletal muscle weakness, especially in the legs, is a sign of a moderate potassium loss. As weakness progresses, the patient develops paresthesia and leg cramps. Deep tendon reflexes may be decreased or absent and respiratory muscles can become paralyzed. Because potassium affects cell function, hypokalemia can lead to rhabdomyolysis.

* Cardiovascular alerts: The patient's pulse may be weak and irregular, and he may have orthostatic hypotension. Electrocardiograms may show a flattened T wave, a depressed ST segment, and a characteristic U wave. Arrhythmias associated with hypotension are premature ventricular contractions and ventricular tachycardia and fibrillation. Watch for hypokalemia in a patient taking digoxin, especially if he's also taking a diuretic; hypokalemia can potentiate the action of the digoxin and cause a toxic reaction.

Now hypokalemia is treated

Focus on restoring a normal potassium balance, preventing serious complications, and removing or treating the underlying causes. Treatment, which varies depending on the severity of the imbalance, may include the following interventions.

* Place the patient on a high-- potassium diet.

* If increasing dietary potassium is insufficient to treat moderate hypokalemia, provide oral potassium supplements.

* A patient who has severe hypokalemia or who can't take oral supplements may need IN. potassium replacement therapy. For more on I.V. potassium administration, see "How to Safeguard Delivery of High-Alert IN. Drugs," by Lynn Hadaway in Nursing2001's February issue (pp 36-42).

* If the patient is on a diuretic, switch to a potassium-sparing one, such as spironolactone.

How you intervene

Careful monitoring and skilled interventions can help prevent hypokalemia and spare your patient from its associated complications.

Source: Fluid, & Electrolytes Made Incredibly Easy! 2nd edition, Springhouse Corp., 2002.

TEACHING YOUR PATIENTS ABOUT HYPOKALEMIA

When you explain hypokalemia, cover these topics with your patient, then evaluate his learning.

* signs, symptoms, and complications of hypokalemia

* causes and risk factors

* prevention of future episodes

* medication, including dosages and possible adverse effects

* need for a potassium-rich diet

* warning signs and symptoms to report to the primary care provider.

Copyright Springhouse Corporation Mar 2002
Provided by ProQuest Information and Learning Company. All rights Reserved

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