Hypokalemia resident survival guide: Difference between revisions
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{{Family tree | | | E01 | | | | | | | | | | E02 | E01= '''Check the acid/base status'''| E02= <div style="float: left; text-align: left; width: 12em; padding:1em;">Possible etiologies are: <br> [[Primary aldosteronism]] <br> [[Secondary aldosteronism]] <br> Non aldosterone increase in [[mineralcorticoid]]s </div>}} | {{Family tree | | | E01 | | | | | | | | | | E02 | E01= '''Check the acid/base status'''| E02= <div style="float: left; text-align: left; width: 12em; padding:1em;">Possible etiologies are: <br> [[Primary aldosteronism]] <br> [[Secondary aldosteronism]] <br> Non aldosterone increase in [[mineralcorticoid]]s </div>}} | ||
{{Family tree | |,|-|^|-|v|-|-|-|.| | | | | |!| | }} | {{Family tree | |,|-|^|-|v|-|-|-|.| | | | | |!| | }} | ||
{{Family tree | F01 | | F02 | | F03 | | | | F04 | F01= [[Acidemia]]| F02= [[Alkalemia]] | F03= Variable | F04= div style="float: left; text-align: left; width: 12em; padding:1em;">Order: <br> ❑ [[Aldosterone]] <br> ❑ [[Renin]] </div>}} | {{Family tree | F01 | | F02 | | F03 | | | | F04 | F01= [[Acidemia]]| F02= [[Alkalemia]] | F03= Variable | F04= <div style="float: left; text-align: left; width: 12em; padding:1em;">Order: <br> ❑ [[Aldosterone]] <br> ❑ [[Renin]] </div>}} | ||
{{Family tree | |!| | | |!| | | |!| | | |,|-|^|-|v|-|-|.|}} | {{Family tree | |!| | | |!| | | |!| | | |,|-|^|-|v|-|-|.|}} | ||
{{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | | G01= <div style="float: left; text-align: left; width: 12em; padding:1em;">Possible etiologies are: <br>[[Diabetic ketoacidosis]] <br> [[Renal tubular acidosis]] </div>| G02= '''Check urinary chloride (U<sub>Cl</sub>)''' | G03= [[Hypomagnesemia]] | G04 = ↑ [[Aldosterone]] <br> ↓ [[Renin]] | G05= ↑ [[Aldosterone]] <br> ↑ [[Renin]]| G06= ↓ [[Aldosterone]]}} | {{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | | G01= <div style="float: left; text-align: left; width: 12em; padding:1em;">Possible etiologies are: <br>[[Diabetic ketoacidosis]] <br> [[Renal tubular acidosis]] </div>| G02= '''Check urinary chloride (U<sub>Cl</sub>)''' | G03= [[Hypomagnesemia]] | G04 = ↑ [[Aldosterone]] <br> ↓ [[Renin]] | G05= ↑ [[Aldosterone]] <br> ↑ [[Renin]]| G06= ↓ [[Aldosterone]]}} |
Revision as of 22:02, 21 October 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hypokalemia is defined as plasma potassium levels less than 3.5 mEq/L
Causes
Life Threatening Causes
Life-threatening conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Shown below is a table summarizing the different pathophysiological processes that can lead to hypokalemia.
Trans-cellular shifts | Renal loss | GI loss | Increased hematopoiesis | Decreased intake of potassium | |
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Subject is normo or hypotensive
Associated with alkalosis
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Subject is hypertensive
Secondary hyperaldosteronism
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Associated with metabolic acidosis
Associated with metabolic alkalosis
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|
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Diagnostic Algorithm
Shown below is an algorithm depicting the possible laboratory findings and their interpretation.
Hypokalemia [K+] < 3.5 | |||||||||||||||||||||||||||||||||||||||||||||||
Order: ❑ 24 hours urinary K+ (UK) ❑ Transtubular potassium gradient (TTKG) | |||||||||||||||||||||||||||||||||||||||||||||||
UK > 25-30 mEq/L TTKG > 7 | UK < 25 mEq/L TTKG < 3 | ||||||||||||||||||||||||||||||||||||||||||||||
Renal loss of potassium | GI loss of potassium | ||||||||||||||||||||||||||||||||||||||||||||||
What is the blood pressure? | |||||||||||||||||||||||||||||||||||||||||||||||
Normal or ↓ | ↑ | ||||||||||||||||||||||||||||||||||||||||||||||
Check the acid/base status | Possible etiologies are: Primary aldosteronism Secondary aldosteronism Non aldosterone increase in mineralcorticoids | ||||||||||||||||||||||||||||||||||||||||||||||
Acidemia | Alkalemia | Variable | |||||||||||||||||||||||||||||||||||||||||||||
Check urinary chloride (UCl) | Hypomagnesemia | ↑ Aldosterone ↓ Renin | ↑ Aldosterone ↑ Renin | ↓ Aldosterone | |||||||||||||||||||||||||||||||||||||||||||
UCl < 20 | UCl > 20 | Primary aldosteronism | Secondary aldosteronism | Non aldosterone increase in mineralcorticoids | |||||||||||||||||||||||||||||||||||||||||||
Management
1) Hypokalemia may present as ileus, muscle cramps, rhabdomyolysis, and hypomagnesemia.
2) Treat the etiology.
3) For severe hypokalemia (K < 2.5 mEq/L)
- EKG findings show 'U' wave, flat or inverted T waves.
- Intravenous KCL 80 mEQ/L @ 10-15mEq/hr with oral KCL 40-80mEq/L
- Recheck potassium levels in 2-4 hours