Hypokalemia

Hypokalemia

  • <3.5 mmol/L
  • Severe < 2.5 mmol/L
  • ECG changes
    • ST depression
    • U wave
    • QT prolongation (>450 ms)
    • PVCs
    • AV block
    • Bradycardia
    • Vtach
    • Vfib
  • Treatment- Replacement
    • Each 10 mEq raises K 0.1 mmol/L
    • PO replacement preferred
    • ECG changes require admission and IV + oral replacement.
    • Magnesium replacement is also indicated.
    • Many foods contain potassium. Replacement need not be tablets only. See list here.
  • Symptoms
    • Muscle cramps
    • Muscle weakness
    • Ileus
  • Causes
    • Insulin administration shifts K+ into intracellular space
    • Albuterol administration
    • Metabolic alkalosis ( 0.1 increase in pH = 0.5 mmol/L decrease in K+ )
    • Alcohol abuse
    • Vomiting, Diarrhea
    • Diuretic use
    • Hypercalcemia
    • Hypomagnesemia
    • Verapamil (with overdose)
    • Quetiapine (particularly in overdose)
    • Ampicillin, carbenicillin, high-dose penicillins
    • Bicarbonate
    • Antifungal agents (amphotericin B, azoles, echinocandins)
    • Gentamicin
References & Resources:
  1. EM:RAP Episode – Electrolytes Part 1
  2. Life In The Fastlane – Hypokalemia

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