Hypokalemia

Hypokalemia is defined as serum potassium less than 3.5mEq/L1. Hypokalemia is a relatively rare occurrence and is usually the result of potassium depletion due to either deficient intake or/and increased excretion. Hypokalemic patients are mostly asymptomatic; however, depending on the degree of depletion, hypokalemia can be associated with mild muscle weakness to serious manifestations such as sudden cardiac death. The most severe consequences of hypokalemia are related to cardiac rhythm disorders, which can lead to cardiac arrest1,2.

Etiology1

  • Low dietary potassium intake
  • Malnutrition
  • Chronic diarrhea
  • Drugs: Increment of colonic potassium excretions
    • Mineralocorticoids3
    • Imprudent use of potassium-exchange resins4

Prevention and Treatment

The treatment goal for hypokalemia in hemodialysis patients is to prevent cardiac rhythm disorders and neuromuscular symptoms. The oral administration of potassium preparations is the first line treatment, except in patients who have hypokalemia associated with respiratory disturbances and/or cardiac instability, in those cases the IV route is preferred1. When given intravenously, the administration of potassium should not exceed 20 mmol/hour5 and continuous cardiac monitoring is mandatory. Other important considerations in hypokalemia management are:

  • When potassium is administered intravenously, the concentrations should not exceed 50 mmol/L, IV fluids that contain higher potassium concentration can cause peripheral vein irritation
  • Use of 0 mEq/L potassium in the dialysate is not recommended. Modelling of dialysate potassium may be helpful6

References:

  1. Choi HY, Ha SK. Potassium balances in maintenance hemodialysis. Electrolyte Blood Press. 2013;11(1):9-16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23946760.
  2. Podrid PJ. Potassium and ventricular arrhythmias. Am J Cardiol. 1990;65(10):33E-44E; discussion 52E.
  3. Furuya R, Kumagai H, Sakao T, Maruyama Y, Hishida A. Potassium-lowering effect of mineralocorticoid therapy in patients undergoing hemodialysis. Nephron. 2002;92(3):576-581.
  4. Hoskote SS, Joshi SR, Ghosh AK. Disorders of potassium homeostasis: pathophysiology and management. J Assoc Physicians India. 2008;56:685-693.
  5. Kim G-H, Han JS. Therapeutic approach to hypokalemia. Nephron. 2002;92 Suppl 1:28-32.
  6. Morrison G, Michelson EL, Brown S, Morganroth J. Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int. 1980;17(6):811-819. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6447822.

P/N 103055-01 Rev A 03/2021