Definition/Description
Hypokalemia is known as a electrolyte imbalance that is lower than normal level of potassium in your bloodstream. A normal blood potassium is 3.6 to 5.2 mmol/L. Severe and life threatening hypokalemia level is known as [2]
Prevalence
Hypokalemia is more common in hospitalized patients, up to 15%, as a result of other pathologies. While only 3% of the outpatient population is found to have Hypokalemia. There has been no significant difference in prevalence between gender and race. [3]
Characteristics/Clinical
An individual with Hypokalemia may exhibit signs of the following:
- Abnormal heart rhythyms
- Constipation
- Fatigue
- Muscle Damage
- Muscle Weakness or spasms
- Paralysis[2]
- Nausea and vomiting
- Polyuria, nocturia or polydipsia
- Altered mental status
- Signs of Ileus
- Hypotension
- Cardia arrest
- Bradycardia or Tachycardia
- Premature atrial or ventricular beats
- Hypoventilation/Respiratory distress
- Respiratory failure
- Lethargy
- Edema (Cushingoid appearance)[4]
Associated Co-morbidities
Hypokalemia may present as a result of:
- Chronic Kidney Failure
- Diabetic Ketoacidosis
- Diarrhea/Vomiting
- Excessive Sweating
- Excessive use of laxatives
- Prescription Diuretic Pills
- Primary Aldosteronism [2]
- Liddle Syndrome
- Cushing Syndrome
- Bartter Syndrome
- Fanconi Syndrome
- Bulimia [5]
- Eating large amounts of licorice, herbal teas or chewing tobacco
- Magnesium Deficiency
- Glue Sniffing
- Alcoholism (poor appetite and/or vomiting)
- Amphotericin B therapy
- Hypothermia [3]
Medications
In order to correct Hypokalemia, potassium supplements can be administered orally or intervenously.
Oral preparations of potassium include:
- 8m Eq KCl slow release tablets
- 20 mEq KCl elixir
- 20 mEq KCl powder
- 25mEq KCl tablet
If the patient has severe hypokalemia ([4]
Diagnostic Tests/Lab Tests/Lab Values
Hypokalemia is commonly found in a blood test, with [2]
In severe cases, a 12-lead electrocardiogram may be necessary if to check for cardiac arrythymias. Findings such as T-wave flattening or prominent U waves will result in hospital admission.[3]
Other tests may include:
- arterial blood gas
- basic or comprehensive metabolic panel
Blood tests will also be administered to check the following:
- glucose
- magnesium
- calcium
- sodium
- phosphorus
- thyroxine
- aldosterone levels.[5]
Etiology/Causes
Low potassium has many causes with the most common being excessive loss in urine or from the digestive tract. Very seldom it may be caused by not consuming enough potassium in your diet.[2]
Other causes include excessive sweating or overuse of laxatives, diuretics, and alcoholism.[2]Certain medications (penicillin, nafcillin, cerbencillin, gentamicin, amphotericin B, foscarnet) are known to be possible causes, as well.Pathologies such as Cushing syndrome, Liddle Syndrome, Barrtter Syndrome and Fanconi Syndrome can all potentially casue low potassium levels.[5]
Systemic Involvement
| Systems | Impairments |
| Cardiovascular | Cardiac Arrythmias, Hypotension, Premature Artrial or Ventricular Contractions, Bradycardia/Tachycardia/3 |
| Pulmonary | Respiratory Failure or complete paralysis in cases |
| Musculoskeletal |
Muscle weakness, cramping or paralysis. |
| Genitourinary | Polyuria or sexual dysfunction.[2] |
Medical Management (current best evidence)
Severe hypokalmeia levels that cause ECG changes such as T-wave flattening or prominent U waves require hospital admission. Mild hypokalemia ([3]
Physical Therapy Management (current best evidence)
Potassium levels [6]
Thus, hypokalemia is not managed primarily by a physical therapist. Physical therapists should be mindful of common signs of symptoms of hypokalemia when working with patients.
Differential Diagnosis
- Emesis
- Nasogastric suctioning
- Pyloric stenosis
- Diarrhea
- Malabsorption
- Villous adenoma
- Renal losses
- Electrolyte abnormalities
- Hypomagnesemia
- Endocrine abnormalities
- Cushing disease or syndrome
- Congenital adrenal hyperplasia
- Hyperaldosteronism
- High renin states
- Increased mineralocorticoid – chewing tobacco, licorice
- Intrinsic renal abnormalities
- Bartter’s Syndrome
- Gitelman’s Syndrome
- Renal tubular acidosis, types I or II [7]
Case Reports/ Case Studies
The syndrome of refractory watery diarrhea and hypokalemia in patients with a non-insulin—secreting islet cell tumor ☆: A further case study and review of the literature http://www.sciencedirect.com/science/article/pii/0002934362901882
–Summary: Surgical removal of islet cell adenoma results in a decrease of severe diarrhea and a reduced risk of hypokalemia.
Hypokalemic nephropathy in anorexia nervosa http://connection.ebscohost.com/c/case-studies/67145420/hypokalemic-nephropathy-anorexia-nervosa
–summary: 25 year old female that has a history of multiple hospital admissions due to hypokalemia caused by chronic purging.
Resources
http://www.mayoclinic.com/health/low-potassium/MY00760
References
- ↑ Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html
- ↑ 2.02.12.22.32.42.52.6 Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760
- ↑ 3.03.13.23.3 Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089
- ↑ 4.04.1 Garth D.,Schraga E.Hypokalemia in emergency medicine.[homepage on the Internert]2012 April 13 [cited 2013 March 27] Available from: http://emedicine.medscape.com/article/767448-overview
- ↑ 5.05.15.2 Hypokalemia [Internet]. 2013 March 22 [cited 2013 March 27] Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm
- ↑ Goodman CC. Fuller KS. In K Falk editor. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009. pp.150, 157, 187-189, 480, 558, 927, 1243, 1640-1641
- ↑ Alessandro D. Alessandro M. What is the differential diagnosis of hypokalemia? [Internet] 2006 February 6. [cited 2013 April 4] Available from:http://www.pediatriceducation.org/2006/02/06/what-is-the-differential-diagnosis-of-hypokalemia/
see adding references tutorial.
