Hypokalemia for Everyone. #7. Treatment of Hypokalemia.

By Second Medical Opinions PLC | SMO Blog Kidney | 4 Jan 2020

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The election of a treatment for hypokalemia depends on what caused it. In most cases, hypokalemia is multifactorial, meaning that several causes can be present at the same time.

When hypokalemia is caused by increased losses, it has to be determined if the losses are gastrointestinal, urinary or both. The replacement of the lost potassium can be oral or intravenous. The choice between oral and intravenous is determined by the severity of the hypokalemia and the availability of the route. For example, if a patient is vomiting, it is not possible to use the oral route.

When hypokalemia is caused by decreased intake, the strategies are similar as in the previous paragraph. In these particular cases, the reason for the decreased intake has to be determined. For example, if the case is an eating disorder, in addition to replacing potassium as described, there has to be a secured enteral route (which may be a feeding tube) and the proper psychological or psychiatric support. In patients with poor appetite due to malignancy or chronic illness appetite stimulants may be used.

If the cause of the hypokalemia is the sudden movement of potassium from the extracellular space to the intracellular space, once the diagnosis is made, quick potassium administration, preferably by the IV route is needed. The evaluating physician has to keep in mind that a patient who has suffered from starvation, as soon as he or she is provided with food (specifically in the form of a feeding solution through a feeding tube or parenteral solution), they can develop severe hypokalemia as part of something called refeeding(1) syndrome.

In all cases, in order to avoid hypokalemia becoming worse, potassium supplementation has to be given. If the potassium concentration in the plasma is below 2.5 mEq/L the use of intravenous, potassium solutions will reduce the risk of life-threatening cardiac arrhythmias. In all cases, the potassium supplementation has to be followed by rechecking of the values, in order to avoid overcorrection or under-treatment

Notes

Hisham Mehanna, Jamil Moledina and Jane Travis, “Refeeding syndrome: what it is, and how to prevent and treat it,” British Medical Journal 336, no. 7635 (2008): 1495, https://doi.org/10.1136/bmj.a301.