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Internal Medicine – Hypokalemia By Steven Cheng MD
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medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. • Internal Medicine – Hypokalemia • Whiteboard Animation Transcript • with Steven Cheng, MD • https://medskl.com/Module/Index/ • Hypokalemia is defined as a serum potassium level less than 3.5 mEq/L. This level is tightly regulated and plays a crucial role in a wide array of cellular functions. • When potassium levels fall, patients may experience cramps, weakness, and muscle aches. At its most severe, patients can experience paralysis and changes in cardiac conduction. • Hypokalemia is most commonly caused by a loss of potassium-rich fluids from the body. • The kidneys are responsible for the majority of potassium excretion. An increase in the flow of filtrate or a rise in mineralocorticoid activity can cause more potassium to be wasted in the urine. Diuretics and hyperaldosteronism are common renal causes of hypokalemia. • There are also non-renal causes of hypokalemia including: • Diarrhea, which is a common cause of potassium loss from the GI tract, and • Hypokalemic periodic paralysis, which is a rare genetic condition. • While history often suggests the cause of hypokalemia, urine tests can differentiate renal from non-renal causes. The urine potassium level is high when potassium is wasted in the urine, but low when it is wasted from a non-renal source. • Flattened T waves and the presence of a U wave can be seen on electrocardiography in patients with severe or symptomatic hypokalemia. • Once the cause of hypokalemia is determined, the condition can be corrected by reversing any underlying pathologic processes and then replacing the lost potassium: • Mild to moderate hypokalemia, can be treated with oral supplements. • Intravenous potassium is needed when there are cardiovascular manifestations or when potassium concentrations are less than 2.5 mEq/L.
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