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 Because J.P. has been unable to eat for the past few days, decreased oral intake

may have contributed to her hypokalemia. Because most foods are rich in potassium,

however, inadequate intake rarely is the sole cause of potassium depletion unless

inappropriate and continued renal or extrarenal losses occur, or potassium intake is

severely restricted to less than 10 to 15 mEq/day.

122 Alkalosis,

119

insulin

administration,

111 hypertonic solution administration, periodic paralysis,

123 β2

-

agonists,

124 barium poisoning,

125 and treatment of megaloblastic anemia with vitamin

B12

126 all have been associated with increased cellular potassium uptake (Table 27-

2). Although the relationship between the degree of hypokalemia and increase in

blood pH varies widely,

118 J.P.’s metabolic alkalosis probably enhances the cellular

uptake of potassium. The transcellular shift of potassium should not result in total

body potassium depletion, however.

The GI tract is an important site of potassium loss, particularly through vomiting

and diarrhea. Because the potassium content of gastric secretion (5–10 mEq/L) is

much less than that of the intestinal secretion (up to 90 mEq/L),

122

loss of a large

volume of gastric secretion is needed to produce substantial potassium depletion.

Potassium deficit induced by vomiting, however, is commonly secondary to renal

potassium loss, especially within the initial 24 to 48 hours.

127 The loss of hydrogen

ion in gastric juice results in an elevated plasma bicarbonate concentration. The

increased amount of bicarbonate ion, as a nonresorbable anion, increases water

delivery to the distal nephron and enhances sodium reabsorption and potassium

secretion, resulting in hypokalemia. The potassium wasting is often transient, because

increased proximal reabsorption of sodium and bicarbonate will result in diminished

bicarbonate delivery to the distal site. Reduced potassium excretion will ensue,

commonly within 48 to 72 hours. Subsequent potassium loss will then be primarily

consequent to gastric secretion removal.

The absence of diarrhea in J.P. excludes the GI tract as the source of potassium

loss. Potassium loss through the skin is also unlikely in J.P. because the potassium

concentration of sweat is less than 10 mEq/L. Therefore, profuse sweating, such as

that induced by vigorous exercise in a hot, humid environment, or severe burns are

needed to cause substantial loss.

J.P.’s inappropriately high urinary potassium concentration indicates that the

kidney is the source of the potassium loss.

34,122 The urinary potassium concentration is

a good marker for differentiating various hypokalemic syndromes. A urinary

potassium excretion of less than 20 mEq/day suggests extrarenal potassium loss.

Renal potassium wastage cannot be excluded, however, unless the low urinary

potassium excretion is accompanied by a sodium intake of at least 100 mEq/day,

because a low-sodium diet can reduce renal potassium excretion.

34

In J.P., the

metabolic alkalosis and hypovolemia promote renal potassium wastage.

34,122 The

distal delivery of a large sodium bicarbonate load and increased aldosterone activity

(from hypovolemia) enhance potassium secretion and severely impair the kidney’s

ability to conserve potassium. The hydrochlorothiazide, which J.P. had been taking

until 3 days before admission, could also have induced hypokalemia through volume

depletion, hypochloremic metabolic alkalosis, and renal potassium wastage. The

diuretic is unlikely, however, to be the cause for J.P.’s hypokalemia because she has

stopped taking the medication, and this is reflected by the low urinary chloride

concentration.

15 Bartter syndrome, which presents as normotension, hypokalemia,

hypochloremic metabolic alkalosis, and renal potassium wastage, is characterized by

impaired renal sodium and chloride reabsorption. The low urinary chloride

concentration in J.P. can rule out Bartter syndrome. Other causes of hypokalemia are

listed in Table 27-2.

In an asymptomatic hypokalemic patient with no apparent causes for potassium

depletion or transcellular redistribution, pseudohypokalemia should be excluded

before pursuing an intensive evaluation.

106 Spurious hypokalemia can occur in

leukemic patients whose leukocyte count ranges from 100,000 to 250,000 cells/μL.

128

The potassium in serum is taken up by the large number of leukemic cells when the

blood specimen is allowed to stand at room temperature.

CLINICAL MANIFESTATIONS

CASE 27-8, QUESTION 2: What clinical manifestations of hypokalemia are evident in J.P.?

Table 27-2

Drugs that Most Commonly Induce Hypokalemia

Drug Mechanism Predisposing Factors

Acetazolamide Marked ↑ in renal K+ loss Most profound with short-term therapy

Amphotericin Renal K+ loss (renal tubular acidosis) Concurrent piperacillin, ticarcillin

β2

-Agonists Intracellular shift of K+

Cisplatin Renal K+ loss secondary to renal tubular

damage

May be dose related but can occur after a

single 50-mg/m

2 dose

Corticosteroids Renal K+ loss. Enhanced Na+ reabsorption

at distal tubule and collecting ducts in

exchange for K+ and H+

Supraphysiologic doses of agents with

moderate to strong mineralocorticoid

activity (e.g., prednisone, hydrocortisone)

Insulin with glucose Intracellular shift of K+ Predictable effect when insulin

administered to patients with diabetic

ketoacidosis’ combination used to treat

hyperkalemia

Penicillins

(piperacillin,

ticarcillin)

High Na+ load and nonresorbable anions

can ↑ K+ loss

Was more common with carbenicillin when

it was available; newer penicillins are used

in lower doses; less likely to produce

hypokalemia

Thiazide and loop

diuretics

Renal K+ loss. ↑ Na+ delivery to the late

distal tubule, resulting in Na+ resorption in

exchange for K+

Patients with hyperaldosteronism (e.g.,

cirrhosis, HF) predisposed; may be dose

related

HF, heart failure.

p. 583

p. 584

The clinical presentation of hypokalemia, which depends on the severity of

potassium depletion, is a result of changes in cell membrane polarization.

122 Patients

are usually asymptomatic when the plasma potassium level is 3.0 to 3.5 mEq/L, but

they may complain of malaise, weakness, fatigue, and myalgia. J.P.’s muscle

weakness and ECG changes reflect the muscular and cardiac manifestations of

hypokalemia, respectively.

129,130

Potassium depletion can lead to hyperpolarization of myocardial cells and a

prolonged refractory period. When serum potassium concentrations fall below 3

mEq/L, T-wave flattening, straight tubule segment depression, and prominent U

waves are seen on the ECG.

130

Mild hypokalemia (potassium concentration of 3.0–3.5 mEq/L) is potentially

arrhythmogenic in patients with underlying coronary artery disease. The incidence of

ventricular arrhythmia increases with the degree of hypokalemia. Patients without

underlying heart disease may be susceptible to these myocardial effects during

exercise, especially if the patient’s pre-exercise potassium concentration is less than

3.5 mEq/L, because the potassium concentration may drop to less than 3.0 mEq/L as

a result of β2

-adrenergic receptor-mediated cellular potassium uptake.

122 Potassium

depletion may also increase the BP,

123 which can be lowered with potassium

supplementation.

131

When the serum potassium concentration is less than 2.5 to 3.0 mEq/L, muscle

weakness, cramps, general malaise, fatigue, restless leg syndrome, and paresthesia

can occur, probably because potassium is necessary for vasodilation in skeletal

muscle. In addition, severe potassium depletion (<2.5 mEq/L) can result in elevation

of serum creatine phosphokinase, aldolase, and aspartate aminotransferase levels.

Rhabdomyolysis can ensue when the serum potassium concentration falls below 2.0

mEq/L.

122,129

Chronic potassium depletion can alter renal function and structure, which can

manifest as decreased GFR and renal blood flow, disturbance in tubular sodium

handling, impaired urinary concentrating ability with polydipsia, and ADH-resistant

nephrogenic diabetes insipidus.

106,115 Reversible pathologic changes include renal

hypertrophy and epithelial vacuolization of the proximal convoluted tubule.

Interstitial scarring and tubular atrophy have been reported with prolonged potassium

depletion.

122

Other effects of hypokalemia and potassium depletion include decreased insulin

secretion resulting in carbohydrate intolerance,

132 metabolic alkalosis, and increased

renal ammoniagenesis, which may play a role in the development of hepatic

encephalopathy.

133

TREATMENT

CASE 27-8, QUESTION 3: How should J.P.’s hypokalemia be treated?

J.P.’s protracted vomiting should be corrected, and fluids and electrolytes

(sodium, potassium, and chloride) should be replaced to correct the volume deficit,

hypokalemia, and hypochloremic metabolic alkalosis. Hydrochlorothiazide should

continue to be withheld.

The amount of potassium deficit and the rate of continued potassium loss should be

determined to guide replacement therapy. It has been estimated that a 1-mEq/L fall in

serum potassium from 4 to 3 mEq/L represents a total body deficit of approximately

200 mEq. When the serum potassium falls to less than 3 mEq/L, the total body deficit

increases by 200 to 400 mEq for each 1 mEq/L reduction in serum concentration.

Other data suggest that even greater degrees of potassium loss can occur—a deficit of

100 mEq per 0.27-mEq/L fall in the serum potassium concentration.

110 Transcellular

redistribution of potassium may, however, significantly alter the relationship between

serum concentration and total body deficit.

122 Therefore, potassium repletion should

be guided by close monitoring of serum concentrations and analysis of J.P.’s urine

for potassium content to help assess the need for additional replacement.

The route of potassium administration depends on the acuity and severity of

hypokalemia,

134 but oral supplementation is usually preferred. The parenteral route is

indicated for patients who cannot tolerate high dosages of oral potassium

supplements and for those with severe or symptomatic hypokalemia. J.P.’s potassium

deficit is estimated to be 300 to 500 mEq, but because she is only moderately

symptomatic, aggressive therapy is not indicated. Potassium chloride can be added to

her IV fluid in a concentration of 40 mEq/L and infused at a rate that does not exceed

10 mEq/hour. For patients with life-threatening, hypokalemia-induced arrhythmias or

those with a serum potassium level less than 2.0 mEq/L, a more concentrated

potassium solution (60 mEq/L) can be infused at a rate not exceeding 40 mEq/hour. A

solution that is too concentrated or a rate of infusion that is too rapid would likely

cause phlebitis in the peripheral veins and could cause arrhythmias, especially when

administered through a central line. The potassium concentration should be monitored

every 4 hours, more frequently in patients with severe potassium depletion or when a

rapid infusion is given.

135 ECG monitoring is mandatory to identify life-threatening

hyperkalemia that can result from over-correction.

Parenteral potassium can be given as chloride, acetate, or phosphate. The chloride

salt is preferred in J.P., who has concurrent hypochloremic metabolic alkalosis. The

acetate preparation is useful in cases of concomitant metabolic acidosis. Potassium

phosphate is indicated if hypophosphatemia coexists. In the latter condition, the

serum calcium concentration should also be monitored because hypocalcemia may

ensue. Glucose solution should be avoided as the vehicle because glucose-induced

insulin secretion will promote intracellular potassium uptake.

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