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 refeeding1 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
References
- 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.
Disclaimer
Any information or statement present in this post does not replace your health care provider’s advice or treatment. This blog does not provide medical advice, prescribe medications or therapies, or diagnose conditions, it only expresses an opinion. If you have a health-related question or condition, confer with your healthcare provider.
Quotations
- In order to quote from this article please use the following (Chicago style):
Marco A. Ramos, “Hypokalemia for Everyone. #7. Treatment of Hypokalemia,” SMO Blog (blog), June 21, 2019, https://steemit.com/health/@secondmedicalop/hypokalemia-for-everyone-7-treatment-of-hypokalemia
Read the other sections of this series:
Introduction
What Causes Hypokalemia? A
What Causes Hypokalemia? B
What Causes Hypokalemia? C
How Common is Hypokalemia?
What Happens When Someone Has Hypokalemia?
Signs and Symptoms of Hypokalemia
Diagnosis and Tests Used in Hypokalemia