HYPOKALEMIA
Andal, Charlotte
Ang, Jessy
A2
Salient Features
• 55 year old, male
• Diarrhea for several weeks
• Progressive weakness
Laboratory Findings
Patient
Blood Chemistry
• Na = 140 meq/L
• Cl = 110 meq/L
• K = 2.0 meq/L
Normal Values
135-145 meq/L
98-106 meq/L
3.5-5.0meq/L
Urinalysis
• K = 15 meq/L
>15 meq/L
ABG
• pH
• pCO2
• HCO3
Patient
= 7.28
= 39mmHg
= 16 meq/L
Normal Values
7.45-7.45
35-45 mmHg
22-26 meq/L
1. Discuss the diagnostic approach
to hypokalemia. What is the cause
of hypokalemia in this patient?
Causes of Hypokalemia
• Decreased intake
– Starvation
– Clay ingestion
• Redistribution into cells
– Acid-base
– Hormonal
– Anabolic state
• Increased loss
– Nonrenal
– Renal
Causes of Hypokalemia in the Patient
• Increased loss
– Nonrenal
• Gastrointestinal loss (diarrhea)
• Integumentary loss (sweat)
– Renal
• Increased distal flow
• Increased secretion of potassium
• Increased renal K excretion
• Loss of gastric contents  volume depletion and
metabolic alkalosis  kaliuresis
• Hypovolemia stimulates aldosterone release 
augments K secretion by the principal cells
• Filtered load of HCO3 exceeds the reabsorptive
capacity of the proximal convoluted tubule 
increasing distal delivery of NaHCO3 which
enhances electrochemical gradient favoring K loss
in the urine
2. What are the signs and symptoms of
hypokalemia?
• Fatigue
• Myalgia
• Muscular weakness
• More severe hypokalemia
– Progressive weakness
– Hypoventilation
– Complete paralysis
3. What are the adverse medical
implications of this condition?
4. What is the significance of the
urinary K levels?
5. What is the treatment?
• Therapeutic goals:
– Correct the K deficit
– Minimize ongoing losses
• Potassium chloride
– Preparation of choice
– Promote more rapid correction of hypokalemia
and metabolic alkalosis
• Potassium bicarbonate and citrate
– Tends to alkalinize the patient
– More appropriate for hypokalemia associated with
chronic diarrhea