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Key Words
Hypokalemia * Treatment * Potassium * Replacement
Abstract
For successful potassium replacement, one should consider the optimal potassium preparation, route of administration, and the appropriate speed of administration. In the absence of an independent factor causing transcellular potassium shifts, the plasma potassium concentration can be used as a rough index to estimate body potassium stores. Oral KCl replacement therapy is preferable if there are bowel sounds, except in the setting of life-threatening abnormalities such as ventricular arrhythmias, digitalis intoxication, or paralysis. In patients with impaired renal function or those treated with intravenous potassium, the risk of hyperkalemia should be monitored. Since potassium depletion rarely occurs as an isolated phenomenon, associated fluid and electrolyte disorders should be corrected, and the causes of potassium loss should be sought and eliminated to complete the treatment of hypokalemia.
Hypokalemia is one of the most common electrolyte abnormalities encountered in clinical practice. More than 20% of hospitalized patients have hypokalemia, when defined as a serum potassium level of less than 3.6 mmol/l [1]. The treatment of hypokalemia should address replacement of the potassium deficit and interruption of potassium-losing mechanisms or elimination of underlying causes. This article reviews the general principles applicable to the therapy of potassium depletion of most causes.
Potassium Replacement
Potassium replacement is primarily indicated when potassium has been lost, either in urine or stool. The other indication is hypokalemic periodic paralysis. In general, however, potassium is not usually given in the setting of hypokalemia due to redistribution into the cells, because the hypokalemia is transient and the administration of too much potassium can lead to rebound hyperkalemia when the process is corrected. If severe muscular manifestation is present in hypokalemic periodic paralysis, it is reasonable to give a modest quantity of potassium.
The major aim of treatment of potassium depletion is to get the patient out of danger and to avoid certain serious consequences, such as rhabdomyolysis or life-threatening ventricular ectopy. Uncorrected preoperative hypokalemia (<3.5 mmol/l) may increase the likelihood of developing perioperative arrhythmia and the need for cardiopulmonary resuscitation [2]. On the other hand, one must bear in mind that the entire potassium deficit is not corrected immediately to avoid the potential risk of hyperkalemia. Occasionally, incorrect therapy of hypokalemia can lead...