Hypokalemia history and symptoms: Difference between revisions
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{{Hypokalemia}} | {{Hypokalemia}} | ||
{{CMG}}'''; Associate Editor-In-Chief:''' {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]] | {{CMG}}'''; Associate Editor-In-Chief:''' {{AIDA}} {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]] | ||
== Overview == | |||
A detailed history can help interpret the cause of hypokalemia. Special focus should be on medication intake and past medical conditions. Medical conditions such as, uncontrolled [[diabetes]], [[hyperthyroidism]], [[pernicious anemia]], [[COPD]], [[Cushing's disease]], [[primary hyperaldosteronism]], [[Liddle's syndrome]], Barter's syndrome, [[Gitelman syndrome|Gittelman syndrome]] and [[renal tubular acidosis]] can all lead to hypokalemia. Common [[symptoms]] of hypokalemia include [[nausea]], [[vomiting]], [[constipation]] ([[ileus]]), [[muscle cramps]], [[myalgias]] and [[generalized weakness]]. Less commonly, severe hypokalemia may lead to [[cardiac]] conduction problems and may present as fainting or [[palpitations]]. | |||
==History and Symptoms== | |||
=== History === | |||
A detailed history can help interpret the cause of hypokalemia. | |||
==== Dietary History ==== | |||
[[Malnutrition]]: lack of adequate [[calorie]] intake | |||
==== Medication History ==== | |||
*[[Diuretic]]s (loop and thiazides) | |||
*[[Beta-agonists]] | |||
*[[Chloroquine]] | |||
*[[Theophylline]] | |||
*[[Insulin]] | |||
*[[Corticosteroids]] | |||
*[[Licorice]] | |||
*[[Nephrotoxic drugs]] (platinum-based chemotherapy, [[aminoglycosides]]) | |||
*[[Laxative]]s | |||
==== Past Medical History ==== | |||
*Uncontrolled [[diabetes]] | |||
*[[Hyperthyroidism]] | |||
*[[Pernicious anemia]] | |||
*[[COPD]] (treated with Beta agonists and theophylline) | |||
*[[Cushing’s disease]] | |||
*Periodic [[paralysis]] | |||
*[[Ileostomy]]/[[short bowel]] | |||
*[[Primary hyperaldosteronism]] | |||
*[[Liddle syndrome]] | |||
*[[Bartter syndrome|Bartter]] and [[Gitelman syndrome]] | |||
*Prolonged [[starvation]] | |||
*[[Cancer]] | |||
*[[Renal tubular acidosis]] type I and type II | |||
=== Symptoms === | === Symptoms === | ||
The severity of symptoms depends on the degree of hypokalemia, but keep in mind that there is marked individual variability. | The severity of symptoms depends on the degree of hypokalemia, but keep in mind that there is marked individual variability <ref name="pmid24490479">{{cite journal |vauthors=Wojtaszek E, Matuszkiewicz-Rowińska J |title=[Hypokalemia] |language=Polish |journal=Wiad. Lek. |volume=66 |issue=4 |pages=290–3 |date=2013 |pmid=24490479 |doi= |url=}}</ref><ref name="pmid23594380">{{cite journal |vauthors=Wen Z, Chuanwei L, Chunyu Z, Hui H, Weimin L |title=Rhabdomyolysis presenting with severe hypokalemia in hypertensive patients: a case series |journal=BMC Res Notes |volume=6 |issue= |pages=155 |date=April 2013 |pmid=23594380 |pmc=3637555 |doi=10.1186/1756-0500-6-155 |url=}}</ref><ref name="pmid25436277">{{cite journal |vauthors=Gaduputi V, Chandrala C, Abbas N, Tariq H, Chilimuri S, Balar B |title=Prognostic significance of hypokalemia in hepatic encephalopathy |journal=Hepatogastroenterology |volume=61 |issue=133 |pages=1170–4 |date=2014 |pmid=25436277 |doi= |url=}}</ref><ref name="pmid24176583">{{cite journal |vauthors=Mirijello A, Rinninella E, De Leva F, Tosoni A, Vassallo G, Antonelli M, Addolorato G, Landolfi R |title=Hypokalemia-induced pseudoischemic electrocardiographic changes and quadriplegia |journal=Am J Emerg Med |volume=32 |issue=3 |pages=286.e1–4 |date=March 2014 |pmid=24176583 |doi=10.1016/j.ajem.2013.09.033 |url=}}</ref>. | ||
==== Constitutional ==== | ==== Constitutional ==== | ||
* [[Ddx:Fatigue|Fatigue]] | * [[Ddx:Fatigue|Fatigue]] | ||
| Line 11: | Line 47: | ||
* [[Ddx:Constipation|Constipation]] | * [[Ddx:Constipation|Constipation]] | ||
* Muscle cramps and paralysis (the lower extremity muscles are most commonly involved) which may involve the intestine and cause ileus | * Muscle cramps and paralysis (the lower extremity muscles are most commonly involved) which may involve the intestine and cause ileus | ||
* Respiratory muscle weakness leading to respiratory failure | * Respiratory muscle weakness leading to [[respiratory failure]]. | ||
==== Cardiac ==== | ==== Cardiac ==== | ||
* Hypertension | * [[Hypertension]] | ||
* Arrhythmias including premature atrial and ventricular complexes, paroxysmal atrial or junctional tachycardia and even ventricular tachycardia or fibrillation | * [[Arrhythmias]] including premature atrial and ventricular complexes, paroxysmal atrial or junctional [[tachycardia]] and even [[ventricular tachycardia]] or [[fibrillation]] | ||
* Heart block | * [[Heart block]] | ||
* Digoxin therapy, CAD and left ventricular hypertrophy potentiate hypokalemia effects on the heart | * Digoxin therapy, CAD and left ventricular hypertrophy potentiate hypokalemia effects on the heart | ||
==== Renal ==== | ==== Renal ==== | ||
*Nephrogenic diabetes insipidus due to decreased concentrating ability. As a consequence, the patient presents with polyuria and polydipsia | *[[Nephrogenic diabetes insipidus]] due to decreased concentrating ability. As a consequence, the patient presents with [[polyuria]] and [[polydipsia]] | ||
*Increased bicarbonate reabsorption | *Increased bicarbonate reabsorption | ||
*Increased ammonia formation which may precipitate hepatic encephalopathy in cirrhotic patients | *Increased ammonia formation which may precipitate [[hepatic encephalopathy]] in cirrhotic patients | ||
*Decreased sodium reabsorption resulting in hyponatremia | *Decreased sodium reabsorption resulting in [[hyponatremia]] | ||
==== Other ==== | ==== Other ==== | ||
* Rhabdomyolysis | * [[Rhabdomyolysis]] | ||
* [[Ddx:Hyperglycemia|Hyperglycemia]] | * [[Ddx:Hyperglycemia|Hyperglycemia]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs overview]] | |||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 15:27, 2 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Aida Javanbakht, M.D. Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Jack Khouri
Overview
A detailed history can help interpret the cause of hypokalemia. Special focus should be on medication intake and past medical conditions. Medical conditions such as, uncontrolled diabetes, hyperthyroidism, pernicious anemia, COPD, Cushing's disease, primary hyperaldosteronism, Liddle's syndrome, Barter's syndrome, Gittelman syndrome and renal tubular acidosis can all lead to hypokalemia. Common symptoms of hypokalemia include nausea, vomiting, constipation (ileus), muscle cramps, myalgias and generalized weakness. Less commonly, severe hypokalemia may lead to cardiac conduction problems and may present as fainting or palpitations.
History and Symptoms
History
A detailed history can help interpret the cause of hypokalemia.
Dietary History
Malnutrition: lack of adequate calorie intake
Medication History
- Diuretics (loop and thiazides)
- Beta-agonists
- Chloroquine
- Theophylline
- Insulin
- Corticosteroids
- Licorice
- Nephrotoxic drugs (platinum-based chemotherapy, aminoglycosides)
- Laxatives
Past Medical History
- Uncontrolled diabetes
- Hyperthyroidism
- Pernicious anemia
- COPD (treated with Beta agonists and theophylline)
- Cushing’s disease
- Periodic paralysis
- Ileostomy/short bowel
- Primary hyperaldosteronism
- Liddle syndrome
- Bartter and Gitelman syndrome
- Prolonged starvation
- Cancer
- Renal tubular acidosis type I and type II
Symptoms
The severity of symptoms depends on the degree of hypokalemia, but keep in mind that there is marked individual variability [1][2][3][4].
Constitutional
- Fatigue
- Weakness
- Vomiting
- Constipation
- Muscle cramps and paralysis (the lower extremity muscles are most commonly involved) which may involve the intestine and cause ileus
- Respiratory muscle weakness leading to respiratory failure.
Cardiac
- Hypertension
- Arrhythmias including premature atrial and ventricular complexes, paroxysmal atrial or junctional tachycardia and even ventricular tachycardia or fibrillation
- Heart block
- Digoxin therapy, CAD and left ventricular hypertrophy potentiate hypokalemia effects on the heart
Renal
- Nephrogenic diabetes insipidus due to decreased concentrating ability. As a consequence, the patient presents with polyuria and polydipsia
- Increased bicarbonate reabsorption
- Increased ammonia formation which may precipitate hepatic encephalopathy in cirrhotic patients
- Decreased sodium reabsorption resulting in hyponatremia
Other
References
- ↑ Wojtaszek E, Matuszkiewicz-Rowińska J (2013). "[Hypokalemia]". Wiad. Lek. (in Polish). 66 (4): 290–3. PMID 24490479.
- ↑ Wen Z, Chuanwei L, Chunyu Z, Hui H, Weimin L (April 2013). "Rhabdomyolysis presenting with severe hypokalemia in hypertensive patients: a case series". BMC Res Notes. 6: 155. doi:10.1186/1756-0500-6-155. PMC 3637555. PMID 23594380.
- ↑ Gaduputi V, Chandrala C, Abbas N, Tariq H, Chilimuri S, Balar B (2014). "Prognostic significance of hypokalemia in hepatic encephalopathy". Hepatogastroenterology. 61 (133): 1170–4. PMID 25436277.
- ↑ Mirijello A, Rinninella E, De Leva F, Tosoni A, Vassallo G, Antonelli M, Addolorato G, Landolfi R (March 2014). "Hypokalemia-induced pseudoischemic electrocardiographic changes and quadriplegia". Am J Emerg Med. 32 (3): 286.e1–4. doi:10.1016/j.ajem.2013.09.033. PMID 24176583.