Hypokalemia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Jack Khouri
Diagnosis
History
A detailed history can help depict the cause of hypokalemia.
Dietary history
Malnutrition: lack of meat and fruit 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.
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