Low Potassium (Hypokalemia)

Potassium is a mineral (electrolyte) in the body that is important to maintain several bodily functions.

Potassium is a mineral (electrolyte) in the body. Almost 98% of potassium is found inside the cells. Small changes in the level of potassium that is present outside the cells can have severe effects on the heart, nerves, and muscles.

Potassium is important to maintain several bodily functions:

• Muscles need potassium to contract.
• The heart muscle needs potassium to beat properly and regulate blood pressure.

The kidney is the main organ that controls the balance of potassium by removing excess potassium into the urine.

When potassium levels are low (hypokalemia), you can become weak as cellular processes are impaired.

• Normal potassium levels are around 3.5-5.0 mEq/L (mEq/L stand for milliequivalents per liter of blood and this is a unit measure used to evaluate the level). Low potassium is defined as a potassium level below 3.5 mEq/L.
• Almost 1 out of 5 people hospitalized in the United States has a low potassium level.
• People with eating disorders such as anorexia nervosa and bulimia, patients with AIDS, alcoholics, and those who have had bariatric surgery have a higher incidence of hypokalemia than others.

Low potassium can occur for many reasons. Use of water pills (diuretics), diarrhea, and chronic laxative abuse are the most common causes of low potassium levels. Illness and other medications may also lower potassium levels. Risk factors for low potassium include:

• Female sex
• African-Americans ethnicity

Other causes of hypokalemia include:

Kidney losses

• Certain kidney disorders such as renal tubular acidosis (for example, chronic kidney failure and acute kidney failure)
• Magnesium deficiency
• Leukemia
• Cushing's disease (and other adrenal disorders)

Loss of potassium through stomach and intestines

• Vomiting
• Enemas or excessive laxative use
• Diarrhea
• After ileostomy operation

Side effect of medications

• Water pills (diuretics)
• Medicines used for asthma or emphysema (beta-adrenergic agonist drugs such as bronchodilators, steroids, or theophylline)
• Aminoglycosides (a type of antibiotic)

Shifting of potassium into and out of cells

• Use of insulin
• Certain metabolic states (such as alkalosis)

Decreased food intake or malnutrition

• Anorexia
• Bulimia
• Bariatric surgery
• Alcoholism

Symptoms of low potassium are typically mild and sometimes vague. There may be more than one symptom involving the gastrointestinal (GI) tract, kidneys, muscles, heart, and nerves:

• Weakness, tiredness, or cramping in arm or leg muscles, sometimes severe enough to cause inability to move arms or legs due to weakness (much like a paralysis)
• Tingling or numbness
• Nausea or vomiting
• Abdominal cramping, bloating
• Constipation
• Palpitations (feeling your heart beat irregularly)
• Passing large amounts of urine or feeling thirsty most of the time
• Fainting due to low blood pressure
• Abnormal psychological behavior: depression, psychosis, delirium, confusion, or hallucinations

If you are having symptoms of low potassium, call your doctor. If you have muscle cramps, weakness, palpitations, or feel faint and you are taking a diuretic (water pill), contact your healthcare professional or go to an urgent care facility or hospital emergency department immediately.

Without symptoms, you will not know you have low potassium levels until you have a routine blood test or an electrocardiogram (ECG, EKG).

Sometimes the cause of low potassium is unclear. Your doctor may perform certain tests to rule out other conditions such as renal tubular acidosis, Cushing syndrome, and hypocalcemia:

• If an electrolyte imbalance is suspected, blood tests will be ordered check potassium levels, kidney function (BUN and creatinine), glucose, magnesium, calcium, and phosphorous if an electrolyte imbalance is suspected.
• Because low potassium is known to affect heart rhythms (arrhythmias), your doctor may order a digoxin (Lanoxin) level if the patient is taking a digitalis preparation.
• ECG or a heart tracing is done to detect electrical changes in the heart and certain types of irregular heart rhythms that may be caused by low potassium.

If you are monitoring low potassium levels, avoid long, strenuous physical activities because loss of potassium occurs with sweating.

If dietary supplements, herbal supplements, diuretics (water pills), or laxatives are causing the low potassium symptoms, avoid taking these products and talk to your doctor. Never stop taking a prescribed medication without first consulting your doctor.

Potassium replacement therapy will be directed by the type and severity of the patient's symptoms. Treatment begins after lab tests confirm the diagnosis.

Medical Treatment

• People suspected of having severely low potassium need to be placed on a cardiac monitor and have an IV started.
• Usually, those with mild or moderately low potassium levels (2.5-3.5 mEq/L), who have no symptoms, or who have only minor complaints only need to be treated with potassium given in pill or liquid form. This is preferred because it is easy to administer, safe, inexpensive, and readily absorbed from the gastrointestinal tract. Some preparations, or too high of a dose, may irritate the stomach and cause vomiting.
• If cardiac arrhythmias or significant symptoms are present or if the potassium level is less than 2.5 mEq/L, IV potassium should be given. In this situation, admission or observation in the emergency department is indicated. Replacing potassium takes several hours as it must be administered very slowly intravenously to avoid serious heart problems and avoid irritating the blood vessel where the IV is placed.
• For those with severely low potassium and symptoms, both IV potassium and oral medication are necessary.

Precautions

• When potassium is used with medications such as ACE inhibitors, there is a risk of developing a high level of potassium.
• Potassium-sparing diuretics and potassium-containing salt substitutes can also result in high potassium levels.

Usually doctors recommend a certain dosage of potassium supplementation and arrange to have a repeat blood level taken 2-3 days later.

Your doctor may consider switching to potassium-sparing diuretics (water pills) if the patient needs to continue taking diuretics for another condition.

Diet changes may be recommended if the patient is likely to develop low potassium levels. Examples of foods high in potassium include:

• Bananas
• Tomatoes
• Oranges
• Cantaloupes
• Peaches

Do not overuse diuretics (water pills), and never use someone else's medications.

If you are taking medication, ask your doctor how often electrolyte levels need to be checked.

Low potassium is treatable. The reason for the low potassium must be identified, or it will most likely reoccur. With the right therapy, there are typically no further problems.