Approaching hypokalemia (Treatment of hypokalemia)

The article was written by Master, Doctor Phan Van Phong - Emergency Doctor - Emergency Department - Vinmec Central Park International General Hospital.

Hypokalemia is a common electrolyte disorder in clinical practice. In healthy individuals, this condition is compensated, but severe hypokalemia can be life-threatening. In cardiovascular patients, hypokalemia increases mortality.

Hypokalemia is defined as hypokalemia below 3.5 mmol/l, which is a common electrolyte disorder in clinical practice; This condition occurs in about 20% of hospitalized patients and in about 10-40% of patients being treated with thiazide diuretics. Normally, a blood potassium level of about 3-3.5mmol/l will be relatively well compensated in healthy bodies; however, in patients with cardiovascular disease, hypokalemia can have serious consequences. Therefore, it is extremely important to treat and diagnose the cause.
Blood potassium < 3 mEq/L Decrease 1 mEq/L: The body loses about 200 - 400 mEq

Muscle fatigue, myalgia, muscle weakness, muscle paralysis Electrocardiogram: flattened or inverted T wave, high U wave, ST depression, long QT interval, wide QRS, ventricular arrhythmia

Hypokalemia has two main causes: cellular metabolism and potassium loss (gastrointestinal and renal). Taking diuretics is the most common cause of hypokalemia. Tests to evaluate acid-base disorders and urinalysis can be well-directed to the correct diagnosis of the cause of hypokalemia. In each case, it is essential to treat the cause.
Decrease in supply: Malnutrition, alcoholism, imbalanced diet Potassium movement into cells: Alkalosis, insulin, catecholamine Extrarenal potassium loss: Vomiting, diarrhea, gastrointestinal leak,... Potassium loss Renal: Diuretics, osmotic diuretics, hyperaldosteronism, hypomagnesemia, type 1 renal tubular acidosis

1. Principle The rate of compensation is mainly based on the clinical and the degree of hypokalemia, the normal rate is 10-20mmol/h Central intravenous infusion concentration < 60mmol/l (the highest allowed is 100mmol/l). ) Peripheral intravenous infusion, the maximum concentration should be < 40mmol/l. Solution for dilution: ideally Potassium chloride (KCl) is mixed with physiological saline 0.9% or 0.45%, do not mix with dextrose because dextrose has May cause insulin-mediated hypokalemia that delivers intracellular potassium. 2. Specific a) Use of peripheral intravenous line. The usual concentration is mixed as follows: 1.5 ampoules of Potassium chloride (KCL) 10% 10ml mixed in 500 ml of 0.9% Sodium chloride (concentration 40mmol/l). 01 ampoules of Potassium chloride 10% 10ml, 13 mEq K+ (13 mmol) b) Life-threatening severe hypokalemia: (K+: < 2.0 mmol/L) Infuse at 120 drops/min (360ml/h or 15mmol) /H) . Or if using a central intravenous line: 1 ampoule of 10% KCL with 100ml of 0.9% sodium chloride at 100ml/h (13mmol/h). Closely monitor ECG through monitor, dangerous clinical symptoms and repeat ionogram after 1-2 hours. c) Severe hypokalemia: (K+: 2.0 - 2.5 mmol/L) Infuse at an average rate of 60 drops/minute (180ml/h or 7 mmol/h). Closely monitor the ECG through the monitor and repeat the ionogram after 4 hours. Moderate hypokalemia: (K+ 2.5 - 3.0 mmol/L) Infuse at a slow rate of 20 drops/minute (60ml/h or 2.5mmol/h). Take 2 tablets of Potassium Chloride 600mg, 3 times a day (mix in 100-150mL of water). Closely monitor the ECG through the monitor and repeat the ionogram after 6 hours. Conclusions In summary, hypokalemia is a common electrolyte disorder in clinical practice and is often discovered incidentally on blood tests. Although this condition usually responds in well-rounded patients, in patients with concomitant cardiovascular disease, hypokalemia can have serious, life-threatening consequences.
Understanding the mechanism of potassium regulation in the body will help us approach the diagnosis of the cause and treatment of hypokalemia in a timely manner.
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