Hypokalemia history and symptoms

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.

A detailed history can help interpret the cause of hypokalemia.

Malnutrition: lack of adequate calorie intake

The severity of symptoms depends on the degree of hypokalemia, but keep in mind that there is marked individual variability ^[1]^[2]^[3]^[4].

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.

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

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

↑ 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.