Hypokalemia-causes

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Hypokalemia-causes

• Decreased K intake
• Low calorie diets rare
• Increased K entry into cells
• Alkalosis
• Increased insulin
• Increased Catecholamines
• Channelopathies
• Increased RBC production
• Hypothermia
• Chlorquine intox

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Hypokalemia

• Increased GI losses
• Vomiting, Diarrhea, NG tube, laxatives
• Increased Urinary losses
• Diuretics
• Mineralocorticoid excess
• Nonreabsorbable ions
• Metabolic acidosis
• HypoMg
• Nephropathies
• Ampho B
• Polyuria
• Licorice

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Hypokalemia

• Increased Sweat Losses
• Dialysis
• Plasmaphoresis

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Presentation

• Neuro muscular K 2-2.5
• Weakness prox gt distal, loss of reflexes
• Cardiac
• Arrhythmias
• EKG
• U waves, prolonged QT, small T wave

Hyper
K
Hypo
T wave
K
K
K
K
K
K
K
K
K
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Familial Periodic Paralysis

• Types
• Hyper Kalemic HyperPP
• Hypo Kalemic HypoPP
• Thyrotoxic- TPP
• Genetic mutation
• Autosomal dominant and sporadic

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Channelopathies

• Inability to find a decent TV program despite
  having cable and 150 channels to chose from.
• Functional disturbances of ion channels in the
  cell membrane
• Flaccid muscle weakness due to under
  excitability of sarcolemma.

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HypoPP

• Rare, potentially fatal episodes of muscle
  weakness
• Asian population
• Acute attacks due to K moving into cells
• Precipitated by exercise, carbs, stress
• K level
• Low
• Normal (low K Rhabdo)
• Often self limiting

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Treating K problems

• ABCs
• IV O2 Monitor
• Stat labs
• Check Mg, CPK, TFTs
• Oral K is good for non life threatening hypoK
• Watch N/V
• Use PO KCl if hypo K is due to loss of Cl

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HypoPP - Rx

• Administer K
• 10-20meq/hr IV (Higher via central line if
  severe)
• 40-60meq PO x2
• Check the K q 15-30min
• Rx thyrotoxicosis w/ propanolol

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HypoPP - Discharge

• Daily oral K does not prevent attacks
• Carbonic anhydrase inhibitors- Acetozolamide
• Low carb diet
• Consult/referral

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Caveats K problems

• 1meq decrease in K represents 300meq deficit
• If hypo K is due to loss
• Remember, 98 of K is in the ICF
• 0.1 drop in pH raises K by 0.6
• Think of acid/base problems
• Is this primary or secondary problem?

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Dangers in Rx PP

• Check the type before starting K
• Must confirm if hypo, hyper or nl
• Remember this is a cellular shift
• Rebound hyper K can occur if you are too
  aggressive w/ K replacement
• Watch for respiratory insufficiency

!
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M U D P I L E S

• Methanol/Ethylene glycol
• Certainly possible
• Pt denied
• No visual sx
• No Ca oxalate xtals
• Woods lamp
• Osm gap

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M U D P I L E S

• Uremia
• BUN/Creat OK
• DKA
• Not a diabetic, Glucose OK
• Paraldahyde
• No pungent odor
• Isoniazid
• No hx TB Rx

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M U D P I L E S

• Lactic Acidosis
• Abd pain -gt dead gut
• Decreased perfusion
• Liver failure
• Alcohols
• Meds
• Inborn errors
• Lactate -gt 27

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M U D P I L E S

• Ethanol - Alcohol Ketoacidosis
• Binge drinker, Not eating
• Salicylates
• No Hx of ASA use

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Hospital Course

• Developed DTs
• C. Dif culture
• Feeding tube placed
• acute alcoholic hepatitis and severe dehydration
  and metabolic disarray with severe hypokalemia,
  hypophosphatemia, hypomagnesemia, acute renal
  failure, lactic acidosis,

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Alcohol ketoacidosis

• Uncommon, often missed
• Binge drinkers

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AKA - 3 factors

• Alcohol intake
• Decreased caloric intake
• Volume depletion

Results in starvation physiology
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AKA

• Decreased caloric intake
• Counter regulatory hormone release
• Epinephrine, cortisol, growth hormone
• Elevated glucagon, decreased insulin
• Promotes lipolysis and fatty acid mobilization
• Volume depletion
• Elevated glucagon, decreased insulin

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AKA

• Alcohol intake
• Oxidation of ETOH-gt -gtacetate
• NAD-gtNADH which raises glucagon, decreases
  insulin
• Promotes betahydoxybutyrate vs acetoacetate
• Decreased gluconeogenisis

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AKA

• Symptoms
• N, V, abd pain
• Dyspnea, tremulousness
• Muscle pain, fever, diarrhea, syncope, Sz
• Physical
• Tacycardia, tachypnea, abdominal pain,
• Hepatomegaly, hypotension

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AKA

• Differential Dx
• Cholecystitis
• Peptic ulcer, gastritis
• Mesenteric ischemia
• Pacreatitis
• Withdrawal syndromes
• Metabolic acidosis
• DKA
• Methanol, Ethylene glycol

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AKA - labs

• pH low, high or nl
• Metabolic acidosis -gt ketones
• Metabolic alkalosis -gt vomiting
• Respiratory alkalosis -gt hyperventilation
• Serum ketones low, high or nl
• Betahydoxybutyrate
• Lytes abnormal
• Lactate mildly elevated

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AKA-treatment

• Volume replace
• Carbohydrate replacement
• D5NS
• Fix electrolyte abnormalities
• K, Mg, acidosis
• Address associated problems
• Withdrawal, Wernikes, GI bleed, hepatitis,
  pancreatitis, pneumonia, rhabdo, etc.

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I have never been lost, but I will admit to being
confused for several weeks.