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Hypokalemia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Defined as a serum potassium level <3.5 mEq/L:

    • Mild: 3–3.5 mEq/L

    • Moderate: 2.5–3 mEq/L

    • Severe: <2.5 mEq/L

  • Frequency:

    • Up to 20% of inpatients have documented hypokalemia (5% have lev...

Diagnosis

Signs and Symptoms

History

  • Neuromuscular:

    • Severe weakness (K <2.5 mEq/L):

      • Begins in the lower extremities and progresses cephalad

    • May progress to paralysis if K <2 mEq/L and rapid developme...

Treatment

Initial Stabilization/Therapy

  • Establish IV access/volume resuscitation

  • ABCs

  • Cardiac monitoring

Ed Treatment/Procedures

  • Total body deficit is 200–300 mEq per 1 mEq/L decrement in serum potassium l...

Follow-Up

Disposition

Admission Criteria

  • Need of IV potassium repletion

  • Cardiac dysrhythmias

  • Profound muscle weakness

  • Ongoing K losses

  • Serum potassium <2.5 mEq/L

  • Associated with significant hypotension or...

Pearls and Pitfalls

  • If hypokalemia is accompanied by acidosis, correct hypokalemia 1st before treating the acidosis so as to avoid life-threatening hypokalemia from transcellular shifts.

  • Minimize gluco...

Additional Reading

  • Alkaabi  JM, Mushtaq  A, Al-Maskari  FN, et al. Hypokalemic periodic paralysis: A case series, review of the literature and update of management. Eur J Emerg Med.  2010;17(1):4...

Codes

ICD9

  • 255.13 Bartter's syndrome

  • 276.3 Alkalosis

  • 276.8 Hypopotassemia

ICD10

  • E26.81 Bartter's syndrome

  • E87.3 Alkalosis

  • E87.6 Hypokalemia

SNOMED

  • 43339004 hypokalemia (disorder)

  • 22774003 Hypokalemic alkalosis ...

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