Hypokalemia is common and can be associated with serious adverse consequences, including paralysis, ileus, cardiac arrhythmias, and death. In a logical, stepwise approach to patients presenting with hypokalaemia or hyperkalaemia the clinician must first recognise circumstances in which the dyskalaemia represents a clinical emergency because therapy then takes precedence over diagnosis. We present a patient with hypertension and hypokalemia secondary to an aldosteroneproducing adenoma that was renin responsive aparr. The hypokalemia is thought to be from the combination of the diuretic effect of caffeine and copious fluid intake, although it may also be related to diarrhea caused by heavy fructose ingestion. A physiologicbased approach to the evaluation of a patient with. Jan 28, 2011 hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. A physiologicbased approach to the treatment of a patient. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Evaluation of syncope in the emergency department micturition, defecation, shaving, or standing for a prolonged period at the time increases the likelihood of a benign cause of syncope. Patients are often asymptomatic, particularly with mild hypokalemia. Scribd is the worlds largest social reading and publishing site.
A handful of published reports describe individuals with severe hypokalemia related to chronic extreme consumption 410 lday of colas. Approach to polyuria free download as powerpoint presentation. A diagnostic approach to a patient with hypokalemia is presented in fig. Algorithm of the diagnostic approach to a patient with hypokalemia.
A prodrome, consisting of nausea and vomiting, warmth, diaphoresis, and pallor, often precedes neurocardiogenic syncope. In some cases, however, the diagnosis is not readily apparent. Approach to the patient with hypertension, unexplained. Downloaded from the american family physician website at. We discussed the sequential approach to the diagnosis of the different subtypes of primary aldosteronism and confirmed the presence of an aparr. The next step to analyse is the rate of excretion of. In most cases, the cause of hypokalemia is apparent from the history and physical examination. A more practical approach is calculation of the urine potassium to creatinine ratio from a spot urine specimen.
A practical and pathophysiologic approach to hypokalemia core. Thiazide and loop diuretics inhibit renal sodium reabsorption, resulting in increased sodium at distal tubule selectively reabsorbed as potassium excreted. Potassium excretion indices in the diagnostic approach to. The most common cause of primary aldosteronism is an aldosteronoma.
It helps muscles to move, cells to get the nutrients. Potassium is a mineral your body needs to work normally. Although obligate urinary sodium losses can approach zero, there is an obligate renal and extrarenal potassium loss estimated to be about 10 to. The evaluation and treatment of hypokalemia are discussed separately. Dec 05, 2019 3 severe hypokalemia plus dka or overdose of betablockercalcium channel blocker hypokalemia itself isnt immediately lifethreatening here, but hypokalemia impedes the ability to provide insulin which is needed for the treatment of dka or for highdose insulin therapy for poisoning. Asymptomatic and mild hypokalemia can be treated with a potassiumrich diet, whereas symptomatic or severe hypokalemia requires oral or iv potassium 8, 9. When evaluating causes of hypokalemia, a physician must also address other underlying causes of the hypokalemia, such as volume depletion and hypomagnesemia. See evaluation of the adult patient with hypokalemia and clinical manifestations and treatment of hypokalemia in adults. Introduction hypokalemia is a common clinical problem, the cause of which can usually be determined from the history as with diuretic use, vomiting, or diarrhea. A more practical approach is calculation of the urine potassiumtocreatinine ratio from a spot urine specimen. Approach to acidosis medical specialties clinical medicine. Pdf hypokalaemia is a common electrolyte disturbance, especially in hospitalized patients. A physiologicbased approach to the evaluation of a. Hypokalemia is when bloods potassium levels are too low.
Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. In addition, a manual search of key journals and abstracts from the major. A practical and pathophysiologic approach to hypokalemia. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Here is the master list linked to all foam free open access medical education lectures from the university of louisville internal medicine residency program. Pdf diagnosis and clinical approach in gitelmans syndrome. Pdf approach to the patient with metabolic alkalosis. Diuretic use and gastrointestinal losses are common. If you continue browsing the site, you agree to the use of cookies on this website. Familial periodic paralysis, andersens syndrome, congenital chloridelosing diarrhea, and cystic fibrosis are genetic causes of hypokalemia with low urine k. Dec 06, 2018 hypokalemia is defined as a condition in which the serum potassium level is less than 3. Results from total body potassium deficit or shifting of serum potassium into intracellular compartment. Severe hypokalemia is defined as a level less than 2. The physiological approach uses the carbonic acidbicarbonate buffer system.
For successful potassium replacement, one should consider the optimal potassium preparation, route of administration, and the appropriate. If the inline pdf is not rendering correctly, you can download the pdf file here. Regardless of which approach to potassium maintenance therapy is used, the most. As a result, the body maintains serum potassium concentration within very narrow limits by tightly regulated feedback and feedforward systems. Practical algorithms for the optimal diagnostic, treatment and followup strategy are presented, while an individualized approach is emphasized. Physiological approach to assessment of acid base disturbances. Disturbances in potassium homoeostasis presenting as low or high serum potassium are common, especially among hospitalised patients. Symptoms depend on degree and duration of hypokalemia. If you have hypokalemia, that means you have low levels of potassium in your blood. Apr 29, 2014 approach to hypokalemia ranjita pallavi internal medicine pgy2 slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Algorithm for the approach to hypokalemia with a high u openi. By far the most common causes of hypokalemia are potassium losses caused by diuretics or gastrointestinal disorders.
Sir, measurement of urinary potassium excretion is very helpful in the differential diagnosis of both hypokalaemia and hyperkalaemia. At first, since this patient never had history of using. Hypokalemia is a common electrolyte disorder, which in serious cases can be life threatening. Approach to acidosis free download as powerpoint presentation. Presentation mode open print download current view. Definition hypokalemia is defined as a persistently low levels of serum potassium lower than 3. Ppt hypokalemia powerpoint presentation free to download. Potassium helps control how your muscles, heart, and digestive system work. Vol 43 number 1 january 2011 diagnosis and clinical approach in gitelmans syndrome this patient came with hypokalemia and paralysis. Hypokalemia occurs when your body loses too much potassium or does not absorb enough from food. A practical and pathophysiologic approach to hypokalemia shihhua lin hypokalemia is not an isolated disease but an associated finding in a vast number of different diseases.
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