What organ is affected by low potassium?

Hypokalemia

One of the most common electrolyte disturbances seen in clinical practice is hypokalemia. Hypokalemia is an electrolyte imbalance that is lower than normal level of potassium in the bloodstream. [1] The most common cause is excessive potassium loss in urine due to diuretics, often prescribed for people who have hypertension or heart disease [2] .

A normal blood potassium is 3.6 to 5.2 mmol/L.
Severe and life threatening hypokalemia level is known as

Potassium helps carry electrical signals to cells in your body. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells [2] .

Few people meet the daily recommended potassium intake (3,400 mg for men and 2,600 mg for women), however hypokalemia is rarely caused by dietary deficiency alone. It can be caused by a number of factors, including fluid loss, malnutrition, shock, using certain medications, and medical conditions eg kidney failure. [4]

Etiology [ edit | edit source ]

Potential etiologies resulting in hypokalemia are put into the following categories:

Decreased potassium intake
Transcellular shifts (increased intracellular uptake)
Increased potassium loss (skin, gastrointestinal, and renal losses) [1]

Certain illnesses or other factors more likely the cause of hypokalemia, these include:

Chronic diarrhea.
Certain medications. eg diuretics, beta 2-agonists, theophylline, insulin, corticosteroids, and antibiotics
Eating disorders. eg anorexia nervosa, refeeding syndrome, purging, laxative abuse.
Cushing’s syndrome
Hyperaldosteronism.
Kidney failure and Kidney disorders.
Hypomagnesemia.
Overconsumption of licorice
Excessive sweating

Signs and Symptoms [ edit | edit source ]

Blood test

In most cases, low potassium is found by a blood test that is done because of an illness, or because of diuretics use. It is rare for low potassium to cause isolated symptoms.

Hypokalemia symptoms may include:

Weakness

Fatigue
Muscle cramps
Constipation

Abnormal heart rhythms (arrhythmias) are the most worrisome complication of very low potassium levels, particularly in people with underlying heart disease [5] .

Diagnosis [ edit | edit source ]

ECG Pattern Of Hypokalemia

In severe cases, a 12-lead electrocardiogram may be necessary if to check for cardiac arrythymias. Findings such as T-wave flattening or prominent U waves will result in hospital admission. [6] Other tests may include:

Arterial blood gas
Basic or comprehensive metabolic panel

Blood tests will also be administered to check the following: glucose; magnesium; calcium; sodium; phosphorus; thyroxine; aldosterone levels. [7]

Management [ edit | edit source ]

Magnesium Sulfate IV

The overarching goals of therapy for hypokalemia are to prevent or treat life-threatening complications, replace the potassium deficit, and to diagnose and correct the underlying cause. [1]

Management of the underlying disease or contributing factors constitutes the cornerstone of therapeutic approach. Potassium should be gradually replaced, preferably by oral administration if clinically feasible. In cases of severe/symptomatic hypokalemia and cardiac complications, i.v. administration with continuous ECG monitoring is recommended. In some patients, such as in endocrine related hypokalemia cases, multidisciplinary diagnostic and therapeutic approach is needed. [8]

Though diet alone usually will not resolve hypokalemia, it’s still beneficial to increase intake of potassium-rich foods, like fruits, vegetables, beans, and nuts [4] .
The majority of patients who are treated for hypokalemia have a good outcome but those who remain untreated are at a risk for arrhythmias which may be fatal. [7]

Physical Therapy Management [ edit | edit source ]

Hypokalemia is not managed primarily by a physical therapist. Physical therapists should be mindful of common signs of symptoms of hypokalemia when working with patients.

Potassium levels < 3.2 mEq/L is contraindicated for physical therapy intervention due to the potential for arrhythmia . Due to muscle weakness and cramping, exercise is not effective during the state of hypokalemia.
Patients should be monitored for potassium levels in order to determine the appropriate time to participate in Physical Therapy. [9]

Differential Diagnosis [ edit | edit source ]

Bartter syndrome
Hyperthyroidism and thyrotoxicosis
Hypocalcemia
Hypochloremic alkalosis
Hypomagnesemia
Iatrogenic Cushing syndrome
Metabolic alkalosis

References [ edit | edit source ]

↑ 1.01.11.2 Castro D, Sharma S. Hypokalemia. 2018 Available: https://www.ncbi.nlm.nih.gov/books/NBK482465/(accessed 18.9.2021)
↑ 2.02.1 Mayo clinic Hypokalemia Available:https://www.mayoclinic.org/symptoms/low-potassium/basics/causes/SYM-20050632?p=1 (accessed 3.6.2022)
↑ 3.03.1 Low Potassium(hypokalemia)[Internet]. 2012 August 10 [cited 2013 March 27] Available from:http://www.mayoclinic.com/health/low-potassium/MY00760
↑ 4.04.1 Healthline Hypokalemia Available: https://www.healthline.com/nutrition/potassium-deficiency-symptoms#bottom-line (accessed 3.6.2022)
↑ Mayo Clinic Hypokalemia Available: https://www.mayoclinic.org/symptoms/low-potassium/basics/when-to-see-doctor/sym-20050632 (accessed 19.9.2021)
↑ Hypokalemia [Internet]. 2012 [cited 2013 March 27] Available from:https://www.clinicalkey.com/topics/nephrology/hypokalemia.html#720089
↑ 7.07.1 Hypokalemia [Internet]. 2013 March 22 [cited 2013 March 27] Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm
↑ Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocrine connections. 2018 Apr 1;7(4):R135-46. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/ (accessed 18.9.2021)
↑ Goodman CC. Fuller KS. In K Falk editor. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009. pp.150, 157, 187-189, 480, 558, 927, 1243, 1640-1641

Don’t Ignore These Low Potassium Symptoms

Do you get enough potassium? Potassium plays a vital role in keeping muscles working properly, regulating fluids, helping nerves function and promoting a healthy cardiovascular system.

Feb 22, 2018
Medically Reviewed

You do your best to get plenty of calcium and protein into your body every day. But what about potassium? It likely doesn’t come to mind as an important nutrient, but it should. Potassium plays a vital role in keeping muscles working properly, regulating fluids, helping nerves function and promoting a healthy cardiovascular system.

If your potassium levels get off kilter, it can raise your risk for high blood pressure, kidney stones, lower bone turnover, urinary calcium excretion and salt sensitivity.

It can be tough to tell if you’re getting enough potassium. Low levels are occasionally caused by poor diet, but more often by loss of potassium because of vomiting, diarrhea, use of certain prescription medications including diuretics (also known as water pills), overuse of laxatives, excessive sweating, or other conditions affecting the gastrointestinal tract and kidneys.

You might not notice any physical symptoms. And routine tests don’t check for potassium deficiency. Here are a few signs that you’re lacking potassium. If you experience any of these signals and can’t figure out what’s behind them, ask your health care provider to check your potassium levels. Low potassium, known medically as hypokalemia, can be detected with blood and urine tests.

You’re weak and tired.
When you’re potassium deficient, you’ll feel it in your muscles. Yes, a slew of reasons can cause low energy levels. But if you’ve been getting plenty of sleep and still not feeling right, examine what you eat. You need potassium for muscle construction and contraction. Try eating more potassium-rich fruits and veggies. Good potassium veggie sources include spinach, broccoli, carrots, sweet and white potatoes and red peppers. Fruit sources include bananas, strawberries, oranges, mangoes, kiwis and apricots.

You have high blood pressure.
Indeed, family history, OD-ing on salt and being overweight can affect your blood pressure. But, so can potassium. But, rather than reducing intake as you would with salt, most people need to eat more potassium-rich foods. Potassium helps relax blood vessels. If you don’t have enough potassium, blood vessels can become constricted. That causes blood pressure rates to rise. Read more about high blood pressure.

You have muscle cramps.
Muscles need enough potassium for smooth muscle contraction. So, if your levels go below a certain point, you may get muscle cramps. You may experience aches and spasms, too. Don’t miss what to do when muscle cramps strike.

You’re constipated.
Low potassium levels can slow your digestive system. You may also be bloated and have abdominal cramping. Find out five surprising constipation triggers.

You eat a lot of junk food.
If you maintain a poor, unbalanced diet, you could end up with a potassium deficiency. Eating too many processed foods and junk foods puts you at risk for lower potassium levels. All those chips, frozen meals and crackers are loaded with sodium. The more sodium you consume, the more potassium your body excretes. So, cut back on salt to help retain more of the potassium you’re eating. Eat more potassium-rich fruits and veggies (see above). Other good sources of potassium are yogurt, avocados, sun-dried tomatoes, sardines, grilled steak, orange juice, halibut, flounder, tuna, clams and salmon. Serve your family these chicken cutlets with broccoli rabe and mozzarella, which contain sun-dried tomato slivers.

You have irregular heart rhythms.
This problem, also known as arrhythmia, is a serious complication of very low potassium levels and can cause a cardiac emergency, particularly in people with heart disease. Seek medical care immediately if you experience abnormal heart rhythms.

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Low Potassium (Hypokalemia)

Potassium is a mineral (electrolyte) in the body that is important to maintain several bodily functions.

Potassium is a mineral (electrolyte) in the body. Almost 98% of potassium is found inside the cells. Small changes in the level of potassium that is present outside the cells can have severe effects on the heart, nerves, and muscles.

Potassium is important to maintain several bodily functions:

Muscles need potassium to contract.
The heart muscle needs potassium to beat properly and regulate blood pressure.

The kidney is the main organ that controls the balance of potassium by removing excess potassium into the urine.

When potassium levels are low (hypokalemia), you can become weak as cellular processes are impaired.

Normal potassium levels are around 3.5-5.0 mEq/L (mEq/L stand for milliequivalents per liter of blood and this is a unit measure used to evaluate the level). Low potassium is defined as a potassium level below 3.5 mEq/L.
Almost 1 out of 5 people hospitalized in the United States has a low potassium level.
People with eating disorders such as anorexia nervosa and bulimia, patients with AIDS, alcoholics, and those who have had bariatric surgery have a higher incidence of hypokalemia than others.

What Causes Low Potassium?

Low potassium can occur for many reasons. Use of water pills (diuretics), diarrhea, and chronic laxative abuse are the most common causes of low potassium levels. Illness and other medications may also lower potassium levels. Risk factors for low potassium include:

Female sex
African-Americans ethnicity

Other causes of hypokalemia include:

Kidney losses

Certain kidney disorders such as renal tubular acidosis (for example, chronic kidney failure and acute kidney failure)
Magnesium deficiency
Leukemia
Cushing’s disease (and other adrenal disorders)

Loss of potassium through stomach and intestines

Vomiting
Enemas or excessive laxative use
Diarrhea
After ileostomy operation

Side effect of medications

Water pills (diuretics)
Medicines used for asthma or emphysema (beta-adrenergic agonist drugs such as bronchodilators, steroids, or theophylline)
Aminoglycosides (a type of antibiotic)

Shifting of potassium into and out of cells

Use of insulin
Certain metabolic states (such as alkalosis)

Decreased food intake or malnutrition

What Are Symptoms of Low Potassium?

Symptoms of low potassium are typically mild and sometimes vague. There may be more than one symptom involving the gastrointestinal (GI) tract, kidneys, muscles, heart, and nerves:

Weakness, tiredness, or cramping in arm or leg muscles, sometimes severe enough to cause inability to move arms or legs due to weakness (much like a paralysis)
Tingling or numbness
Nausea or vomiting
Abdominal cramping, bloating
Constipation
Palpitations (feeling your heart beat irregularly)
Passing large amounts of urine or feeling thirsty most of the time
Fainting due to low blood pressure
Abnormal psychological behavior: depression, psychosis, delirium, confusion, or hallucinations

When to Seek Medical Care for Low Potassium

If you are having symptoms of low potassium, call your doctor. If you have muscle cramps, weakness, palpitations, or feel faint and you are taking a diuretic (water pill), contact your healthcare professional or go to an urgent care facility or hospital emergency department immediately.

Without symptoms, you will not know you have low potassium levels until you have a routine blood test or an electrocardiogram (ECG, EKG).

How Is Low Potassium Diagnosed?

Sometimes the cause of low potassium is unclear. Your doctor may perform certain tests to rule out other conditions such as renal tubular acidosis, Cushing syndrome, and hypocalcemia:

If an electrolyte imbalance is suspected, blood tests will be ordered check potassium levels, kidney function (BUN and creatinine), glucose, magnesium, calcium, and phosphorous if an electrolyte imbalance is suspected.
Because low potassium is known to affect heart rhythms (arrhythmias), your doctor may order a digoxin (Lanoxin) level if the patient is taking a digitalis preparation.
ECG or a heart tracing is done to detect electrical changes in the heart and certain types of irregular heart rhythms that may be caused by low potassium.

What Home Remedies Can Help Treat Low Potassium?

If you are monitoring low potassium levels, avoid long, strenuous physical activities because loss of potassium occurs with sweating.

If dietary supplements, herbal supplements, diuretics (water pills), or laxatives are causing the low potassium symptoms, avoid taking these products and talk to your doctor. Never stop taking a prescribed medication without first consulting your doctor.

How Is Low Potassium Treated?

Potassium replacement therapy will be directed by the type and severity of the patient’s symptoms. Treatment begins after lab tests confirm the diagnosis.

Medical Treatment

People suspected of having severely low potassium need to be placed on a cardiac monitor and have an IV started.
Usually, those with mild or moderately low potassium levels (2.5-3.5 mEq/L), who have no symptoms, or who have only minor complaints only need to be treated with potassium given in pill or liquid form. This is preferred because it is easy to administer, safe, inexpensive, and readily absorbed from the gastrointestinal tract. Some preparations, or too high of a dose, may irritate the stomach and cause vomiting.
If cardiac arrhythmias or significant symptoms are present or if the potassium level is less than 2.5 mEq/L, IV potassium should be given. In this situation, admission or observation in the emergency department is indicated. Replacing potassium takes several hours as it must be administered very slowly intravenously to avoid serious heart problems and avoid irritating the blood vessel where the IV is placed.
For those with severely low potassium and symptoms, both IV potassium and oral medication are necessary.

Precautions

When potassium is used with medications such as ACE inhibitors, there is a risk of developing a high level of potassium.
Potassium-sparing diuretics and potassium-containing salt substitutes can also result in high potassium levels.

What Is the Follow-up for Low Potassium?

Usually doctors recommend a certain dosage of potassium supplementation and arrange to have a repeat blood level taken 2-3 days later.

Your doctor may consider switching to potassium-sparing diuretics (water pills) if the patient needs to continue taking diuretics for another condition.

How Can You Prevent Low Potassium Levels?

Diet changes may be recommended if the patient is likely to develop low potassium levels. Examples of foods high in potassium include:

Bananas
Tomatoes
Oranges
Cantaloupes
Peaches

Do not overuse diuretics (water pills), and never use someone else’s medications.

If you are taking medication, ask your doctor how often electrolyte levels need to be checked.

What Is the Prognosis for Low Potassium?

Low potassium is treatable. The reason for the low potassium must be identified, or it will most likely reoccur. With the right therapy, there are typically no further problems.

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What Are Electrolytes?

Are there any risks from low potassium?

Electrolytes are chemicals that the body produces, and the cells in the body need them to function. Examples of electrolytes that the cells need are sodium (Na), potassium (K), and magnesium (Mg).

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