Emergency: requires immediate attention
Hypokalemia
Alerts and Notices
Synopsis
Conditions that contribute to K+ losses are excessive K+ urinary output and prolonged vomiting or diarrhea. Other causes include laxative abuse, diuretics, salicylates, tumors (ie, VIPoma, villous adenoma), burns, malnutrition, alcohol use disorder, excessive sweating, jejunoileal bypass, and renal tubular disease. Chemotherapy and radiation as well as a variety of medication classes can contribute to excessive potassium loss. These include bronchodilators, caffeine, mineralocorticoids, glucocorticoids, and penicillin in high doses. Excessive consumption of natural licorice is a less common cause.
Conditions that contribute to increased transfer of potassium into the cells are excessive insulin, insulin administered with dextrose or glucose (rather than saline solution), refeeding syndrome, and other drug-induced agents that elevate beta-adrenergic activity. Additional causes include hypothermia, alkalosis, increased extracellular pH, and toxicity of chloroquine, barium, and similar agents. Hypokalemic periodic paralysis is an autosomal dominant inherited disorder that can cause episodic muscle weakness when K+ levels are low.
Conditions that contribute to decreased K+ intake include potassium-deficient diet, parenteral therapy, and malnutrition. These conditions are usually seen in combination with other factors in patients with hypokalemia.
Codes
ICD10CM:E87.6 – Hypokalemia
SNOMEDCT:
43339004 – Hypokalemia
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Potential factors associated with hypokalemia include the following.Gastrointestinal:
- Vomiting
- Diarrhea
- Laxative use
- Fistula
- Tumor – villous adenoma
- Refeeding syndrome
- Insufficient potassium absorption – jejunoileal bypass
- Low potassium intake – malnutrition, parenteral nutrition
- Renal tubular acidosis – type 1 (distal) or type 2 (proximal)
- Hyperaldosteronism – primary or secondary
- Malignant hypertension
- Hypomagnesemia
- Profuse perspiration
- Bartter syndrome
- Gitelman syndrome
- Liddle syndrome
- Hereditary and acquired Fanconi syndrome
- EAST syndrome (epilepsy, ataxia, sensorineural deafness, and salt-wasting renal tubulopathy)
- Metabolic alkalosis / alkalemia
- Hyperthyroidism
- Cushing syndrome
- Diabetic ketoacidosis – secondary to treatment with insulin
- Hypothermia
- Tumors – VIPoma (WDHA syndrome [watery diarrhea, hypokalemia, and achlorhydria]), insulinoma
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:07/25/2019
Last Updated:01/31/2023
Last Updated:01/31/2023
Emergency: requires immediate attention
Hypokalemia