SIGNS AND SYMPTOMS OF HYPOKALEMIA

SYMPTOMS Seldom occur unless the plasma K+ conc is <3mmol/L Fatigue, myalgia, and muscular weakness of the lower extremities Palpitations; constipation; nausea or vomiting; abdominal cramping; polyuria, nocturia, or polydipsia; psychosis, delirium, or hallucinations; depression Severe hypokalemia may lead to progressive weakness, hypoventilation and eventually complete paralysis Hypokalemic periodic paralysis Patients are often asymptomatic, particularly with mild hypokalemia. Symptoms are often due to the underlying cause of the hypokalemia rather than the hypokalemia itself. Hypokalemia should be suggested by a constellation of symptoms that involve the GI, renal, musculoskeletal, cardiac, and nervous systems. The clinical manifestations of K depletion vary between individual and severity depends on degree of hypokalemia. Fatigue, myalgia, and muscular weakness of the lower extremities – common complaints; due to a lower (more negative) resting membrane potential. Hypoventilation due to respi muscle involvement. states can potentially result in hypokalemia due to a K shift into cells. This may occur following rapid cell growth seen in px with pernicious anemia treated with Vit B12 or with neutropenia after tx with granulocyte-macrophage colony stimulating factor

SIGNS Signs of ileus Hypotension Ventricular arrhythmias Cardiac arrest Bradycardia or tachycardia Premature atrial or ventricular beats Hypoventilation, respiratory distress Respiratory failure Lethargy or other mental status changes Decreased muscle strength, fasciculations, or tetany Decreased tendon reflexes Cushingoid appearance (eg, edema) http://emedicine.medscape.com/article/767448-overview Potassium affects the way neuromuscular cells discharge energy (depolarize) and then regenerate (repolarize) that energy to be able to fire again. When potassium levels are low, the cells cannot repolarize and are unable to fire repeatedly, as is needed for the function of muscles and nerves.

ADVERSE MEDICAL IMPLICATIONS OF THIS CONDITION

Hypokalemia Impaired muscle metabolism and blunted hyperemic response to exercise associated with profound K+ depletion increase the risk of rhabdomyolysis Smooth muscle function may also be affected and manifest as paralytic ileus ECG changes: Early changes: T wave flattening or inversion, prominent U wave, ST segment depression, prolonged QU interval Severe K+ depletion: prolonged PR interval, decreased voltage and widening of QRS complex, and an increased risk of ventricular arrythmias (px with Myocardial Ischemia or left ventricular hypertrophy) Predispose to digitalis toxicity Associated with acid-base disturbances related to the underlying disorder Intracellular acidification and an increase in net acid excretion or new HCO3- production: consequence of enhanced proximal HCO3- reabsorption, increased renal ammoniagenesis, and increased distal H + secretion → generation of metabolic alkalosis Glucose intolerance attributed to either impaired insulin secretion or peripheral insulin resistance. ECG changes are due to delayed ventricular repolarization and do not correlate well with plasma K conc. Since the heart is also a muscle, there can be some changes in the electrocardiogram(EKG or ECG) that are associated with hypokalemia, especially in the repolarization section of the EKG tracing. Palpitations (irregular heartbeats) may be perceived by the patient. In severe cases, hypokalemia can lead to dangerous disturbances in heart rhythm (arrhythmias).

Hypokalemic periodic paralysis: rare condition characterized by recurrent episodic weakness or paralysis. Since K is the major ICF cation, anabolic