Hypokalemia history and symptoms

; Associate Editor-In-Chief: ; Assistant Editor(s)-In-Chief: Jack Khouri

Symptoms
The severity of symptoms depends on the degree of hypokalemia, but keep in mind that there is marked individual variability.

Constitutional

 * Fatigue
 * Weakness
 * Vomiting
 * Constipation
 * Muscle cramps and paralysis (the lower extremity muscles are most commonly involved) which may involve the intestine and cause ileus
 * Respiratory muscle weakness leading to respiratory failure

Cardiac

 * Hypertension
 * Arrhythmias including premature atrial and ventricular complexes, paroxysmal atrial or junctional tachycardia and even ventricular tachycardia or fibrillation
 * Heart block
 * Digoxin therapy, CAD and left ventricular hypertrophy potentiate hypokalemia effects on the heart

Renal

 * Nephrogenic diabetes insipidus due to decreased concentrating ability. As a consequence, the patient presents with polyuria and polydipsia
 * Increased bicarbonate reabsorption
 * Increased ammonia formation which may precipitate hepatic encephalopathy in cirrhotic patients
 * Decreased sodium reabsorption resulting in hyponatremia

Other

 * Rhabdomyolysis
 * Hyperglycemia

History
A detailed history can help depict the cause of hypokalemia.

Dietary history
Malnutrition: lack of meat and fruit intake

Medication history

 * Diuretics (loop and thiazides)
 * Beta agonists
 * Chloroquine
 * Theophylline
 * Insulin
 * Corticosteroids
 * Licorice
 * Nephrotoxic drugs (platinum-based chemotherapy, aminoglycosides)
 * Laxatives

Past medical history

 * Uncontrolled diabetes
 * Hyperthyroidism
 * Pernicious anemia
 * COPD (treated with Beta agonists and theophylline)
 * Cushing’s disease
 * Periodic paralysis
 * Ileostomy/short bowel
 * Primary hyperaldosteronism
 * Liddle syndrome
 * Bartter and Gitelman syndrome
 * Prolonged starvation
 * Cancer
 * Renal tubular acidosis type I and type II