Hypokalemia, also spelled hypokalaemia, is a low level of potassium (K+) in the blood serum. The normal range of plasma potassium is 3.5 – 5.1 mmol/l. Daily potassium requirements of a 70kg male are 70 mmol compared to a 40kg woman who will need 40 mmol. The Kidneys help keep potassium at the correct levels. Healthy kidneys take excess potassium out of the urine to keep it at a normal level.Hypokalaemia is the most common electrolyte abnormality in hospitalised patients. 

Mild hypokalemia usually does not have many symptoms besides slight rises in blood pressure. With more serious cases of the disease some symptoms are muscles weakness muscle cramps and constipation. In cases with these symptoms the condensation levels are between 2.5-3 mmol/l. A very severe case would be less the 2.0 mmol/l condensation level. Some symptoms of this would be with more severe hypokalaemia, flaccid paralysis, hyporeflexia. and tetany may result.   

Causes of hypokalemia include, medications like furosemide and steroids, dialysis, diabetes insipidus, hyperaldosteronism (co to je?), hypomagnesemia (co to je?), and not enough intake in the diet. Heavy potassium losses come from things like diarrhea or some surgical procedures.

Hypokalaemia can be also life-threatening when severe (<2.5 mmol/L) but is usually well tolerated in otherwise healthy people and patients are often asymptomatic. Consequently, the diagnosis is easily missed and recognition of high risk patients, frequent laboratory monitoring, and prompt treatment is essential to reduce the incidence of hypokalaemic complications. Low levels can also be detected on an electrocardiogram (ECG, Pic. 1). The speed at which potassium should be replaced depends on whether or not there are symptoms or ECG changes. 

Common complications associated with severe hypokalaemia include thirst (43%), paraesthesias (38%), muscle weakness (14%), and muscle cramps (7%). 

It increases also the risk of an abnormal heart rhythm, which are often too slow, and can cause cardiac arrest. The incidence of ventricular fibrillation (heart rhytm problem) has been found to be fivefold higher in patients with hypokalaemia than in patients with hyperkalaemia (high potassium levels). 

Treatment including addressing the cause, such as improving the diet, treating diarrhea, or stopping an offending medication. Mildly low levels can be managed with changes in the diet. For very serious cases of hypokalemia doctors use sodium chrloride. The thing about that is it increases the heart rate to an unsafe level so doctors have to monitor the patient very carfully. People without a significant source of potassium loss and who show no symptoms of hypokalemia may not require treatment.

Symptoms

  • weakness
  • fatigue
  • paralysis and rhabdomyolysis (rapid destruction of skeletal muscle)
  • respiratory difficulty
  • constipation/ileus
  • leg cramps

Associated diseases

  • cardiovascular disease (CVD)
  • anorexia nervosa 
  • diarrhea
  • acquired immune deficiency syndrome (AIDS) 

Complications

Cardiovascular disease

Deviations to both extremes (hypo- and hyperkalaemia) are related to an increased risk of cardiac complications. Potassium levels below 3.0 mmol/l may cause heart complications. Those at particular risk are patients with cardiac ischemia (heart muscle receives insufficient blood flow), heart failure, and left ventricular hypertrophy (thickening of the heart muscle of the left ventricle of the heart), in whom even mild-to-moderate hypokalaemia increases the likelihood of cardiac arrhythmias (irregular heartbeat). 

Pregnancy complications

Hypokalemic periodic paralysis is one form of periodic paralysis, a rare group of disorders that can cause of sudden onset weakness. High blood pressure (hypertension) is another complication that can arise during pregnancy because of hypokalemia.

Risk factors

  • oral contraceptives
  • alcohol drinking
  • cigarette smoking
  • athletics
  • heart failure
  • nephrotic syndrome (collection of symptoms due to kidney damage)

Prevention

As a general rule, it is suggested to eat a whole food, balanced diet as the way to consume the nutrients necessary for optimal health. Balanced diet may help to full daily intake of potassium.

Male fertility

Hypokalemia may lead to male infertility, as potassium constitutes a vital element of seminal fluid. The seminal plasma provides a nutritive and protective medium for the spermatozoa during their journey through the female reproductive tract. The normal environment of the vagina is a hostile one for sperm cells, as it is very acidic, viscous, and patrolled by immune cells. The components in the seminal plasma attempt to compensate for this hostile environment and to ensure proper fertilization.

Female fertility

Potassium deficiency is considered to be one of the major factors that contribute to the formation of ovarian cysts. Ovarian cyst are generally associated with irregularities in menstruation, which can lead to irregular ovulation. Without regular ovulation every month, there is lower possibility of natural conception. Without egg which is released during ovulation from ovary, the conception will not occur.

As a potentially life threatening condition, quality care of patients with hypokalaemia is paramount. Taking potassium supplements can usually correct the problem and lower the complications such as infertility. In severe cases, without proper treatment a severe drop in potassium levels can lead to serious heart rhythm problems that can be fatal.

Sources

Hypokalemia ―sourced from Wikipedia licensed under CC BY-SA 3.0
Semen ―sourced from Wikipedia licensed under CC BY- SA 3.0
Ovarian cysts ―sourced from Fertilitypedia licensed under CC BY-SA 4.0
Hypokalemia natural history ―sourced from Wikidoc licensed under CC BY-SA 3.0
Hypokalemia ―by Zack and Kevin licensed under CC BY 3.0
ECG Pattern Of Hypokalemia ―by unknown licensed under CC BY-SA 3.0
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