From the Guidelines
Hypokalemia debe ser tratada con suplementos de potasio oral o intravenoso, dependiendo de la gravedad y las causas subyacentes, con el objetivo de mantener los niveles de potasio por encima de 3,5 mEq/L. La hipokalemia es una condición médica caracterizada por niveles bajos de potasio en la sangre, específicamente por debajo de 3,5 mEq/L 1. El tratamiento depende de la gravedad y las causas subyacentes. Para la hipokalemia leve (3,0-3,5 mEq/L), se recomiendan suplementos de potasio oral como cloruro de potasio 40-80 mEq diarios en dosis divididas. Para los casos moderados a graves (<3,0 mEq/L) o pacientes sintomáticos, puede ser necesario potasio intravenoso a 10-20 mEq/hora (no excediendo 40 mEq/hora en situaciones críticas) con monitoreo cardíaco.
Algunas de las causas subyacentes de la hipokalemia incluyen:
- Diuresis excesiva
- Administración de fluidos intravenosos sin potasio
- Pérdida de potasio por vómitos y diarrea
- Mecanismos endocrinos y renales
Es esencial abordar estas causas subyacentes, lo que puede incluir:
- Suspensión de diuréticos
- Corrección de la deficiencia de magnesio
- Tratamiento de condiciones como el síndrome de Cushing o el hiperaldosteronismo
Las modificaciones dietéticas para aumentar la ingesta de potasio a través de alimentos como plátanos, naranjas y papas pueden ayudar a mantener los niveles después de la corrección. El potasio es crucial para la función nerviosa y muscular adecuada, particularmente para el músculo cardíaco, y la hipokalemia puede llevar a complicaciones peligrosas, incluyendo arritmias cardíacas, debilidad muscular y, en casos graves, insuficiencia respiratoria. El monitoreo regular de los niveles de potasio durante el tratamiento es importante para prevenir la sobre corrección, que puede llevar a hiperkalemia 1.
From the FDA Drug Label
For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxication, and in patients with hypokalemic familial periodic paralysis. The use of potassium salts in patients receiving diuretics for uncomplicated essential hypertension is often unnecessary when such patients have a normal dietary pattern and when low doses of the diuretic are used Serum potassium should be checked periodically, however, and if hypokalemia occurs, dietary supplementation with potassium-containing foods may be adequate to control milder cases. In more severe cases, and if dose adjustment of the diuretic is ineffective or unwarranted, supplementation with potassium salts may be indicated.
Hipokalemia treatment involves the use of potassium salts, such as potassium chloride.
- Indications for potassium chloride include the treatment of patients with hypokalemia with or without metabolic alkalosis.
- Supplementation with potassium salts may be indicated in more severe cases of hypokalemia, or if dose adjustment of the diuretic is ineffective or unwarranted.
- Dietary supplementation with potassium-containing foods may be adequate to control milder cases of hypokalemia 2. Metabolic acidosis requires treatment with an alkalinizing potassium salt, such as potassium bicarbonate, potassium citrate, potassium acetate, or potassium gluconate 2.
From the Research
Definition and Causes of Hipokalemia
- Hipokalemia is defined as a serum potassium level less than 3.5 mEq per L 3
- It can be caused by decreased intake, renal losses, gastrointestinal losses, or transcellular shifts 3
- Other studies also suggest that hipokalemia can be caused by impaired renal excretion, transcellular shifts, or increased potassium intake, although these are more commonly associated with hyperkalemia 4, 5, 6
Symptoms and Diagnosis of Hipokalemia
- Symptoms of hipokalemia can include muscle weakness, fatigue, and constipation, with more severe cases leading to muscle necrosis, paralysis, cardiac arrhythmias, and impaired respiration 4, 5
- Diagnosis of hipokalemia is typically made through measurement of serum potassium levels, with values below 3.5 mEq per L indicating hipokalemia 3
- Urinary potassium wasting can also be an indicator of hipokalemia, and can be caused by pathophysiologic conditions that couple increased distal sodium delivery with increased plasma aldosterone levels or aldosterone-like effects 6
Treatment of Hipokalemia
- Treatment of hipokalemia typically involves replenishing potassium levels, either through oral or intravenous routes 3, 5, 7
- The speed and extent of potassium replacement should be dictated by the clinical picture and guided by frequent reassessment of serum potassium concentration 5
- Oral replacement is preferred except when there is no functioning bowel or in the setting of electrocardiogram changes, neurologic symptoms, cardiac ischemia, or digitalis therapy 5, 7
- Potassium-sparing diuretics may also be helpful in cases where renal potassium clearance is abnormally increased 5