What are the causes of hypokalemia (low potassium levels)?

From the Guidelines

Hypokalemia is most commonly caused by diuresis, administration of potassium-free intravenous fluids, potassium loss from vomiting and diarrhea, and other endocrine and renal mechanisms. According to the American Heart Association, hypokalemia, defined as K<3.5 mEq/L, can result from various factors, including 1. The causes of hypokalemia can be broken down into several key categories:

• Excessive fluid loss:
  • Diarrhea
  • Vomiting
  • Diuresis
• Medication-related:
  • Potassium-free intravenous fluids
  • Certain diuretics
• Endocrine and renal mechanisms:
  • Hormonal imbalances, such as hyperaldosteronism
  • Kidney problems, including conditions that impair renal function It is essential to note that hypokalemia can have severe consequences, including cardiac arrhythmias and muscle weakness, emphasizing the need for prompt identification and treatment 1. To manage hypokalemia, it is crucial to address the underlying cause, and in some cases, potassium supplements may be necessary under medical supervision.

From the FDA Drug Label

Hypokalemia may develop with Furosemide tablets, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives. Hypokalemia may develop, especially with brisk diuresis when severe cirrhosis is present, during concomitant use of corticosteroid or adrenocorticotropic hormone (ACTH) or after prolonged therapy. Interference with adequate oral electrolyte intake will also contribute to hypokalemia

The causes of hypokalemia (low potassium levels) include:

• Brisk diuresis
• Inadequate oral electrolyte intake
• Cirrhosis
• Concomitant use of
  • Corticosteroids
  • Adrenocorticotropic hormone (ACTH)
  • Licorice in large amounts
  • Prolonged use of laxatives 2 3

From the Research

Causes of Hypokalemia

The causes of hypokalemia can be categorized into several factors, including:

• Decreased intake: Inadequate dietary intake of potassium can lead to hypokalemia, especially if it occurs over an extended period 4.
• Renal losses: Increased renal excretion of potassium can cause hypokalemia, which can be due to various factors such as diuretic use, kidney disease, or abnormalities of the pituitary-adrenal axis 5, 6, 7.
• Gastrointestinal losses: Potassium wasting through the gastrointestinal tract, such as through diarrhea or vomiting, can lead to hypokalemia 5, 6, 7.
• Transcellular shifts: Potassium can shift from the extracellular space to the intracellular space, leading to hypokalemia, which can be caused by various factors such as insulin, beta-agonists, or alkalosis 6, 8.
• Medications: Certain medications, such as diuretics, can increase potassium excretion and lead to hypokalemia 5, 6, 7.
• Other factors: Hypokalemia can also be caused by other factors, such as magnesium deficiency, which can increase renal potassium excretion 4.

Risk Factors

Certain individuals are at increased risk of developing hypokalemia, including:

• Patients with hypertension, heart failure, or diabetes 5.
• Patients on diuretic therapy 5, 6, 7.
• Patients with kidney disease or renal disorders 6, 7.
• Patients on peritoneal dialysis, especially pediatric patients 4.