From the Guidelines
Hypokalemia in the absence of recent illness can be caused by primary aldosteronism, a condition where aldosterone production is inappropriately high, leading to increased potassium excretion and potentially causing hypokalemia, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Causes of Hypokalemia
- Certain medications like diuretics (such as hydrochlorothiazide or furosemide), laxatives, or some antibiotics can deplete potassium levels.
- Dietary factors play a significant role—inadequate potassium intake from fruits, vegetables, and other potassium-rich foods can lead to deficiency over time.
- Excessive sweating from intense exercise or hot weather can cause potassium loss through sweat.
- Some chronic conditions like kidney disorders, adrenal gland problems (such as Cushing's syndrome or hyperaldosteronism), or magnesium deficiency can also cause low potassium.
- Excessive alcohol consumption or eating disorders may contribute as well.
Importance of Addressing Hypokalemia
Potassium is crucial for proper muscle and nerve function, and maintaining normal heart rhythm, so addressing low levels is important for overall health.
Diagnosis and Treatment
If you have low potassium, it's essential to consult a healthcare provider for proper diagnosis, as treatment depends on the underlying cause and may include potassium supplements (typically 10-20 mEq doses), dietary changes to include potassium-rich foods like bananas, oranges, potatoes, and spinach, or addressing the underlying condition, as discussed in the expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors 1.
From the FDA Drug Label
The most common signs and symptoms observed are those caused by electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. The FDA drug label does not answer the question.
From the Research
Causes of Hypokalemia
- Hypokalemia can be caused by decreased intake, renal losses, gastrointestinal losses, or transcellular shifts 2
- Diuretic therapy is a common cause of potassium deficiency, with factors such as high salt diets, large urine volumes, metabolic alkalosis, increased aldosterone production, and the simultaneous use of two diuretics increasing the incidence or severity of potassium deficiency 3
- Gastrointestinal losses and renal losses are also common causes of hypokalemia 4, 5
- Transcellular shifts, such as those caused by insulin or beta agonists, can also lead to hypokalemia 4, 2
Risk Factors for Hypokalemia
- Patients with hypertension, heart failure, or diabetes are at increased risk of developing hypokalemia 6
- Patients taking diuretics or other medications that increase potassium excretion are also at increased risk 3, 4
- A high salt diet and large urine volumes can increase the risk of hypokalemia in patients taking diuretics 3
Diagnosis and Evaluation of Hypokalemia
- Measurement of spot urine for potassium and creatinine, as well as evaluation of acid-base status, can be used as an initial step in the diagnosis of hypokalemia 5
- Subsequent evaluations, such as measurement of spot urinary chloride, blood pressure, serum aldosterone, renin, and cortisol levels, may be needed in certain circumstances 5
- Electrocardiography can identify cardiac conduction disturbances, but may not correlate with serum potassium levels 4, 2