From the Research
Intravenous Corrections for Severe Hypokalemia
- For patients with severe hypokalemia, intravenous potassium replacement is recommended during cardiac monitoring, especially for those with marked symptoms, ECG abnormalities, or severe hypokalemia (level less than 3.0 mEq/L) 1.
- Intravenous calcium is administered to patients with hypokalemic electrocardiography changes to prevent cardiac conduction disturbances 2.
Oral Corrections for Severe Hypokalemia
- Oral replacement is preferred for asymptomatic patients with less severe hypokalemia (level greater than 2.5 mEq/L) and a functioning gastrointestinal tract 3, 4.
- Oral liquid potassium chloride is optimal for inpatient use due to its rapid absorption and subsequent increase in serum potassium levels 5.
- The speed and extent of potassium replacement should be dictated by the clinical picture and guided by frequent reassessment of serum potassium concentration 4.
General Considerations
- The underlying cause of hypokalemia should be addressed, and potassium levels replenished 3.
- For both hypokalemia and hyperkalemia, it is essential to consider potential causes of transcellular shifts because patients are at increased risk of rebound potassium disturbances 2.
- Drug regimens should be reevaluated, and hypokalemia- or hyperkalemia-causing drugs should be discontinued when possible 1.