Electrolyte Imbalance

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Hypokalemia

An abnormally low level of potassium (K+) is called hypokalemia. The adrenal gland makes a hormone (aldosterone) that signals the kidneys to excrete or conserve potassium, based on the body's needs. In hypokalemia, the adrenal gland retains the hormone and the kidneys conserve potassium when more is needed.

Causes
The most common cause of potassium depletion is diuretic medication that increases urination. Diuretics are prescribed for medical conditions and are used in weight-loss programs. Other causes include:

• Diarrhea
• Dietary deficiency
• Excessive sweating
• Magnesium deficiency (causes overexcretion of fluid)

Signs and Symptoms
Symptoms of deficiency include cardiac arrhythmia, muscle pain, general discomfort or irritability, weakness, and paralysis.

Diagnosis
Diagnosis may require urinalysis and blood tests to determine the amount of potassium being excreted by the kidneys.

Treatment
Treatment involves potassium supplements, proper diet, and intravenous (IV) solution. The best way to maintain an adequate potassium level is to eat foods such as sweet potatoes, bananas, avocados, spinach, and oranges. Patients taking diuretic medication are also given potassium supplements. Potassium is given slowly to avoid hyperkalemia.

Hyperkalemia

An abnormally high level of potassium is called hyperkalemia. Potassium is released into the blood when cells are damaged.

Causes
Conditions that cause hyperkalemia include:

• Burn
• Chemotherapy
• Hemolysis (red blood cell destruction caused by infection or burn)
• Rhabdomyolysis (destruction of skeletal muscle; associated with acute tubule necrosis, or ATN)
• Strenuous exercise (rarely)

Urinary excretion of potassium can be impaired by the following:

• Acute renal failure (ARF)
• Chronic renal failure (CRF)
• Impaired aldosterone release or production
• Medications that decrease potassium excretion:
  • Amiloride (diuretic)
  • Bactrim® (antibiotic)
  • Cyclosporine (immunosuppressive)

Signs and Symptoms
Hyperkalemia affects the heart and causes electrocardiogram (EKG) changes, ventricular fibrillation, and cardiac arrest. Other symptoms include tingling in the extremities, weakness, and numbness.

Treatment
Treatment of low-grade hyperkalemia may involve diuretics and calcium given intravenously to promote potassium excretion. Insulin is given with glucose to help cell absorption of potassium, and albuterol may be added to increase absorption. Drugs that bind to potassium, such as Kayexalate®, force potassium into the intestine to be excreted.

Some drugs used to treat electrolyte imbalance may be unsafe for pregnant women and should not be taken without consulting a physician.

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