What are the guideline sources, guidelines and references for Hypokalemia ?
Guideline sources The following summarized guidelines for the evaluation and management of hypokalemia are prepared by our editorial team based on guidelines from the American Association of Family Physicians (AAFP 2015) and the National Council on Potassium in Clinical Practice (NCPCP 2000). 1 2 2 2 2 2 2 Definition Hypokalemia refers to the presence of serum potassium levels < 3.6 mmol/L. 2 Epidemiology Potassium depletion occurs due to inadequate dietary intake, increased renal excretion (e.g. due to diuretic therapy), or increased gastrointestinal losses in the context of diarrhea. 2 Pathophysiology Hypokalemia is the most common electrolyte disorder encountered in clinical practice. 2 Disease course Manifestations of hypokalemia include muscle weakness, ileus, and cardiac arrhythmias. Typical electrocardiographic changes include flat or inverted T waves, ST-segment depression, and prominent U waves. 2 Prognosis and risk of recurrence https://web.pathway.md/diseases/recJkzF5VNUOm60du 1/3 6/24/23, 12:47 PM Hypokalemia Pathway Severe untreated hypokalemia can lead to rhabdomyolysis and malignant cardiac arrhythmias, such as VT and VF. 2 Guidelines 1. Diagnostic investigations Measurement of potassium levels: Use serum potassium as the most convenient laboratory test to establish the diagnosis if hypokalemia, recognizing that it is not always an accurate indicator of total body potassium. E Consider measurement of 24-hour urinary potassium excretion as a more appropriate indicator of total body potassium in patients who are at high risk of complications from hypokalemia, such as those with HF. E 2. Medical management General principles: Initiate potassium replacement in individuals who are subject to nausea, vomiting, diarrhea, bulimia, or diuretic/laxative abuse. E Administer potassium supplements are best administered PO in a moderate dosage over a period of days to weeks to achieve full repletion of potassium. E Electrocardiographic monitoring: consider electrocardiographic monitoring in patients with severe hypokalemia (serum potassium < 2.5 mmol/L). C Intravenous potassium replacement: Intravenous potassium should be reserved for patients with: serum potassium < 2.5 mmol/L hypokalemic ECG changes physical signs or symptoms of hypokalemia inability to tolerate the oral form. B Oral potassium replacement: Consider using a dosage of 20 mmol/day of potassium in oral form for the prevention of hypokalemia. E Consider using a dosage of 40 to 100 mmol/day of potassium in oralform for for the tratment of hypokalemia. E Optimization of patient adherence: Use the simplest regimen possible for potassium supplementation, in order to optimize long- term compliance. E Consider using compliance-enhancing regimens, such as microencapsulated potassium, in order to increase patient adherence to potassium supplementation. E https://web.pathway.md/diseases/recJkzF5VNUOm60du 2/3 6/24/23, 12:47 PM Hypokalemia Pathway 3. Nonpharmacologic interventions Dietary considerations: initiate potassium replacement therapy in combination with dietary consumption of potassium-rich foods. E 4. Specific circumstances Patients with hypertension: Initiate potassium supplementation in patients with drug-related hypokalemia (such as therapy with a non-potassium-sparing diuretic). E Maintain serum potassium levels 4.0 mmol/L patients with asymptomatic hypertension. Dietary consumption of potassium-rich foods and potassium supplementation should be instituted as necessary. E Patients with heart disease: As per AAFP 2015 guidelines, maintain serum potassium levels 4.0 mmol/L patients with a history of congestive HF or myocardial infarction. B As per NCPCP 2000 guidelines, consider potassium supplementation routinely in patients with HF, even if the initial potassium determination appears to be normal. E Patients with cardiac arrhythmias: maintain serum potassium levels 4.0 mmol/L patients with cardiac arrhythmias. E Patients at risk of stroke: consider maintaining optimal potassium levels in patients at high risk for stroke, including those with a history of atherosclerotic or hemorrhagic cerebral vascular accidents. E Patients with diabetes mellitus: monitor potassium levels closely monitored in patients with diabetes mellitus, and initiate potassium replacement therapy when appropriate. E References 1. J N Cohn, P R Kowey, P K Whelton et al. New Guidelines for Potassium Replacement in Clinical Practice. Arch Intern Med. 2000 Sep 11;160 16 2429 36. Open 2. Anthony J Viera, Noah Wouk. Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam Physician. 2015 Sep 15;92 6 487 95. Open 3. Ashish R Panchal, Jason A Bartos, Jos G Caba as et al. Part 3 Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142 16_suppl_2 S366 S468. Open https://web.pathway.md/diseases/recJkzF5VNUOm60du 3/3