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Pathophysiology and management of hypokalemia: a clinical perspective

Abstract

Potassium (K+) ions are the predominant intracellular cations. K+ homeostasis depends on external balance (dietary intake [typically 100 mmol per day] versus excretion [95% via the kidney; 5% via the colon]) and internal balance (the distribution of K+ between intracellular and extracellular fluid compartments). The uneven distribution of K+ across cell membranes means that a mere 1% shift in its distribution can cause a 50% change in plasma K+ concentration. Hormonal mechanisms (involving insulin, β-adrenergic agonists and aldosterone) modulate K+ distribution by promoting rapid transfer of K+ across the plasma membrane. Extrarenal K+ losses from the body are usually small, but can be marked in individuals with chronic diarrhea, severe burns or prolonged sweating. Under normal circumstances, the kidney's distal nephron secretes K+ and determines final urinary excretion. In patients with hypokalemia (plasma K+ concentration <3.5 mmol/l), after the exclusion of extrarenal causes, alterations in sodium ion delivery to the distal nephron, mineralocorticoid status, or a specific inherited or acquired defect in distal nephron function (each of which affects distal nephron K+ secretion), should be considered. Clinical management of hypokalemia should establish the underlying cause and alleviate the primary disorder. This Review aims to inform clinicians about the pathophysiology and appropriate treatment for hypokalemia.

Key Points

  • Hypokalemia is common and generally limited; however, the condition can be life threatening

  • Understanding the basis of potassium (K+) distribution in the body is the first step in the diagnosis of hypokalemia

  • Levels of insulin, adrenergic activity, aldosterone, Na+,K+-ATPase activity, pH and osmolality can shift the internal distribution of K+ ions

  • Extrarenal losses, such as diarrhea or excess sweating, are generally (though not always) obvious

  • Renal losses of K+ ions are often an adverse effect of therapy

  • Successful treatment of hypokalemia requires the primary cause to be established and the underlying problem to be addressed

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Figure 1: Distribution of K+ in the body.
Figure 2: Cellular shifts in K+.
Figure 3: Renal K+ handling.
Figure 4: K+ secretion by principal cells.
Figure 5: A clinical algorithm for investigating hypokalemia.

References

  1. 1

    Paltiel, O., Salakhov, E., Ronen, I., Berg, D. & Israeli, A. Management of severe hypokalemia in hospitalized patients: a study of quality of care based on computerized databases. Arch. Intern. Med. 161, 1089–1095 (2001).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  2. 2

    Crop, M. J., Hoorn, E. J., Lindemans, J. & Zietse, R. Hypokalaemia and subsequent hyperkalaemia in hospitalized patients. Nephrol. Dial. Transplant. 22, 3471–3477 (2007).

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3

    Widodo, D., Setiawan, B., Chen, K., Nainggolan, L. & Santoso, W. D. The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto Mangunkusumo Hospital, Jakarta. Acta Med. Indones. 38, 202–205 (2006).

    PubMed  PubMed Central  Google Scholar 

  4. 4

    Paice, B. J. et al. Record linkage study of hypokalaemia in hospitalized patients. Postgrad. Med. J. 62, 187–191 (1986).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  5. 5

    Lam, M. H., Chau, S. W. & Wing, Y. K. High prevalence of hypokalemia in acute psychiatric inpatients. Gen. Hosp. Psychiatry 31, 262–265 (2009).

    PubMed  Article  PubMed Central  Google Scholar 

  6. 6

    Tziviskou, E. et al. Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis: one center's experience and review of the literature. Int. Urol. Nephrol. 35, 429–434 (2003).

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7

    Hawkins, R. C. Gender and age as risk factors for hypokalemia and hyperkalemia in a multiethnic Asian population. Clin. Chim. Acta 331, 171–172 (2003).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  8. 8

    Toner, J. M. & Ramsay, L. E. Thiazide-induced hypokalaemia; prevalence higher in women. Br. J. Clin. Pharmacol. 18, 449–452 (1984).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  9. 9

    Sodi, R., Davison, A. S., Holmes, E., Hine, T. J. & Roberts, N. B. The phenomenon of seasonal pseudohypokalemia: effects of ambient temperature, plasma glucose and role for sodium-potassium-exchanging-ATPase. Clin. Biochem. 42, 813–818 (2009).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  10. 10

    Greenlee, M., Wingo, C. S., McDonough, A. A., Youn, J. H. & Kone, B. C. Narrative review: evolving concepts in potassium homeostasis and hypokalemia. Ann. Intern. Med. 150, 619–625 (2009).

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11

    Hibino, H. et al. Inwardly rectifying potassium channels: their structure, function, and physiological roles. Physiol. Rev. 90, 291–366 (2010).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  12. 12

    Tannen, R. L. & Hallows, K. R. In Oxford Textbook of Clinical Nephrology 3rd edn Vol. 1 Ch. 2.2 (eds Davison, A. M. et al.) 241–267 (Oxford University Press, Oxford, 2005).

    Google Scholar 

  13. 13

    Therien, A. G. & Blostein, R. Mechanisms of sodium pump regulation. Am. J. Physiol. Cell Physiol. 279, C541–C566 (2000).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  14. 14

    Ewart, H. S. & Klip, A. Hormonal regulation of the Na+-K+-ATPase: mechanisms underlying rapid and sustained changes in pump activity. Am. J. Physiol. 269, C295–C311 (1995).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  15. 15

    Vick, R. L., Todd, E. P. & Luedke, D. W. Epinephrine-induced hypokalemia: relation to liver and skeletal muscle. J. Pharmacol. Exp. Ther. 181, 139–146 (1972).

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 16

    Allon, M. & Shanklin, N. Adrenergic modulation of extrarenal potassium disposal in men with end-stage renal disease. Kidney Int. 40, 1103–1109 (1991).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  17. 17

    Halperin, M. L. & Kamel, K. S. Potassium. Lancet 352, 135–140 (1998).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  18. 18

    Wehling, M. Nongenomic aldosterone effects: the cell membrane as a specific target of mineralocorticoid action. Steroids 60, 153–156 (1995).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  19. 19

    Mihailidou, A. S., Buhagiar, K. A. & Rasmussen, H. H. Na+ influx and Na+-K+ pump activation during short-term exposure of cardiac myocytes to aldosterone. Am. J. Physiol. 274, C175–C181 (1998).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  20. 20

    Edwards, R., Winnie, A. P. & Ramamurthy, S. Acute hypocapneic hypokalemia: an iatrogenic anesthetic complication. Anesth. Analg. 56, 786–792 (1977).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  21. 21

    Krapf, R., Caduff, P., Wagdi, P., Staubli, M. & Hulter, H. N. Plasma potassium response to acute respiratory alkalosis. Kidney Int. 47, 217–224 (1995).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  22. 22

    Clemessy, J. L. et al. Hypokalaemia related to acute chloroquine ingestion. Lancet 346, 877–880 (1995).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  23. 23

    Malik, A. R., Wolf, P. K. & Ravasia, S. Hypokalemia from risperidone and quetiapine overdose. Can. J. Psychiatry 50, 76 (2005).

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24

    Lyon, A. W. & Mayhew, W. J. Cesium toxicity: a case of self-treatment by alternate therapy gone awry. Ther. Drug Monit. 25, 114–116 (2003).

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25

    Diengott, D., Rozsa, O., Levy, N. & Muammar, S. Hypokalaemia in barium poisoning. Lancet 2, 343–344 (1964).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  26. 26

    Pinter, A., Dorian, P. & Newman, D. Cesium-induced torsades de pointes. N. Engl. J. Med. 346, 383–384 (2002).

    PubMed  Article  PubMed Central  Google Scholar 

  27. 27

    Wells, J. A. & Wood, K. E. Acute barium poisoning treated with hemodialysis. Am. J. Emerg. Med. 19, 175–177 (2001).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  28. 28

    Liu, Y. C., Tsai, W. S., Chau, T. & Lin, S.-H. Acute hypercapnic respiratory failure due to thyrotoxic periodic paralysis. Am. J. Med. Sci. 327, 264–267 (2004).

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29

    Lin, S.-H., Lin, Y.-F. & Halperin, M. L. Hypokalaemia and paralysis. QJM 94, 133–139 (2001).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  30. 30

    Stedwell, R. E., Allen, K. M. & Binder, L. S. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am. J. Emerg. Med. 10, 143–148 (1992).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  31. 31

    Christensen, K. S. Hypokalemic paralysis in Sjøgren's syndrome secondary to renal tubular acidosis. Scand. J. Rheumatol. 14, 58–60 (1985).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  32. 32

    Barta, Z., Miltenyi, Z., Toth, L. & Illes, A. Hypokalemic myopathy in a patient with gluten-sensitive enteropathy and dermatitis herpetiformis Duhring: a case report. World J. Gastroenterol. 11, 2039–2040 (2005).

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33

    Verner, J. V. & Morrison, A. B. Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia. Am. J. Med. 25, 374–380 (1958).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  34. 34

    Sato, K., Feibleman, C. & Dobson, R. L. The electrolyte composition of pharmacologically and thermally stimulated sweat: a comparative study. J. Invest. Dermatol. 55, 433–438 (1970).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  35. 35

    Godek, S. F., Bartolozzi, A. R. & Godek, J. J. Sweat rate and fluid turnover in American football players compared with runners in a hot and humid environment. Br. J. Sports Med. 39, 205–211 (2005).

    PubMed  PubMed Central  Article  Google Scholar 

  36. 36

    Bates, C. M., Baum, M. & Quigley, R. Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent. J. Am. Soc. Nephrol. 8, 352–355 (1997).

    CAS  PubMed  PubMed Central  Google Scholar 

  37. 37

    Wang, W. H. & Giebisch, G. Regulation of potassium (K) handling in the renal collecting duct. Pflügers Arch. 458, 157–168 (2009).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  38. 38

    Ring, A. M. et al. An SGK1 site in WNK4 regulates Na+ channel and K+ channel activity and has implications for aldosterone signaling and K+ homeostasis. Proc. Natl Acad. Sci. USA 104, 4025–4029 (2007).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  39. 39

    Rabinowitz, L. Aldosterone and potassium homeostasis. Kidney Int. 49, 1738–1742 (1996).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  40. 40

    Pan, Y.-J. & Young, D. B. Experimental aldosterone hypertension in the dog. Hypertension 4, 279–287 (1982).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  41. 41

    Young, D. B. Quantitative analysis of aldosterone's role in potassium regulation. Am. J. Physiol. 255, F811–F822 (1988).

    CAS  PubMed  PubMed Central  Google Scholar 

  42. 42

    Welling, P. A. & Ho, K. A comprehensive guide to the ROMK potassium channel: form and function in health and disease. Am. J. Physiol. Renal Physiol. 297, F849–F863 (2009).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  43. 43

    Liapis, H., Nag, M. & Kaji, D. M. K-Cl cotransporter expression in the human kidney. Am. J. Physiol. 275, C1432–C1437 (1998).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  44. 44

    Hropot, M., Fowler, N., Karlmark, B. & Giebisch, G. Tubular action of diuretics: distal effects on electrolyte transport and acidification. Kidney Int. 28, 477–489 (1985).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  45. 45

    Unwin, R. J., Walter, S. J., Giebisch, G., Capasso, G. & Shirley, D. G. Localization of diuretic effects along the loop of Henle: an in vivo microperfusion study in rats. Clin. Sci. (Lond.) 98, 481–488 (2000).

    CAS  Article  Google Scholar 

  46. 46

    Kamel, K. S., Ethier, J., Levin, A. & Halperin, M. L. Hypokalemia in the “beautiful people”. Am. J. Med. 88, 534–536 (1990).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  47. 47

    Velazquez, H., Ellison, D. H. & Wright, F. S. Luminal influences on potassium secretion: chloride, sodium, and thiazide diuretics. Am. J. Physiol. 262, F1076–F1082 (1992).

    CAS  PubMed  PubMed Central  Google Scholar 

  48. 48

    Amorim, J. B., Bailey, M. A., Musa-Aziz, R., Giebisch, G. & Malnic, G. Role of luminal anion and pH in distal tubule potassium secretion. Am. J. Physiol. Renal Physiol. 284, F381–F388 (2003).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  49. 49

    Wang, W.-H., Yue, P., Sun, P. & Lin, D.-H. Regulation and function of potassium channels in aldosterone-sensitive distal nephron. Curr. Opin. Nephrol. Hypertens. 19, 463–470 (2010).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  50. 50

    Stanton, B. A. & Giebisch, G. H. In Handbook of Physiology, Section 8 Vols I and II Ch. 15 (ed. Windhager, E. E.) 813–874 (American Physiological Society, Bethseda, 1992).

    Google Scholar 

  51. 51

    Batlle, D., Moorthi, K. M., Schlueter, W. & Kurtzman, N. Distal renal tubular acidosis and the potassium enigma. Semin. Nephrol. 26, 471–478 (2006).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  52. 52

    Jaeger, P., Karlmark, B. & Giebisch, G. Ammonium transport in rat cortical tubule: relationship to potassium metabolism. Am. J. Physiol. 245, F593–F600 (1983).

    CAS  PubMed  PubMed Central  Google Scholar 

  53. 53

    Field, M. J., Stanton, B. A. & Giebisch, G. H. Influence of ADH on renal potassium handling: a micropuncture and microperfusion study. Kidney Int. 25, 502–511 (1984).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  54. 54

    Cundy, T. & Dissanayake, A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin. Endocrinol. (Oxf.) 69, 338–341 (2008).

    CAS  Article  Google Scholar 

  55. 55

    Huang, C. L. & Kuo, E. Mechanism of hypokalemia in magnesium deficiency. J. Am. Soc. Nephrol. 18, 2649–2652 (2007).

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  56. 56

    Rossetti, L., Klein-Robbenhaar, G., Giebisch, G., Smith, D. & DeFronzo, R. Effect of insulin on renal potassium metabolism. Am. J. Physiol. 252, F60–F64 (1987).

    CAS  PubMed  PubMed Central  Google Scholar 

  57. 57

    Ahloulay, M., Dechaux, M., Laborde, K. & Bankir, L. Influence of glucagon on GFR and on urea and electrolyte excretion: direct and indirect effects. Am. J. Physiol. 269, F225–F235 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  58. 58

    Rabelink, T. J., Koomans, H. A., Hene, R. J. & Dorhout Mees, E. J. Early and late adjustment to potassium loading in humans. Kidney Int. 38, 942–947 (1990).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  59. 59

    Campen, T. J., Vaughn, D. A. & Fanestil, D. D. Mineralo- and glucocorticoid effects on renal excretion of electrolytes. Pflügers Arch. 399, 93–101 (1983).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  60. 60

    Stanton, B., Pan, L., Deetjen, H., Guckian, V. & Giebisch, G. Independent effects of aldosterone and potassium on induction of potassium adaptation in rat kidney. J. Clin. Invest. 79, 198–206 (1987).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  61. 61

    Caló, L., Borsatti, A., Favaro, S. & Rabinowitz, L. Kaliuresis in normal subjects following oral potassium citrate intake without increased plasma potassium concentration. Nephron 69, 253–258 (1995).

    PubMed  Article  PubMed Central  Google Scholar 

  62. 62

    Lee, F. N., Oh, G., McDonough, A. A. & Youn, J. H. Evidence for gut factor in K+ homeostasis. Am. J. Physiol. Renal Physiol. 293, F541–F547 (2007).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  63. 63

    Michell, A. R., Debnam, E. S. & Unwin, R. J. Regulation of renal function by the gastrointestinal tract: potential role of gut-derived peptides and hormones. Annu. Rev. Physiol. 70, 379–403 (2008).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  64. 64

    Morita, H., Fujiki, N., Miyahara, T., Lee, K. & Tanaka, K. Hepatoportal bumetanide-sensitive K+-sensor mechanism controls urinary K+ excretion. Am. J. Physiol. Regul. Integr. Comp. Physiol. 278, R1134–R1139 (2000).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  65. 65

    Youn, J. H. & McDonough, A. A. Recent advances in understanding integrative control of potassium homeostasis. Annu. Rev. Physiol. 71, 381–401 (2009).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  66. 66

    Unwin, R., Capasso, G. & Giebisch, G. Potassium and sodium transport along the loop of Henle: effects of altered dietary potassium intake. Kidney Int. 46, 1092–1099 (1994).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  67. 67

    Trojak, B. et al. Hypokalemia is associated with lengthening of QT interval in psychiatric patients on admission. Psychiatry Res. 169, 257–260 (2009).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  68. 68

    Coca, S. G., Perazella, M. A. & Buller, G. K. The cardiovascular implications of hypokalemia. Am. J. Kidney Dis. 45, 233–247 (2005).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  69. 69

    He, F. J. & MacGregor, G. A. Fortnightly review: beneficial effects of potassium. BMJ 323, 497–501 (2001).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  70. 70

    Reddy, V. G. Potassium and anesthesia. Singapore Med. J. 39, 511–516 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  71. 71

    Vitez, T. S., Soper, L. E., Wong, K. C. & Soper, P. Chronic hypokalemia and intraoperative dysrhythmias. Anesthesiology 63, 130–133 (1985).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  72. 72

    Conn, J. W. & Johnson, R. D. Kaliopenic nephropathy. Am. J. Clin. Nutr. 4, 523–528 (1956).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  73. 73

    Arimura, Y. et al. Anorexia nervosa: an important cause of chronic tubulointerstitial nephropathy. Nephrol. Dial. Transplant. 14, 957–959 (1999).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  74. 74

    Bock, K. D., Cremer, W. & Werner, U. Chronic hypokalemic nephropathy: a clinical study. Klin. Wochenschr. 56 (Suppl. 1), 91–96 (1978).

    PubMed  Article  PubMed Central  Google Scholar 

  75. 75

    Reimann, D. & Gross, P. Chronic, diagnosis-resistant hypokalaemia. Nephrol. Dial. Transplant. 14, 2957–2961 (1999).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  76. 76

    West, M. L. et al. Development of a test to evaluate the transtubular potassium concentration gradient in the cortical collecting duct in vivo. Miner. Electrolyte Metab. 12, 226–233 (1986).

    CAS  PubMed  PubMed Central  Google Scholar 

  77. 77

    Chacko, M., Fordtran, J. S. & Emmett, M. Effect of mineralocorticoid activity on transtubular potassium gradient, urinary [K]/[Na] ratio, and fractional excretion of potassium. Am. J. Kidney Dis. 32, 47–51 (1998).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  78. 78

    Colussi, G. et al. A thiazide test for the diagnosis of renal tubular hypokalemic disorders. Clin. J. Am. Soc. Nephrol. 2, 454–460 (2007).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  79. 79

    Unwin, R. J. & Capasso, G. Bartter's and Gitelman's syndromes: their relationship to the actions of loop and thiazide diuretics. Curr. Opin. Pharmacol. 6, 208–213 (2006).

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  80. 80

    Lin, S.-H. et al. Laboratory tests to determine the cause of hypokalemia and paralysis. Arch. Intern. Med. 164, 1561–1566 (2004).

    PubMed  Article  PubMed Central  Google Scholar 

  81. 81

    Lin, S.-H. Thyrotoxic periodic paralysis. Mayo Clin. Proc. 80, 99–105 (2005).

    PubMed  Article  PubMed Central  Google Scholar 

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R. J. Unwin, F. C. Luft and D. G. Shirley contributed equally to all aspects of this manuscript.

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Unwin, R., Luft, F. & Shirley, D. Pathophysiology and management of hypokalemia: a clinical perspective. Nat Rev Nephrol 7, 75–84 (2011). https://doi.org/10.1038/nrneph.2010.175

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