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XI. INTRODUCTION
A low serum potassium concentration is perhaps the most
common electrolyte abnormality encountered in clinical practice. When
defined as a value of less than 3.6 mmol of potassium per liter,
hypokalemia is found in over 20 percent of hospitalized patients.1 The
majority of these patients have serum potassium concentrations between
3.0 and 3.5 mmol per liter, but as many as one quarter have values below
3.0 mmol per liter. Comparable data are not available for outpatients, but a
low serum potassium concentration has been found in 10 to 40 percent of
patients treated with thiazide diuretics.2 Hypokalemia is usually well
tolerated in otherwise healthy people, but it can be life-threatening when
severe. Even mild or moderate hypokalemia increases the risks of
morbidity and mortality in patients with cardiovascular disease. As a result,
when hypokalemia is identified, the underlying cause should be sought and
the disorder treated.

2. XII. OVERVIEW OF THE DISEASE
A. ANATOMY AND PHYSIOLOGY
Potassium is a very important mineral for the proper function
of all cells, tissues, and organs in the human body. It is also
an electrolyte, a substance that conducts electricity in the
body, along with sodium, chloride, calcium, and magnesium.
Potassium is crucial to heart function and plays a key role in
skeletal and smooth muscle contraction, making it important
for normal digestive and muscular function. Many foods
contain potassium, including all meats, some types of fish
(such as salmon, cod, and flounder), and many fruits,
vegetables, and legumes. Dairy products are also good
sources of potassium.
Having too much potassium in the blood is called
hyperkalemia; having too little is known as hypokalemia.
Keeping the right potassium balance in the body depends on
the amount of sodium and magnesium in the blood. Too much
sodium -- common in Western diets that use a lot of salt --
may increase the need for potassium. Diarrhea, vomiting,
excessive sweating, malnutrition, malabsorption syndromes
(such as Crohn's disease) can also cause potassium

3. deficiency, as well as use of a kind of heart medicine called
loop diuretics.
Most people get all of the potassium they need from a healthy
diet rich in vegetables and fruits. Older people have a greater
risk of hyperkalemia because their kidneys are less efficient at
eliminating potassium as they age. Older people should be
careful when taking medication that may affect potassium
levels, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
and ACE inhibitors (see section on Interactions).
Whatever your age, talk to your doctor before taking
potassium supplements.
Bone Health
Studies show a positive link between a diet rich in potassium
and bone health, particularly among elderly women,
suggesting that increasing consumption of foods rich in
potassium may play a role in osteoporosis prevention. More
research is needed to determine whether a diet high in
potassium can reduce bone turnover in people.
Hypokalemia
The most important use of potassium is to treat the symptoms
of hypokalemia (low potassium), which include weakness, lack
of energy, muscle cramps, stomach disturbances, an irregular

4. heartbeat, and an abnormal EKG (electrocardiogram, a test
that measures heart function). Hypokalemia is usually caused
by the body losing too much potassium in the urine or
intestines; it's rarely caused by a lack of potassium in the diet.
Hypokalemia can be life threatening and should always be
treated by a doctor.
High Blood Pressure
Some studies have linked low levels of potassium in the diet
with high blood pressure. And there is some evidence that
potassium supplements might cause a slight drop in blood
pressure. Other studies show that increasing potassium intake
reduces the risk of dying from cardiovascular disease.
Researchers suspect this is largely due to potassium's blood
pressure lowering effects. But not all studies agree -- 2 large
studies found no effect on blood pressure. It may be that
taking potassium helps lower blood pressure only if you're not
getting enough of this mineral to start with. Before taking
potassium or any supplement for high blood pressure, talk to
your doctor.
Stroke

5. People who get a lot of potassium in their diet have a lower
risk of stroke. However, potassium supplements don't seem to
produce the same benefit.
Inflammatory Bowel Disease (IBD)
People with IBD (ulcerative colitis or Crohn's disease) often
have trouble absorbing nutrients from their intestine, and may
have low levels of potassium and other important nutrients. If
you have IBD, your doctor may check your potassium levels
and recommend a supplement.
Dietary Sources:
Good sources of potassium include bananas, citrus juices
(such as orange juice), avocados, cantaloupes, tomatoes,
potatoes, lima beans, flounder, salmon, cod, chicken, and
other meats.
Available Forms:
Several potassium supplements are on the market, including
potassium acetate, potassium bicarbonate, potassium citrate,
potassium chloride, and potassium gluconate. Supplements
are available in tablets, capsules, effervescent tablets,
powders, and liquids.
Potassium can also be found in multivitamins.
How to Take It:

6. Potassium supplements, other than the small amount included
in a multivitamin, should be taken only under your doctor's
supervision. Do not give potassium supplements to a child
unless your doctor prescribes it.
Adequate intake of potassium from dietary sources are listed
below:
Pediatric
 Infants birth - 6 months: 400 mg/day
 Infants 7 months - 12 months: 700 mg/day
 Children 1 -3 years: 3 grams (3,000 mg)/day
 Children 4 - 8 years: 3.8 grams (3,800 mg)/day
 Children 9 - 13 years: 4.5 grams (4,500 mg)/day
Adult
 Adults 19 years and older: 4.7 grams (4,700 mg)/day
 Pregnant women: 4.7 grams (4,700 mg)/day
 Breastfeeding women: 5.1 grams (5,100 mg)/day
Precautions:
Because of the potential for side effects and interactions with
medications, you should take dietary supplements only under
the supervision of a knowledgeable health care provider.
Older adults should talk to their doctor before taking
potassium supplements.

7. Side effects can include diarrhea, stomach irritation, and
nausea. At higher doses, muscle weakness, slowed heart
rate, and abnormal heart rhythm may occur. Contact your
health care provider if you develop severe stomach pain,
irregular heartbeat, chest pain, or other symptoms.
People with hyperkalemia or kidney disease should not take
potassium supplements.
People who take ACE inhibitors, potassium-sparing diuretics,
or the antibiotic trimethoprim and sulfamethoxazole (Bactrim,
Septra) should not take potassium.
Possible Interactions:
If you are being treated with any of the following medications,
you should not use potassium without first talking to your
health care provider.
Angiotensin Converting Enzyme (ACE) Inhibitors: These
drugs, including benazepril, captopril, enalapril, fosinopril,
lisinopril, moeexipril, perdinodopril, quinapril, ramipril,
trandolapril, may increase the risk of hyperkaleimia.
Angiotensin Receptor Blockers: Increased risk of
hyperkalemia.

8. Potassium Sparing Diuretics: These drugs, including
amiloride, triamterene, spironolactone, may increase the risk
of hyperkalemia.
Indomethacin: May increase the risk of hyperkalemia.
The following medications may cause potassium levels to rise:
 Nonsteroidal anti-inflammatory drugs (NSAIDs): People who
have poor kidney function and take NSAIDs are at higher risk.
 ACE inhibitors: These drugs treat high blood pressure, heart
disease, diabetes, some chronic kidney diseases, migraines, and
scleroderma. People who take ACE inhibitors and NSAIDs,
potassium sparing diuretics, or salt substitutes may be particularly
vulnerable to hyperkalemia (too much potassium). A rise in
potassium from ACE inhibitors may also be more likely in people
with poor kidney function and diabetes. ACE inhibitors include:
o Benazepril (Lotensin)
o Captopril (Capoten)
o Enlapril (Vasotec)
o Fosinopril (Monopril)
o Lisinopril (Zestril)
o Moexipril (Univasc)
o Peridopril (Aceon)
o Ramipril (Altace)

9. o Trandolapril (Mavik)
 Heparin (used for blood clots)
 Cyclosporine (used to suppress the immune system)
 Trimethoprimand sulfamethoxazole, called Bactrim or Septra (an
antibiotic)
 Beta-blockers: Used to treat high blood pressure, glaucoma,
migraines
o Atenolol (Tenormin)
o Metoprolol (Lopressor, Toprol-XL)
o Propranolol (Inderal)
The following medications may cause potassium levels to
decrease:
 Thiazide diuretics
o Hydrochlorothiazide
o Chlorothiazide (Diuril)
o Indapamide (Lozol)
o Metolzaone (Zaroxolyn)
 Loop diuretics
o Furosemide (Lasix)
o Bumetanide (Bumex)
o Torsemide (Demadex)
o Ethacrynic acid (Edecrin)

10.  Corticosteroids
 Amphotericin B (Fungizone)
 Antacids
 Insulin
 Fluconazole (Diflucan): Used to treat fungal infections
 Theophylline (TheoDur): Used for asthma
 Laxatives
If you are taking any of these medications, it is important for
your doctor to test your potassium levels to see whether or not
you need a supplement. Do not start taking a supplement on
your own.
Other potential interactions include:
Digoxin -- Low blood levels of potassium increase the
likelihood of toxic effects from digoxin, a medication used to
treat abnormal heart rhythms and heart failure. Your doctor
will test your potassium levels to make sure they stay normal.
1. Muscle contraction and nerve transmission
Potassium plays an important role in muscle contraction
and nerve transmission. Many of our muscle and nerve
cells have specialized channels for moving potassium in
and out of the cell. Sometimes potassium moves freely

11. in and out, and sometimes a special energy-driven
pump is required. When the movement of potassium is
blocked, or when potassium is deficient in the diet,
activity of both muscles and nerves can become
compromised.
B. DISEASE PROFILE
Hypokalemic periodic paralysis is an inherited disorder
that causes occasional episodes of muscle weakness.
It is one of a group of genetic disorders that
includes hyperkalemic periodic paralysis and thyrotoxic
periodic paralysis.
CAUSES
Hypokalemic periodic paralysis is a condition in which a
person has episodes of muscle weakness and sometimes
severe paralysis.
The condition is caused by a defect in the the CNA4A
gene. It is congenital, which means it is present from birth. In
most cases, it is passed down through families (inherited) as
an autosomal dominant disorder. That means only one parent

12. needs to pass the gene related to this condition on to you in
order for you to be affected.
Occasionally, the condition may be the result of a
genetic problem that is not inherited.
Unlike other forms of periodic paralysis, persons with
congenital hypokalemic periodic paralysis have normal thyroid
function and very low blood levels of potassium during
episodes of weakness. This results from potassium moving
from the blood into muscle cells in an abnormal way.
Risks include having other family members with periodic
paralysis. The risk is slightly higher in Asian men who also
have thyroid disorders.
Disorders that cause intermittent episodes of paralysis
as their primary effect are uncommon. Hypokalemic periodic
paralysis occurs in approximately 1 out of 100,000 people.
SYMPTOMS
The disorder involves attacks of muscle weakness or
loss of muscle movement (paralysis) that come and go.
Initially, there is normal muscle strength between attacks.

13. Attacks usually begin in adolescence, but they can
occur before age 10. Attacks that do not begin until adulthood
are rare in people with hypokalemic periodic paralysis and are
usually caused by other disorders.
How often the attacks occur varies. Some people have
attacks every day, while others have them once a year.
Episodes of muscle weakness usually last between a few
hours and a day.
The weakness or paralysis:
 Most commonly is located at the shoulders and hips
 May also affect the arms, legs, muscles of the eyes, and muscles
that help you breathe and swallow
 Occurs intermittently
 Most commonly occurs on awakening
 Most commonly occurs after sleep or rest
 Is rare during exercise, but may be triggered by rest after exercise
 May be triggered by high-carbohydrate, high-salt meals or alcohol
consumption

14.  Usually lasts 3 - 24 hours
Other symptoms may include:
 Eyelid myotonia (a condition in which after opening and closing the
eyes, the patient cannot open them for a short time)
Note: The patient's thinking remains alert during
attacks.
TREATMENT
Muscle weakness that involves the breathing or
swallowing muscles is an emergency situation. Dangerous
heart arrhythmias may also occur during attacks.
The goals of treatment are relief of symptoms and
prevention of further attacks.
Potassium that is given during an attack may stop the
attack. It is preferred that potassium be given by mouth, but if
weakness is severe, potassium may need to be given through
a vein (IV). Note: Potassium, especially intravenous
potassium, should be given with extreme caution, especially in
persons with kidney disease.

15. Taking potassium supplements will not prevent attacks.
Avoiding alcohol and eating a low-carbohydrate diet
may help.
A medicine called acetazolamide prevents attacks in
many cases. If you take this medicine, your doctor may tell
you to also take potassium supplements because
acetazolamide may cause your body to lose potassium.
Triamterene or spironolactone may help to prevent
attacks in people who do not respond to acetazolamide.
POSSIBLE COMPLICATIONS
 Kidney stones (a side effect of acetazolamide)
 Heart arrhythmias during attacks
 Difficulty breathing, speaking, or swallowing during attacks (rare)
 Progressive muscle weakness
PREVENTION
Hypokalemic periodic paralysis cannot be prevented.
Because it can be inherited, genetic counseling may be
advised for couples at risk for the disorder.

16. Treatment prevents attacks of weakness. Before an
attack, there may be leg stiffness or heaviness in the legs.
Performing mild exercise when these symptoms start may
help prevent a full-blown attack.
C. PATHOPHYSIOLOGY
Modifiable Factors
- Diet
- Excessive Exercise
- Diuretics
- Diarrhea
- Vomiting
Non-Modifiable Factors
- Gender
- Genetics
- Idiopathic
- Race
Decreased potassium
levels
Cells cannot repolarize
Cells become less
excitable
Impaired function of the
skeletal and smooth
muscle.
Decreased bowel motility
Slow neural transmission
Failure of the kidney to
regulate potassium level
localized w eakness
in low er and upper
extremities
Fatigue
Muscle tiredness
muscle spasms
muscle tenderness
Constipation
Potassium
level
KUB
Hypokalemia Periodic
Paralysis

17. XIII. PATIENTS GENERAL DATA

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