Hypokalemia is a medical condition where potassium levels in the blood fall below the normal range. Normal potassium levels in the extracellular fluid are 3 to 5 mEq/L.

It is a disorder that may be life threatening rarely but is treatable in most of the cases.

Causes.

• Direct Loss of potassium from the body in the form of vomiting, and diarrhoea.
• Loss of potassium in urine due to renal tubular acidosis, Cushing’s syndrome, and hyperaldosteronism.
• Electrolyte imbalance: hypomagnesemia.
• Acid and base imbalance: alkalosis.
• Reduced dietary intake like meat, orange, grapes, banana, cashew, almonds, etc.
• Patient on diuretic group of medications like furosemide, torsemide, bumetanide and thiazide diuretics etc.

How does a hypokalemic patient present as?

• Weakness: full body lethargy, inability to carry out activities of daily living, early fatigability as compared to the earlier time.
• Muscle cramps are the major complaints of the patient.
• Dehydrated person, sunken eyes, dry lips, sometimes pale skin.
• Dizziness, hypotension, irregular and abnormal pulse rate.
• History of vomiting, diarrhoea, and loss of appetite for a considerable amount of time.
• Deep tendon reflexes may sometimes be diminished due to low potassium levels.
• Irregular heartbeat, arrhythmias, and abnormal blood circulation in the body.
• Classic ECG findings.
• Nausea.
• Irritability, mental confusion, slowness in understanding.

How is a hypokalaemic person treated?

• As hypokalaemia is due to various reasons mentioned above, the first concern should be to remove the cause or treat the cause. This can be done by increasing excessive potassium-rich foods in the diet, and use of antiemetic and antidiarrheal medications. Treating the cause of vomiting and diarrhoea will itself treat hypokalaemia.
• Potassium supplementation in the form of tablets, injections, and other forms can be given.
•  Hypokalaemia can be mild, moderate, or severe. The mild level can be treated with dietary modifications and supplementation of potassium chloride. 
• A saline injection can be given.
• Electrolyte balance is maintained.

How to treat mild hypokalemia?

• Mild hyperkalemia can be treated by consuming potassium rich foods like bananas, dry fruits, and green vegetables.
• Loss of potassium should be stopped immediately by required measures.
• Early detection and dietary modifications for a few months can bring back the levels to normal.
• If the patient is not a Chronic Kidney disease patient and has no other dietary restrictions, the patient can consume k+ rich foods like raisins, almonds, spinach, fenugreek, tamarind, and other dry fruits 4-5 times a day in moderate quantities.
• Dehydration should be assured.

How to treat moderate hypokalemia?

• Immediate hospitalisation in case of symptoms like unconsciousness, and giddiness.
• IV infusion of potassium chloride.
• Maintaining an acid base balance of the body.
• Stopping or replacing the medications like loop diuretics with potassium sparing diuretics.

Hypokalemia in patients with kidney issues and is on diuretics.

The kidney is the major organ that carries out the function of excretion of unwanted or waste material and hence maintaining the water and electrolyte balance. When the kidney is incapable of carrying out its function correctly patients are prescribed diuretics. 

Diuretics are a group of medications that increases the production of urine by reducing the reabsorption of water in the tubules of the nephrons. This reduces the tension and volume overload on the kidney and as the volume of blood is reduced the volume overload on the heart reduces as well.

When a patient is on diuretics, it is not only the water that is lost but also the potassium ions are lost along with it. This causes hypokalemia in the patient. Hence, there are chances of the patient developing hypokalaemia when on diuretics which are usually prescribed for heart issues, kidney issues, and mainly hypertension.

In what conditions can hypocalcemia occur as a secondary complication?

• When a patient is on loop diuretics.
• A patient who is hypertensive and is on medication.
• The patient who is previously diagnosed with myocardial infarction, arrhythmias, and other cardiac conditions.
• Patient with chronic Kidney disease with a very strict diet.
• A person with poor eating habits or low socioeconomic status.
• It can sometimes lead to psychosis.
• It may cause flaccid paralysis in some patients.

What does hypokalemia lead to?

• The inadequate electrical signal passage in the neuromuscular junction.
• It adversely affects the action potential in the stage of hyperpolarization.
• As potassium is essential for muscle contraction, lack of it causes cardiac muscle abnormalities.
• Potassium is an essential component for normal activities of the brain. And hence lack of potassium causes improper functioning of the brain and therefore the neurological symptoms appear.
• As the heart and brain function inadequately, the entire body is affected in a way that leads to fatigue.

How to diagnose hypokalemia?

• Proper history taking
• Clinical presentation of the patient.
• Assessing the consciousness, and orientation of the patient.
• Basic medical assessment including vitals and physical assessment.
• Performing blood tests and when the levels of potassium are lower than normal it is the main indicator of hypokalemia.
• ECG shows typical waves which denote the same.

Lifestyle modification for such patients.

• Avoid alcohol and tobacco intake.
• Include the necessary dietary supplements like micro and macronutrients.
• Take care of your kidneys by adequate water intake and medication intake whenever advised.
• Visit your doctor whenever the above mentioned symptoms are felt or are seen in people around you.
• Take care of your heart well and do not neglect hypertension or high blood pressure. Take proper medical consultation to avoid secondary hypokalaemia.
• Avoid steroid use and abusive drug injections.
• Eat more fruits like bananas, pomegranates, and dry fruits.
• Frequent health check-ups and regular physical exercise is the must.
• Visit your nephrologist if you are a kidney patient at regular intervals.

Conclusion:

• Hypokalemia is a disorder that can change itself into a serious complication leading to various life threatening conditions.
• It can be treated. 
• Treatment measures mainly include dietary modifications and intravenous administration of potassium chloride.
• Hypokalaemia presents with neurological and musculoskeletal problems.
• Loss of potassium usually is direct in the form of urine, diarrhoea, and vomiting.
• Diuretics like loop diuretics and thiazide diuretics are the main contributors for hypokalemia in pharmacology.
• Hypokalaemia leads to heart issues.
• Improving lifestyle reverses the condition.
• Hypokalaemia is a secondary complication to many primary health issues which can progress and become a major problem of concern and may lead to permanent tissue damage in the body.