HYPOKALEMIA AND HYPERKALEMIA

doi:10.1016/S0025-7125(05)70536-8

Medical Clinics of North America

Volume 81, Issue 3, 1 May 1997, Pages 611-639

https://doi.org/10.1016/S0025-7125(05)70536-8 Get rights and content

Potassium (K⁺) is the major intracellular cation. The total K⁺ content of the body averages 3500 mEq (50 mEq/kg body weight), 90% of which is intracellular. About 8% of the total body K⁺ is in bone and cartilages. Although only 2% of the total body potassium is in the extracellular fluid, its concentration is finely regulated by the flux of K⁺ between the extracellular and intracellular spaces (internal potassium homeostasis). When this concerted balance is offset, however, significant changes occur in serum potassium levels.

Daily minimum requirement of K⁺ is approximately 1600 to 2000 mg (40 to 50 mEq) (40 mg = 1 mEq). Potassium intake varies widely according to the type of diet consumed, age, and race. Thus, 15- to 20-year-olds may consume up to 3400 mg (85 mEq) of K⁺ daily, whereas elderly individuals, especially if they live alone or are disabled and are not eating balanced meals, have low K⁺ intake. People who eat large amounts of fruits and vegetables have a high K⁺ intake, on the order of 8000 to 11,000 mg (200 to 275 mEq) per day.²⁶ Urban whites consume about 2500 mg (62.5 mEq) of K⁺ per day,¹⁷ whereas African-Americans are reported to have a low intake of K⁺ on the order of 1000 mg (25 mEq) per day.¹² Human milk contains small amounts of K⁺, about 500 mg (12.8 mEq) per liter, whereas cow's milk contains almost three times as much, 1365 mg (35 mEq) per liter.

In a balanced state of body potassium, 80% of potassium intake is excreted by the kidneys, 15% of potassium is excreted by the gastrointestinal tract, and the remaining 5% of potassium is excreted in the sweat. Urinary potassium is for the most part secretory potassium. Distal potassium secretion is regulated by the amount of sodium in the lumina of the distal and collecting tubules, flow of urine in these segments of the nephron, and the aldosterone activity. Serum potassium in and of itself is an important factor in the regulation of aldosterone activity. The kidneys are the major regulator of external potassium homeostasis (or balance); therefore, excessive loss through the kidneys or retention because of loss of excretory function of the kidneys eventually leads to hypokalemia or hyperkalemia.

Section snippets

REGULATION OF INTERNAL POTASSIUM HOMEOSTASIS

A number of factors affect the internal potassium homeostasis; among these factors, acid-base status, plasma insulin concentration, and plasma catecholamine levels are important. Aldosterone activity has a minor role in internal potassium homeostasis.

HYPOKALEMIA

Normal serum potassium ranges from 3.5 to 5.5 mEq/L. Serum potassium less than 3.5 mEq/L is hypokalemia. Common causes of hypokalemia include:

1
Diuretics.
2
Alcoholism.
3
Gastrointestinal disorders (vomiting, gastric suction, diarrhea).
4
Renal tubular acidosis type I and II.
5
Primary hyperaldosteronism.
6
Secondary hyperaldosteronism (renovascular hypertension, renin-secreting tumor).
7
Bartter's syndrome.
8
Antibiotics, including penicillin, carbenicillin, aminoglycoside, amphotericin.
9
Magnesium depletion.
10

HYPERKALEMIA

Hyperkalemia is not as common as hypokalemia. If all patients with acute and chronic renal failure are excluded, the incidence of hyperkalemia is rather insignificant. At the outset, it should be stressed that hyperkalemia can be pseudohyperkalemia and is caused most commonly by extravascular hemolysis. Pseudohyperkalemia also can be caused by severe leukocytosis or thrombocytosis. If severe hyperkalemia is observed as an isolated finding in an otherwise normal laboratory report of a patient,

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Little is known about the bioavailability of potassium, especially from dietary sources but the results of blood tests indicated these sources were effective. ( Cumings, 1940; Mandal, 1997). ( Fumagalli & Silveira, 2005) were compared potassium content of pear using different processes adopted in their work.
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: Address reprint requests to Anil K. Mandal, MD, Department of Medicine (IIIW), VA Medical Center, 4100 West Third Street, Dayton, OH 45428

^*: From the Section of Nephrology, Department of Veterans Affairs Medical Center; and the Department of Medicine, Wright State University, Dayton, Ohio

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HYPOKALEMIA AND HYPERKALEMIA

Section snippets

REGULATION OF INTERNAL POTASSIUM HOMEOSTASIS

HYPOKALEMIA

HYPERKALEMIA

Prostaglandins Leukot Essent Fatty Acids

Am J Cardiol

Kidney Int

Am J Med

Am J Med

Ann Emerg Med

Studies on renal function in healthy women with different degrees of induced potassium depletion patterns of hypokalemic renal dysfunction

Boll Soc Ital Biol Sper

Hyperkalemia associated with intravenous labetalol therapy for acute hypertension in renal transplant recipients

Clin Nephrol

Disturbance of potassium homeostasis in poisoning

J Toxicol Clin Toxicol

Indapamide-induced severe hyponatremia and hypokalemia

Ann Pharmacother