6, 8 Serum potassium levels have a U-shaped curve association with morbidity and mortality. 6, 7 Patients with an abnormal potassium level on admission (adjusted odds ratio = 1.49 95% CI, 1.26 to 1.75) and patients with hyperkalemia (adjusted OR = 1.44 95% CI, 1.11 to 1.87) requiring admission to a cardiac intensive care unit have an elevated risk of mortality. 5 The inpatient prevalence of hyperkalemia and hypokalemia ranges from 6.9% to 12.3% and 2.9% to 7.4%, respectively. 4, 5 In patients with chronic kidney disease (CKD), the prevalence of hyperkalemia is 18%. 1 – 3 The prevalence of hyperkalemia in the general population is 3.3%, and hypokalemia is 1.9% however, in the emergency department, the prevalence is 3.6% and 5.5%, respectively. Homeostasis maintains a normal range of serum potassium defined as 3.5 to 5.0 mEq per L. Long-term management of potassium disturbances includes correcting underlying conditions, dietary counseling, and adjusting causative medications. Sodium polystyrene sulfonate is associated with serious gastrointestinal adverse effects. Patiromer and sodium zirconium cyclosilicate are newer potassium binders and may be used in chronic or acute hyperkalemia. Dialysis may be considered in the presence of end-stage renal disease, severe renal impairment, or ongoing potassium release. Acute treatment may include intravenous calcium, insulin, sodium bicarbonate, diuretics, and beta agonists. Emergent treatment is recommended for patients with clinical signs and symptoms (e.g., muscle weakness, paralysis) or if electrocardiography abnormalities are present. Electrocardiography identifies cardiac conduction disturbances but may not correlate with serum potassium levels. Hyperkalemia is caused by impaired renal excretion, transcellular shifts, or increased potassium intake.

An oral route is preferred if the patient has a functioning gastrointestinal tract and a serum potassium level greater than 2.5 mEq per L.

The underlying cause should be addressed, and potassium levels replenished. Severe features of hypokalemia that require urgent treatment include a serum potassium level of 2.5 mEq per L or less, electrocardiography abnormalities, or neuromuscular symptoms. Hypokalemia is caused by decreased intake, renal losses, gastrointestinal losses, or transcellular shifts. The World Health Organization recommends a potassium intake of at least 3,510 mg per day for optimal cardiovascular health. Hypokalemia and hyperkalemia occur when serum potassium levels are less than 3.5 mEq per L or greater than 5.0 mEq per L, respectively.

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