Potassium Homeostasis & Disorders
Potassium Homeostasis & Disorders
Potassium Homeostasis & Disorders
Intracellular [K+]
Na+ 120-150 meq/L
Potassium distribution in body fluid 2 K+
compartments 3 Na+
Total body K+ stores: 50-55 meq/kg K
+
Cellular functions
Primary determinant of cell resting
membrane potential
Substrate for membrane transport
processes
Intracellular [K+]
Na+ 120-150 meq/L
Changes in transmembrane 2 K+
potassium gradient
Alter cell membrane resting potential
K+
K + 3 Na+
0 [K]i
-30 Depolarization
mV Hyperpolarization
-60 Threshold
-90 Resting
-120
Normal Hypokalemia Hyperkalemia
External
Balance
Internal
K +
Balance
K+
3.5-5.0 meq/L
Extracellular Fluid (ECF)
120-150 meq/L
Renal K+ excretion
Mineralocorticoid
deficiency
Hyperkalemia: Disorders of Internal Balance
Insulin deficiency
2-Adrenergic blockade
Hypertonicity
Acidemia
Cell lysis
Clinical Manifestations of Hyperkalemia
Cardiac toxicity
EKG changes
Cardiac conduction defects
Arrhythmias
Neuromuscular changes
Ascending weakness, ileus
EKG Manifestations of Hyperkalemia
Normal
Increasing Serum K+
Peaked T-wave
Sine-Wave Morphology
(e.g. Ventricular Tachycardia)
Medical Treatment of Hyperkalemia
Membrane Stabilization
IV calcium
Internal Redistribution
IV insulin (+ glucose)
-adrenergic agonist (albuterol inhaled)
Enhanced Elimination
Kayexalate (sodium polystyrene sulfonate) ion exchange resin
Loop diuretic
Hemodialysis
Hypokalemia
Plasma [K+] < 3.5
Hypokalemia may also result from disturbances
in external balance (total body K+ deficiency) or
internal balance (transmembrane K+ shifts)
Hypokalemia: Disorders of External Balance
Increased Increased
Inadequate renal K+ losses
extrarenal
dietary intake + Hypertension
K+ losses
Hypokalemia: Disorders of External Balance
Inadequate K+ Intake
Malnutrition
Extrarenal Losses
Gastrointestinal losses
Diarrhea
Enteric fistulas
Cutaneous losses
Burns
Hypokalemia: Disorders of External Balance
Hypertensive Disorders
Hyperreninemia
Renin excess (renal artery stenosis, renin-secreting tumor)
Cushing’s syndrome
Glucocorticoid excess (exogenous, pituitary, adrenal)
Normotensive Disorders
Diuretics
Osmotic diuresis
Glucosuria
Insulin excess
Catecholamine excess
Myocardial ischemia/infarction
Delirium tremens
Pharmacologic agents
Alkalemia
Cell proliferation
Rapidly proliferating leukemia or lymphoma
Clinical Manifestations of Hypokalemia
Cardiac Metabolic
EKG changes Glucose intolerance
Arrhythmias Growth retardation
Skeletal muscle
Weakness
Rhabdomyolysis
EKG
EKG Manifestations
Manifestations of
of Hypokalemia
Hypokalemia
Normal
Decreasing Serum K+
Flat T-wave
Prominent U-wave
Depressed ST-segment
Treatment of Hypokalemia
Potassium Replacement
Oral or IV
Potassium-sparing diuretics
ENaC sodium channel inhibitors
Amiloride, triamterene
Mineralocorticoid antagonists
Spironolactone