00:01
So when we think about the
clinical manifestations
of hypokalemia,
they're actually multi targeted.
00:06
You can have cardiovascular
manifestations
and those are really
the most serious.
00:11
So we might see
cardiac arrhythmias
and EKG abnormalities.
00:14
This includes premature
atrial and ventricular beats.
00:17
Sinus bradycardia,
atrioventricular block
or ventricular,
tachycardia and fibrillation.
00:24
We can also see signs on EKG.
00:26
We have a decrease in the
amplitude of the T wave
and an increase in the
amplitude of the you U-wave
which is shown here in this EKG.
00:32
We tend to see those primarily
in the in the precordial leads.
00:37
We also have muscular
manifestations
from having hypokalemia.
00:41
So patients can feel
weakness and muscle cramps.
00:44
A low potassium typically
less than 2.5 million
equivalents per liter
can hyperpolarize skeletal
muscle impairing contraction.
00:51
This can reduce skeletal
muscle blood flow
by empowering local
nitric oxide release
and predisposes to things like
rhabdomyolysis breakdown of muscle
during vigorous exercise.
01:01
Severe potassium depletion
less than 2 milli equivalents
can cause respiratory
muscle weakness
leading to respiratory
failure and death.
01:07
So it's important to
replete these patients
when they present with
such severe hypokalemia,
and finally we can CGI
muscle weakness as well
which can result in
Ileus bowel obstruction
due to a decrease in muscular
activity in coordination.
01:20
Now hypokalemia also
has hormonal effects
so it can impair
insulin release and end-organ
sensitivity to insulin.
01:27
So what that translates
to is our patients
can have worsened control
if they're a diabetic,
and I want you to think
about that just for a second
because patients who are
on thiazide diuretics
if they're hypokalemic
then that can actually
and they're diabetic
that can translate
into worsening glycemic control
for those particular patients.
01:46
And then finally
hypokalemia itself
can have renal manifestation.
01:50
If somebody has
prolonged hypokalemia,
and we're talking usually years
that can cause tubule
interstitial and cystic changes
in the parenchyma of the kidney.
01:59
So in patients who have
chronic eating disorders,
anorexia, bulimia,
and they have
chronic hypokalemia,
they can often time manifest
with hypokalemic nephropathy.
02:10
These patients often
times are polyuric
because they lose that
concentrating ability
because of where
that hypokalemic
nephropathy is and where
those cystic changes happen
that actually impairs
the medullary gradient.
02:21
And again,
they also have an increase in thirst
and they develop this mild
nephrogenic diabetes insipidus.
02:27
Hypokalemia itself can
worsen hypertension.
02:30
This is important again
in the patient population
that we take care of.
02:33
It can increaserenal
vascular resistance
and it can also
sensitive vessels
to endogenous vasoconstrictors.
02:39
So a hypokalemic patient
can worsen their
hypertensive control.
02:43
Again, very important to
recognize and then correct this.