Patients with hypokalemia are frequently encountered, and its refractoriness to regular supplementation is exasperating. Potassium is a major intracellular cation, and the body maintains its concentration within very narrow limits. Potassium is partially responsible for maintaining the potential difference across the membrane, particularly in excitable tissues such as nerve and muscle, and it catalyzes enzyme activities, as well as cell division and growth, and participates in acid-base regulation.Hypokalemia reflects either total body potassium depletion or redistribution from extracellular to intracellular fluid. Discerning the underlying physiologic mechanisms of hypokalemia and stepwise approach is important to establish a diagnosis as well as to make appropriate therapeutic decisions.
case RePoRts
Case 1A 55-year-old female, known hypertensive, presented with complaints of breathlessness, sweating, and giddiness. Heart rate was 120/min and blood pressure (BP) -180/90 mmHg. Initial laboratory values are as follows: white blood cell (WBC) -12,600, platelets -185,000, Rutherford backscattering spectroscopy (RBS) -575 mg, Na + -128 meq/L, K + -2.6 meq/L, urea -5 mg/dl, creatinine -0.4, arterial blood gas (ABG) K + -4.3 meq/L, and repeat K + -2.8 meq/L.
Case 2A 43-year-old male, hypertensive, presented with complaints of repeated episodes of lethargy and sweating. On examination, he is tachycardic with mild breathlessness. ABG pH was 7.56, PCO 2 -43 mmHg, PO 2 -213 mmHg, HCO 3 -28 meq/L, Na -134 meq/L, K + -3.2 meq/L, urine output -1.5 L/day, urinary potassium -20 meq/L, correction started, repeated samples of potassium came low.
