Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Hypokalemia Severe Urgent Repletion, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as BMP (Renal/electrolytes), UA ± culture (Hematuria/proteinuria/infection), Renal ultrasound (selected) (Obstruction). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include IV Fluids, Electrolyte repletion. Use validated frameworks (e.g., Example Repletion Strategy) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Epidemiology / Risk Factors
- CKD/AKI, nephrotoxins; obstruction
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| BMP | Renal/electrolytes | AKI/lyte changes | |
| UA ± culture | Hematuria/proteinuria/infection | Findings vary | |
| Renal ultrasound (selected) | Obstruction | Hydronephrosis |
Example Repletion Strategy
| Severity | Action |
|---|---|
| K <3.0 with symptoms or ECG changes | IV KCl with monitoring |
| K 3.0–3.4 and stable | Oral potassium divided doses |
| Concurrent hypomagnesemia | Give magnesium first |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Potassium chloride (IV/PO) | K⁺ replacement | Hours | Severe/symptomatic or K<3.0; use central line for >10 mEq/h IV | Phlebitis/arrhythmia |
| Magnesium sulfate (IV) | Mg²⁺ replacement | Hours | Facilitates K⁺ repletion if Mg low | Hypotension |
Prognosis / Complications
- Reversibility by cause; electrolyte/volume complications
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Avoid dextrose infusions that may worsen hypokalemia via insulin response. Use central line for high rate IV infusions as per local policy.