OVERVIEW
低钾血症是血中钾离子含量低于正常范围（<3.5mmol/L）的病理状态
最常见的表现为肌无力，一般先出现四肢无力，之后可延至全身甚至呼吸肌
钾摄入不足和/或丢失过多
主要通过改善饮食、使用补钾药物纠正低钾状态，同时需要对原发病进行治疗
Definition
Hypokalemia is a pathological condition in which the potassium ion level in the blood is below the normal range (<3.5 mmol/L) and is a very common clinical electrolyte disorder.
Potassium is the major cation that determines the concentration of intracellular osmotic pressure, and only 2% of the body’s potassium exists outside the cell.
Adults require a daily potassium intake of 3-4 g, mainly from dietary sources.
The kidneys are the main potassium-excreting organs, accounting for 85% of urinary potassium, 10% in feces and 5% in sweat; even without potassium intake, potassium is still excreted daily.
Potassium is essential for the maintenance of cellular function, conduction of nerve impulses, and contraction of muscle cells, including cardiac muscle.
Relatively small changes in blood potassium concentration can cause significant alterations in clinical presentation.
Pseudohyperkalemia may occur, i.e., hypokalemia that does not appear clinically consistent when the blood specimen is tested.
多见于急性髓系白血病或白细胞计数＞50×109/L。
主要原因是血液标本未能及时检测，使大量白细胞吸收了血清中的钾离子。
Classification
Classification according to the degree of reduction in blood potassium
Mild hyperkalemia: Blood potassium level of 3.0-3.5 mmol/L.
Moderate hyperkalemia: Blood potassium level of 2.5-3.0 mmol/L.
Severe hypokalemia: Blood potassium level <2.5mmol/L.
Classification according to the cause of hypokalemia
缺钾性低钾血症
The serum potassium ion concentration falls below the normal level due to increased potassium loss or concomitant inadequate intake.
Characterized by a decrease in total body potassium, intracellular potassium and serum potassium concentration, it is essentially a potassium deficiency.
According to the rate of decline in blood potassium concentration, it can be further divided into acute and chronic potassium deficiency hypokalemia.
转移性低钾血症
Hypokalemia caused by the entry of extracellular potassium ions into the cell.
Due to the transfer of extracellular potassium into the cells, it is characterized by normal total body potassium, increased intracellular potassium, and decreased serum potassium concentration.
稀释性低钾血症
Hypokalemia resulting from an increase in blood volume or extracellular fluid volume accompanied by a relative decrease in blood sodium concentration.
Morbidity
It has been shown that hypokalemia occurs in approximately 3% of hospitalized patients. Of these, moderate and severe hyperkalemia accounts for 1/4.
It has been found that the incidence of hyperkalemia is higher in men, which is mainly related to the fact that they are mostly engaged in physical labor, and the high intensity of work and sweating can cause potassium loss, resulting in hyperkalemia.
Hypokalemia patients are mostly workers, mostly engaged in hardware, plastic, printing and textile industries, etc. The common features of these industries are poor ventilation environment, high labor intensity, high temperature and long working hours.
Causes
Causes
The causes of hyperkalemia are complex and varied, but the main cause is the loss of total potassium in the body.
Potassium deficiency hypokalemia
钾摄入不足
Prolonged coma, gastrointestinal obstruction, prolonged anorexia, partiality or fasting.
钾排出过多
Transgastrointestinal loss: the most important cause of potassium loss in pediatric patients.
消化液含有大量的钾，消化液丢失可致失钾。
常见原因有长期大量呕吐、腹泻（如霍乱、血管活性肠肽瘤）、胃肠引流、造瘘、透析等。
Transrenal loss: the most important cause of potassium loss in adults.
肾脏疾病：急性肾衰竭多尿期、肾小管性酸中毒、假性醛固酮增多症、范科尼综合征（Fanconi综合征）等。
内分泌疾病：原发性醛固酮增多症、继发性醛固酮增多症（肾动脉狭窄、Bartter综合征、肾素瘤）、库欣综合征、表观盐皮质激素过多综合征、先天性肾上腺皮质增生症（11β-羟化酶缺陷症或17α-羟化酶缺陷症）、糖尿病酮症酸中毒、高血糖高渗状态、胸腺瘤等。
药物因素：排钾利尿剂（如呋塞米、布美他尼、氢氯噻嗪、乙酰唑胺等）、渗透性利尿剂（如甘露醇、山梨醇及高渗糖液等）、补钠过多、抗生素（如青霉素、庆大霉素、羧苄西林、多黏菌素B等）、泻药、糖皮质激素、长期服用复方甘草片（甘草甜素）、两性霉素B、顺铂等。
酸中毒、碱中毒恢复期。
Loss through skin: overheating or prolonged hot work, potassium is lost through sweat and not replaced in time.
Other causes of potassium loss
大面积烧伤、放腹水、腹膜透析、腹腔引流等。
镁缺失，如低镁血症、Gitelman综合征。
Metastatic hypokalemia
Disease factors
碱中毒。
低钾性周期性瘫痪，包括家族性低钾性周期性瘫痪和甲状腺功能亢进症（甲亢）周期性瘫痪。
严重疾病的急性应激状态、甲亢等。
再喂养综合征。
Drugs
使用大量葡萄糖溶液及胰岛素。
使用β受体激动剂（如沙丁胺醇、特布他林）、茶碱类药物等。
使用叶酸、维生素B12治疗贫血。
Poisoning by certain poisons: e.g. cottonseed oil, barium chloride, etc.
Dilutional hypokalemia
Excessive water intake or water intoxication.
Excessive and rapid fluid replacement without timely potassium replacement.
Triggering factors
Hot weather or prolonged exposure to high temperatures.
Strenuous exercise.
Poor dietary habits
如节食、暴饮暴食、大量饮酒等。
长期食用高碳水化合物食物或含糖食品。
Infection or trauma.
Older age, prolonged bed rest or hypertension, cardiovascular disease.
Pathogenesis
Potassium deficiency hypokalemia
钾摄入不足
Potassium is commonly found in a variety of foods, and short-term insufficient intake is not likely to cause hypokalemia.
However, hypokalemia can occur when potassium intake is less than 3 g per day for more than 2 weeks.
钾排出过多
Loss via gastrointestinal tract: Digestive juices are rich in potassium, and loss of digestive juices can cause potassium loss in the gastrointestinal tract.
Loss via the kidneys
肾脏疾病：主要由于肾小管病变导致重吸收钾的能力受损，钾经尿液排出增多。
内分泌疾病：主要是醛固酮或类醛固酮样物质增加、糖皮质激素产生增多等所致。
醛固酮作用于肾小管上皮细胞内的盐皮质激素受体，可促进其对钠的重吸收、减少对钾的重吸收，使钾随尿排出增多。
类醛固酮样物质，如皮质醇、去氧皮质酮等，其作用类似于醛固酮，使钾随尿排出增多。
糖皮质激素具有弱盐皮质激素活性，分泌增加可使钾随尿排出增多。
药物因素
利尿剂：是引起低钾血症最常见的药物。排钾性利尿剂可阻断钠在远端肾小管近端重吸收，使钾排出增多；渗透性利尿剂可形成高渗透压，阻止肾小管对原尿的再吸收，使钾随尿排出增多。
补钠过多：可促进肾小管的钠钾交换，使钾排出增多。
抗生素：某些抗生素通过改变肾小管上皮细胞内的电位差，促进钾的排出。
泻药：长期使用泻药可使大量体液丢失，导致继发于代谢性碱中毒的经肾失钾。
两性霉素B：可与肾小管集合管细胞的结合导致滤过裂孔增大，钾排出增加，引起低钾血症。
顺铂：可产生电解质紊乱等不良反应，如低钾血症。
Other
大面积烧伤等可使体液中的钾丢失。
低镁血症时，Na+-K+-ATP酶失活，肾小管重吸收钾减少，使钾随尿排出增多。
Metastatic hypokalemia
疾病因素
Alkalosis
一般pH每升高0.1，血清钾约下降0.7mmol/L。
碱中毒时，肾小管上皮细胞排H+减少，故钠和H+的交换减少，与钾的交换增强，使尿排钾增多。
呼吸性碱中毒通常对血钾影响较小。
代谢性碱中毒时，细胞外液H+浓度降低，细胞内H+释放出来，而细胞外液中钾进入细胞，发生钾分布异常。
Periodic paralysis: Increased activity of Na+-K+-ATPase can drive potassium into the cells.
Acute stress, hyperthyroidism, etc. can lead to increased catecholamine secretion, which can stimulate Na+-K+-ATPase activity and insulin secretion, and promote the entry of potassium into the cell.
Refeeding syndrome: due to the long-term consumption of the body, when restarting feeding or intake of enteral and parenteral nutrition, exogenous nutrients (especially glucose) can stimulate insulin secretion and enhance cellular metabolism, triggering a large amount of potassium, phosphorus and magnesium to be transferred into the cells.
药物因素
Massive intravenous infusion of glucose solution and insulin: insulin is an important factor in postprandial blood potassium regulation, which can promote potassium entry into cells (e.g. muscle cells, etc.) by stimulating Na+-K+-ATPase. Hypokalemia may result when large amounts of glucose solution are infused and insulin is applied concurrently.
Beta agonists and theophyllines, among others, may allow potassium ions to enter cells by stimulating Na+-K+-ATPase activity.
When folic acid and vitamin B12 are used to treat anemia, the newborn red blood cells utilize more potassium, and extracellular potassium enters the cells, leading to hypokalemia.
某些毒物中毒
In poisoning with cottonseed oil and barium chloride, sustained activation of Na+-K+-ATPase on the cell membrane, blockage of potassium channels, and decreased outflow of intracellular potassium ions trigger hypokalemia.
Dilution hyperkalemia
Dilution mainly due to extracellular fluid water retention, blood potassium concentration is relatively reduced, total body potassium and intracellular potassium concentration may be normal.
Symptoms
The severity of symptoms depends on the degree of potassium deficiency and the rate at which it occurs, with acute hypokalemia being more severe than chronic hypokalemia at the same level of potassium deficiency.
Main symptoms
Skeletal muscle symptoms
The most common symptom is muscle weakness, which usually starts with weakness in the limbs and then extends to the whole body and even the respiratory muscles.
一般血钾＜3.0mmol/L可出现乏力。
当血钾＜2.5mmol/L时可出现全身性肌无力，甚至有心律失常或呼吸肌麻痹，出现心悸、呼吸困难、吞咽困难，甚至窒息。
Attacks occur in the evening and after exertion, and are most common in the extremities, but less common in the head and neck muscles.
During an attack, the patient may be unable to stand or walk; unable to stand up when sitting or squatting, or barely able to stand up with a supportive hand in less severe cases; unable to turn over on his/her own while lying down; and may also experience painful spasms or twitching of the hands and feet.
May be accompanied by numbness, pain and other sensory disorders.
Central nervous system symptoms
Indifferent expression, depression, agitation, drowsiness, delirium, agitation, paralysis, confusion and coma may occur.
Circulatory system symptoms
Various arrhythmias such as tachycardia (sinus, atrial, ventricular) and preterm contraction may occur.
In severe cases, ventricular fibrillation and ventricular flutter may occur.
The symptoms include palpitations, chest tightness, and even chest pain.
Digestive system symptoms
Common loss of appetite, abdominal distension, reduced bowel sounds, constipation.
In severe cases, paralytic intestinal obstruction can be triggered, such as abdominal pain, bloating and vomiting.
Urinary system symptoms
Irritable thirst, polyuria, and increased nocturia are common.
Occasionally, rhabdomyolysis is seen, with muscle weakness, pain, or dark-colored urine.
Endocrine metabolic symptoms
Delayed growth and development may occur in children with chronic potassium deficiency.
Other symptoms
Depending on the cause, some people with hyperkalemia may also experience other symptoms such as periodic paralysis and elevated blood pressure.
Periodic paralysis
The main symptom is severe muscle weakness, which sometimes progresses to flaccid paralysis.
It often comes on suddenly in the middle of the night or early morning.
The attacks are non-continuous and symptoms can last from a few hours to a few days.
Hypertension
Patients may experience varying degrees of elevated blood pressure.
Consultation
Department of Medicine
Endocrinology
When there are symptoms such as weakness in the limbs, may not be able to stand or walk during an attack, and may not be able to stand up when sitting or squatting, it is recommended to consult a doctor promptly.
Emergency Department
When there are symptoms such as paralysis, restlessness, difficulty breathing, drowsiness, coma, fainting, etc., it is recommended to consult a doctor immediately.
Preparation for medical treatment
Preparation for medical consultation: registration, preparation of documents, common problems
Tips for the doctor
For the convenience of the doctor’s examination, women should try not to wear dresses.
It is recommended to record the date of onset of symptoms and the duration of each attack for the doctor’s reference.
Preparation Checklist
症状清单
Is there any weakness in the limbs, may not be able to stand or walk during an attack, unable to stand up when sitting or squatting?
Is there apathy, depression, irritability, drowsiness, confusion?
Are the above symptoms recurrent?
病史清单
Are there any allergies to medications, foods, or other substances?
Are there any diseases such as high blood pressure, diabetes, kidney failure, hyperthyroidism, Cushing’s syndrome, etc.?
Is there any long-term dieting or chronic diarrhea?
检查清单
Laboratory tests: blood electrolytes, urine electrolytes, thyroid function, plasma cortisol, renin-angiotensin-aldosterone (RAAS) system test, blood routine, kidney function, liver function
Imaging: cardiac ultrasound, abdominal ultrasound, renal artery ultrasound, pituitary CT, pituitary magnetic resonance imaging, adrenal CT, adrenal magnetic resonance imaging
Other tests: electrocardiogram, electromyogram
用药清单
Potassium-removing diuretics: furosemide, bumetanide, hydrochlorothiazide, acetazolamide, medications for hyperthyroidism
Osmotic diuretics: mannitol, sorbitol, methimazole
Potassium supplementation: potassium citrate, potassium chloride extended-release tablets, propylthiouracil
Glucocorticoid: hydrocortisone, prednisone acetate, methylprednisolone, dexamethasone
Insulin: Glycine Insulin, Degu Insulin, Menthol 30/50 Injection, Menthol Injection, Arginine Biosynthetic Human Insulin Injection 30R/50R
Drugs for hyperthyroidism: methimazole, propylthiouracil
Diagnosis
Diagnosis is based on
Medical history
There may be a history of prolonged anorexia and fasting.
There may be a history of profuse vomiting, diarrhea, renal disease (e.g., polyuric phase of acute renal failure), or endocrine disease (e.g., aldosteronism).
There may be a history of use of specific medications (e.g., diuretics).
There may be a history of excessive and rapid fluid replacement without potassium replacement.
Clinical manifestations
The most common symptom is muscle weakness, which usually starts with weakness in the extremities and then extends to the whole body and even the respiratory muscles.
Tendon reflexes may be diminished or absent.
Laboratory Tests
Routine blood tests
目的：检查血细胞（红细胞、白细胞、血小板）、血红蛋白等的变化情况。
意义：可用于判断是否存在感染、是否有贫血等。
注意事项：无需空腹。
Blood biochemistry
目的：检查电解质（血钾、血钙、血镁、血磷）、血糖、血脂、转氨酶、血肌酐等的变化情况。
意义：可用于诊断低钾血症。
注意事项：需要空腹。
Others: such as plasma cortisol, urine routine and urine electrolyte test, renin-angiotensin-aldosterone (RAAS) system test, thyroid function test, autoimmune antibodies, etc.
目的：了解皮质醇、尿钾、醛固酮、甲状腺功能等的变化情况。
意义：用于鉴别诊断，明确低钾的病因。
注意事项：遵医嘱。
Electrocardiogram
Purpose: To understand the changes in the electrocardiogram.
Significance: A series of ECG abnormalities can be seen in hypokalemia, which is used to assist diagnosis.
一般来说，血钾浓度越低，心电图改变就越明显。
初期可表现为T波振幅降低，新出现U波或U波明显。
随着血钾浓度进一步降低，T波变得低平、平坦或倒置。
ST段下移，可超过0.5mm。
U波振幅升高，严重低钾血症时心电图上可见巨大U波。
可伴有Q-T间期延长，还可出现P波振幅增大，P-R间期延长。
Precautions: The chest leads of ECG will be placed on the chest, so it is not recommended for women to wear dresses during the examination; during the examination, one should be quiet and lie down, do not take deep breaths or change the position.
Imaging
It mainly includes CT/MRI of pituitary gland, CT/MRI of adrenal gland, color ultrasound of renal artery.
Purpose: To understand the morphology and structural changes of the pituitary gland and adrenal glands, as well as the blood flow of the renal artery.
Significance: for differential diagnosis and clarification of hypokalemia due to adrenal diseases (including primary aldosteronism and Cushing’s syndrome), endocrine diseases, etc.
Precautions
进行CT增强扫描及腹部平扫时，检查前至少禁食4小时；有碘对比剂过敏或不良反应、甲亢和心肾功能不全者，需提前告知医生。
进行MRI检查时，需提前去除身上的金属或磁性物品；体内如有心脏起搏器、金属或磁性物者不能进行检查。
Others
For example, genetic testing can be used to diagnose hypokalemia caused by genetic factors.
Differential diagnosis
Hyperkalemia has a variety of causes and requires a differential diagnosis of the diseases that cause hyperkalemia to determine the cause.
Primary aldosteronism
The most prominent manifestations are hypertension and hyperkalemia.
高血压为最早且最常出现的症状，且使用降压药的效果低于原发性高血压。
低钾血症一般出现在高血压之后。
Laboratory tests: low blood potassium, alkaluria; plasma aldosterone concentration is increased, plasma renin activity is decreased, and the ratio of the two (ARR) is often increased.
Imaging: adrenal space or hyperplasia is seen.
Secondary aldosteronism
It is caused by excessive renin activity or renin levels and can be categorized as primary and secondary hyperreninism.
Primary hyperaldosteronism is caused by renin-secreting tumors; secondary hyperaldosteronism is caused by renal ischemia.
肾素瘤
It is mostly seen in young people.
Most often manifested as severe hypertension, hypokalemia, plasma renin activity and aldosterone levels are elevated.
肾缺血
Renal ischemia caused by malignant hypertension, renal artery stenosis and renal atrophy results in elevated renin levels.
Most of them show severe hypertension with elevated plasma renin activity and aldosterone levels, and some of them may show hypokalemia, often accompanied by azotemia or uremia.
Radionuclide nephrography shows decreased renal blood flow, and renal artery stenosis is seen on renal arteriography.
Some have clinical manifestations of atherosclerosis or vasculitis or changes in laboratory tests.
Episodic Hyperhydrocorticosteroid Syndrome
Most commonly seen in children and young adults.
The main manifestations are severe hypertension, hypokalemic alkalosis.
Urinary 17-hydroxy and free cortisol excretion is decreased, and the urinary corticotropin metabolite/cortisol metabolite ratio is decreased, but plasma cortisol may be normal.
Spironolactone or dexamethasone treatment is effective.
11β-hydroxylase deficiency or 17α-hydroxylase deficiency
The main manifestations are hypertension and hypokalemia, in addition to abnormal sexual differentiation, abnormal reproductive function and abnormal height.
Sexual differentiation and developmental abnormalities
11β-羟化酶缺陷症：可表现为女性男性化、男性假性性早熟。
17α-羟化酶缺陷症：可表现为男性女性化、女性原发性闭经等。
Abnormalities of reproductive function: Most of the patients with abnormal sex characteristics have impaired reproductive function.
Abnormal height
11β-羟化酶缺陷症：常成年身高较低。
17α-羟化酶缺陷症：成年后身高仍可持续而缓慢的生长。
Cushing’s syndrome
Cushing’s syndrome is caused by excessive secretion of glucocorticoids by the adrenal glands.
The main manifestations are centripetal obesity, full moon face, buffalo back, supraclavicular fat pads, polycythemia, purple lines, acne, and masculinization.
Laboratory tests: Hypokalemic alkalosis is seen, and blood cortisol concentration is elevated with no circadian rhythm.
Imaging: Pituitary space-occupying lesions and bilateral diffuse enlargement or space-occupying lesions in the adrenal region are seen.
Ectopic adrenocorticotropic hormone (ACTH) syndrome
It can be caused by ACTH production from malignant tumors other than pituitary gland, such as small cell lung cancer, bronchial related carcinoma, thymic carcinoma, pancreatic carcinoma, etc. Therefore, the imaging findings of the above mentioned sites can assist in the differentiation.
Pseudoaldosteronism syndrome (Liddle syndrome)
There is often a family history of the disease, which usually develops at a young age, and in some cases may not develop until around 50 years of age.
Acquired defects can be triggered by infections or other pathologies (e.g. nephrotic syndrome).
The main manifestations are hypertension, hypokalemia, decreased plasma renin activity and aldosterone levels, and paradoxical aciduria is seen.
Treatment with spironolactone is ineffective and the epithelial sodium channel (ENaC) blocker amphotericin is effective.
Bartter syndrome
Often develops in the perinatal period or at a young age.
The main manifestations are hypokalemia, hyponatremia, hypochlorhydria, hypercalcemia, and metabolic alkalosis.
Plasma renin activity and aldosterone levels are increased, often without hypertension.
Increased urinary potassium, urinary calcium and urinary chloride excretion.
Pathologic examination reveals proliferation of granulocytes in the paraglomerular apparatus.
Gitelman syndrome
It can develop at any age, but is most often diagnosed at a young age.
The main manifestations are hypokalemia, hypomagnesemia, hypocalcemia, and metabolic alkalosis.
Plasma renin activity and aldosterone levels are increased without hypertension.
Increased urinary magnesium and urinary calcium to urinary creatinine ratio (urinary calcium/urinary creatinine) ≤ 0.2.
Genetic testing is needed to clarify the diagnosis.
Renal tubular acidosis
Type I (distal tubular acidosis) and type II (proximal tubular acidosis) are characterized by hypokalemia and metabolic acidosis.
Most of them show normal renal function with alkalinuria.
Plasma renin activity and aldosterone levels are normal.
Fanconi syndrome
Rarely, it is characterized by slow growth, lack of appetite, polyuria, and congenital malformations (dwarfism and skeletal malformations).
Acidosis, decreased serum potassium and phosphorus with glycosuria and aminoaciduria may be present.
Plasma renin activity and aldosterone levels are increased without hypertension.
Acidosis, but urine pH >6 may be present.
Treatment
Hypokalemia should be treated individually, depending on the etiology and causative factors, and in combination with specific conditions.
General treatment
Discontinue medications: e.g. gentamicin, amikacin, tobramycin, cisplatin, compound licorice tablets.
Actively treat the primary disease: such as aldosteronism, Cushing’s syndrome, hyperthyroidism, etc.
Avoid excessive exercise, high temperature and other stimuli.
Actively control infection.
Nutritional support: eat more food containing more potassium, such as fresh vegetables, fruit juice, beans and meat food.
Drug treatment
Hypokalemia is currently treated mainly by potassium supplementation.
All medications for treatment need to be judged by doctor according to age, degree of hypokalemia, progress and so on, and should be carried out under doctor’s guidance.
Potassium supplements
轻度至中度低钾血症（2.5～3.5mmol/L）
Potassium supplementation can be given by oral route, which is safe, simple and easy to administer. However
Commonly used drugs: Potassium chloride or potassium citrate can be chosen for mild cases.
枸橼酸钾：更适用于肾小管酸性中毒等伴高氯血症者。
氯化钾缓释片：胃肠刺激性小，但不适用于肾功能不全、肾小管酸性中毒者。
Adverse effects: Irritation to the mucous membrane of the digestive tract, such as nausea, vomiting, diarrhea and bloating.
Precautions: Blood potassium should be monitored during potassium supplementation; follow the doctor’s instructions for medication, and not increase or decrease the dosage by oneself.
重度低钾血症（＜2.5mmol/L）
Severe hyperkalemia may be life-threatening and requires immediate treatment; intravenous potassium supplementation can rapidly correct hyperkalemia, but blood potassium level and ECG changes should be monitored during intravenous infusion.
氯化钾
一般来说，氯化钾溶于生理盐水，经外周静脉用药是安全的。
24小时氯化钾补充量在10～20g。
氯化钾浓度不应超过0.3%，滴注速度20～30mmol/h为宜，不能超过50mmol/h，因为较高浓度的氯化钾会导致高钾血症、外周静脉处疼痛和血管硬化。
治疗初期不应使用葡萄糖溶液配置氯化钾溶液，可因高血糖引起胰岛素释放，加重病情。当血钾基本正常后可改用氯化钾溶于葡萄糖溶液，有助于预防高钾血症。
高钾血症、急性肾功能不全、慢性肾功能不全者禁用氯化钾注射液。
谷氨酸钾
适用于肝衰竭合并低钾血症者。
可与5%葡萄糖溶液一起缓慢静脉滴注。
高血钾、高血镁、严重肾功能不全或房室传导阻滞者禁用。
不宜与保钾利尿剂合用。
注意事项
补钾时必须检查肾功能和尿量，每日尿量>700ml，每小时尿量>30ml，则补钾安全。
钾进入细胞内较为缓慢，细胞内外的钾平衡时间约需15小时或者更长，故应特别注意输注氯化钾中和输注后的严密观察，防止发生一过性高钾血症。
难治性低钾血症，需注意纠正碱中毒和低镁血症。
Other drugs
低钾性周期性瘫痪
Acetazolamide may reduce the frequency of attacks of familial hypokalemic periodic paralysis.
Precautions: Treatment of hyperthyroid periodic paralysis requires first controlling thyroid function to normal; in acute attacks, potassium chloride may be used orally or intravenously.
原发性醛固酮增多症
Potassium-preserving diuretics (spironolactone) correct metabolic abnormalities and hypertension.
Liddle综合征
Amiloride is the treatment drug of choice.
Bartter综合征
Spironolactone, amiloride, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory drugs are all indicated for this disease and should be individualized to the situation.
Gitelman综合征
Replacement therapy is the mainstay, i.e., replacing excess potassium, magnesium, and chloride lost, such as oral potassium chloride, potassium magnesium mentholatum, and magnesium chloride, but hypokalemia is often difficult to correct with replacement therapy alone.
Non-selective aldosterone receptor antagonists: e.g. spironolactone, which is also commonly used, but higher doses can significantly increase the incidence of adverse effects such as gynecomastia and menstrual disorders in women.
Surgery
Hypertension and hypokalemia due to renal artery stenosis can be improved by stenting or surgical treatment.
Primary aldosteronism (adenoma) and Cushing’s syndrome (pituitary tumor) can also be improved by surgical removal.
Ectopic ACTH syndrome caused by malignant tumors, such as small-cell lung cancer, bronchial-related cancer, thymic cancer, pancreatic cancer, etc., need to be judged by the doctor on a case-by-case basis to determine whether surgical treatment is needed.
Chinese medicine treatment
There is no evidence-based medical evidence to support TCM treatment for hyperkalemia, but some TCM treatments or medications may alleviate the symptoms, and it is recommended to go to a regular medical institution for treatment under the guidance of a TCM practitioner.
Prognosis
Cure
In mild hyperkalemia with clear triggers, the blood potassium concentration may return to normal on its own after removal of the triggers and dietary adjustments.
For hyperkalemia triggered by a primary cause, the decision needs to be made according to the progress of treatment of the primary cause.
如果积极治疗原发病、及时补钾，大多可以恢复正常。
因遗传因素引发的低钾血症需要长期治疗、定期补钾以维持机体状态。
Hazards
Prolonged hyperkalemia may lead to renal dysfunction, paralytic intestinal obstruction or even respiratory distress and coma in severe cases.
If the causative factor is not removed or the primary disease is not treated in time, cardiac arrhythmia can be triggered and even death.
Daily
Daily Management
Dietary management
Maintain a normal diet without picking and favoritism.
Eat a low-salt diet and avoid pickled and smoked foods, such as pickles, dashi and sausages.
For chronic vomiting and diarrhea, avoid spicy and stimulating, oily, crude fiber and flatulence food intake, such as chili, curry, mustard, coffee, fried food, creamy cake, milk, etc. Fruits, vegetables and whole grains are recommended to be chopped, juiced or stewed and cooked.
Eat more potassium-rich foods such as beans, vegetables such as spinach, celery, amaranth, sweet potatoes, and shiitake mushrooms; cornmeal, sweet potatoes, milk, eggs, and carp; fruits such as bananas, kiwis, grapes, grapefruit, and strawberries; and seaweeds are also rich in potassium.
Limit alcohol.
After surgery and for those with renal insufficiency, recipes should be developed under the guidance of a physician.
Exercise management
Avoid strenuous exercise.
After recovery, start with low-intensity exercise such as walking and gradually return to normal activities.
Work and rest management
Regular work and rest.
Take rest during the attack, avoid exertion, and ensure sufficient sleep and rest to reduce physical exertion and promote recovery.
Others
Take medication under doctor’s supervision, do not take medication or increase or decrease the dosage on your own.
Good hygiene habits, avoid infection and trauma.
Maintain a good state of mind.
Quit smoking.
Avoid prolonged exposure to high temperature in summer to prevent loss of potassium ions due to heavy sweating.
Follow-up and review
Some diseases require regular follow-ups, which should be done on time as prescribed by the doctor.
Prevention
A good lifestyle can help prevent hyperkalemia.
Stop smoking and limit alcohol consumption.
Avoid strenuous exercise.
Avoid prolonged exposure to high temperatures.
If you have other related diseases, treat them actively and take medication as prescribed by your doctor.
Ensure balanced diet, diversification of food types, light diet (less salt and oil), and may appropriately increase the intake of vegetables and fruits; for people with primary diseases, diet should be under the guidance of doctors.
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