Hypokalemia and Potassium Supplementation

• Hypokalemia is a condition of low potassium. 
• Potassium is an electrolyte- an element or a compound that releases an electric charge when dissolved in water. 
• Potassium supplementation helps replenish depleted electrolytes. 

Certain illnesses can disturb the homeostasis balance of the body that maintains the levels of water and electrolytes. The balance in the body is delicate. If it gets altered, it can result in a life-threatening condition.  

 It can happen due to medication administration, loss of appetite, surgery, vomiting, and some diagnostic tools. Here we will talk about hypokalemia and overcoming it with the help of supplements.  

Potassium is an electrolyte- an element or a compound that releases an electric charge when dissolved in water. With potassium therapy, you replenish the depleted electrolytes.  

Potassium is the primary intracellular fluid electrolyte- a crucial electrolyte to maintain homeostasis. It is a major positively charged (cation) in the intracellular fluid.  

Under normal conditions, people consume potassium through daily food intake. But due to certain illnesses or conditions, the stored potassium might get depleted. Therefore, you will have to administer supplemental potassium to prevent hypokalemia.  

You can do that orally or through an intravenous route with potassium salts, such as:

• potassium acetate 
• potassium chloride 
• potassium gluconate 
• potassium phosphate 

The potassium ions travel directly into the intracellular fluid to restore the depleted balance and normalize potassium levels. It is an essential element in determining cell membrane potential and excitability. 

Potassium is necessary for  

• Proper functioning of all nerves and muscle cells  
• Nerve impulse transmission  
• Tissue growth and repair 
• Acid-base balance  

Uses For Potassium Supplementation

When normal potassium levels are depleted you will administer supplemental potassium to prevent hypokalemia.

It can happen due to various conditions, when there is increased potassium excretion or depletion, such as: 

• Vomiting and diarrhea when the person loses too much fluid 
• Nasogastric suction  
• Some kidney diseases 
• Excessive urination  
• Burns  
• Cystic fibrosis 
• Excessive antidiuretic hormone levels  
• Alkalosis  
• Laxative abuse  
• Insufficient potassium intake can happen due to anorexia nervosa, clay ingestion, or alcoholism 
• Administration of certain drugs such as glucocorticoids, vitamin B12, folic acid, amphotericin B, granulocyte-macrophage colony-stimulating factor, 
• or IV solutions that contain insufficient potassium. 
• Administration of diuretic therapy that depletes potassium. To overcome it, you can give a potassium-sparing diuretic to the patient that helps prevent hypokalemia.  

Hypokalemia can worsen the toxic effects of digoxin. It happens because potassium inhibits the excitability of the heart. Normal potassium levels moderate the action of digoxin, reducing the chance of toxicity.  

Therefore as a nurse, monitor the serum potassium levels with digoxin therapy. If the patient has hypokalemia, normalize the serum potassium levels soon. 

Drug Interactions With Potassium Supplementation

Potassium supplements can interact with;

• Potassium-sparing diuretics such as spironolactone, triamterene, and amiloride
• Angiotensin-converting enzyme inhibitors, such as captopril, enalapril, and lisinopril
  

When administering these drugs with potassium supplementation, keep an eye on serum potassium levels, as their concomitant administration can cause hyperkalemia. Therefore you need to alter the dose of potassium supplements with them.  

Adverse Reactions of Potassium Supplementation

Commonly, the adverse reactions of potassium therapy are associated with its route of administration.  

• Oral potassium tablets may sometimes cause nausea, vomiting, diarrhea, and abdominal pain. 
• The enteric-coated potassium tablets may cause small bowel ulceration, stenosis, hemorrhage, and obstruction.  
• Intravenous potassium infusion can cause phlebitis and pain at the injection site. If given rapidly, it can result in cardiac arrest. 
• In patients with decreased urine production, a potassium infusion can increase the risk of hyperkalemia. 
  

With potassium supplementation, monitor serum potassium levels to prevent hyperkalemia. Moreover, also monitor the patient closely for any signs and symptoms of hyperkalemia, such as: 

• abdominal cramping 
• confusion 
• diarrhea 
• electrocardiogram changes (tall, tented T wave) 
• hypotension 
• irregular pulse rate 
• irritability 
• muscle weakness 
• nausea 
• paresthesia 

Things to Keep In Mind

As a nurse, keep the following things in mind with potassium therapy. 

• Never mix IV potassium phosphate in a solution that contains calcium or magnesium because precipitates will form.  
• Monitor the patient for phlebitis- veins inflammation. If it occurs, change the administration site.  
• To overcome GI distress with oral potassium therapy, give it after food and not on an empty stomach.  
• If the patient develops nausea, vomiting, or diarrhea, administer antiemetics or antidiarrheals to overcome it.  
• Do not crush or make the patient chew an oral extended-release tablet. Tell the patient that they might notice wax matrices in their stool. They should not worry about it as it does not alter drug absorption.  

The Bottom Line

Potassium supplementation plays an essential role in replenishing depleted potassium stores. Ask the patient to notify you soon if they experience GI distress or signs and symptoms of hyperkalemia, such as diarrhea, muscle weakness, or confusion.  

Compel your patients to attend follow-up visits so that you can monitor their serum potassium levels frequently and prevent hyperkalemia.  

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