I’hypokalemia is a electrolyte disorder which affects serum potassium levels. It is one of the most serious electrolyte disturbances.

Hypokalemia is a medical term which means too low a potassium level in the blood. Indeed, the potassium means the blood potassium concentration. The prefix “hypo” (from the Greek hupo) means “under”.

As a reminder, potassium (chemical element noted K) is a essential electrolyte which regulates thewater-electrolyte balance of the body, maintains a normal heart rhythm and is involved in the conduction of nerve impulses and muscle contraction.

Medically, we speak of hypokalemia when the plasma potassium concentration is strictly less than 3.5 mmol/L.

THE lack of potassium may manifest as muscle weakness or cramps and fatigue. In more severe cases, a potassium deficiency can cause a muscle paralysis even heart rhythm disorders. Cardiac arrest (and sometimes death) is then possible.

Hypokalemia is most often explained by a significant loss of this mineral due to vomiting, chronic diarrhea or the chronic intake of laxatives or diuretics. Finally, certain metabolic disorders and taking certain medications can cause a decrease in potassium stocks in the blood.

THE diagnosis of hypokalemia is based on a simple blood test to measure the blood potassium level. The treatment involves the consumption ofpotassium rich foods or taking food supplements.

A lack of potassium is most often explained by significant losses of this mineral. The causes most often found are:

• Chronic vomiting : they can result from different pathologies such as bulimia nervosa with vomitinga mechanical obstruction (ulcer, digestive tumor..), a neurological disease (intracranial hypertension, epilepsy, migraine, meningitis, etc.), drug or toxic poisoning, pregnancy (especially in the first trimester), digestive or liver disease…
• Of the chronic diarrhea related to a digestive disease for example.
• There overuse of laxatives especially in case ofanorexia nervosa or bulimia nervosa associated with purging behavior.
• The chronic intake of diuretic drugs : in this case, the losses of potassium are of urinary origin.
• A abnormality of the adrenal glands which promotes the elimination of potassium by the kidneys (Cushing’s disease).

Sometimes low potassium levels can also be explained by insufficient potassium intake in the event of:

• anorexia nervosa ;
• restrictive diets even a young prolonged ;
• unbalanced diet (nutritional aberrations);
• a diet rich in carbohydrate (starches) associated with a chronic alcohol consumption.

Finally, hypokalaemia can be the consequence of certain abnormalities causing a transfer of potassium into the cell. This condition can be the consequence of:

• a situation of stress ;
• a metabolic alkalosis (particularly in the context of a diabetes);
• there taking certain medications (insulin, salbutamol, terbutaline…)
• excess coffee.

Hypokalaemia is one of the causes of death by cardiac arrest in anorexic/bulimic people, especially in those who cause vomiting. If you are in this situation, it is best to consult a doctor. Also, you should stop or at least lessen the vomiting. Halving vomiting halves the risk of cardiac arrest. In case of vomiting, the doctor will recommend that you take potassium tablets immediately after these, to compensate for the losses. Do not take them if you know you will vomit within 2 hours. These drugs could well save your life (in no way do they promote weight gain!).

Most of the time, hypokalemia is asymptomatic. In the event of a decrease in potassium in the blood, certain discreet signs may nevertheless appear:

• A great fatigue (asthenia);
• A muscular weakness ;
• of the muscle spasms (involuntary and painless contractions of the muscles);
• of themuscle crampss (especially at night).

Even mild hypokalemia is not trivial and must be taken care of. Indeed, the lack of potassium can cause cardiac arrhythmias even in the event of mild hypokalaemia in patients suffering from heart disease or treated with digoxin.

We should add that the fatigue linked to potassium deficiency can alter alertness and increase the risk of falling especially in the elderly.

The risks of severe hypokalemia (when potassium levels are below 3 mmol/L) are:

• Muscle damage with massive destruction of muscle tissue (rhabdomyolysis);
• A transient tetraparesis (slight paralysis of 4 limbs);
• A bowel obstruction related to paralysis of the small intestine;
• A urinary retention ;
• A respiratory arrest ;
• A cardiac hyperexcitability (heart rhythm disorder) and sometimes a cardiac arrest.

Severe hypokalemia leads to increased risk of death.

I’chronic hypokalemia may affect the ability of the kidneys to concentrate, resulting in urinary disorders.

If the doctor suspects hypokalemia (given the symptoms and the medical background), blood tests are ordered to measure the patient’s blood potassium (kalaemia) level.

Hypokalemia is a serum potassium concentration strictly below 3.5 mmol/L.

A moderate hypokalemia (plasma potassium between 3 and 3.5 mmol/L) rarely causes symptoms.

Below 3 mmol/L, we speak of severe hypokalemia with the risk of sometimes serious complications (such as respiratory or cardiac arrest).

There management of hypokalemia generally involves taking potassium supplementation. Nevertheless, a diet rich in potassium can prevent this health problem and restore mild hypokalemia.

In case of mild hypokalaemia and in the absence of symptoms, a high potassium diet may be sufficient to treat hypokalemia.

However, if the patient is symptomatic and/or if the serum potassium is moderate to severe (less than or equal to 3 mmol/L), potassium food supplements can be prescribed.

Potassium can be administered by oral route. It must be ingested in small quantities, during meals, and several times a day.

In some cases, potassium can be given by intravenous route (severe hypokalaemia, presence of cardiac arrhythmias, failure or insufficiency of oral supplementation).

It takes a few days to a few weeks to feel the effectiveness of oral supplementation. In an emergency situation, the administration of potassium intravenously can correct the hypokalaemia in less than 2 hours.

You can find potassium naturally present in several families of foods such as:

• THE vegetables : spinachchard, mushroomscabbage, potatoes…
• THE fruits : prunelawyers, apricotsblackcurrant, citrus fruits, bananas…
• THE legumes : Chickpeas, lentilsWhite beans…
• THE dried fruits : pistachios, figs, dried dates, nut, almonds, chestnuts…
• fish more specifically oily fish : sardines, mackerel, salmon…
• THE meats
• THE dark chocolate
• THE Whole grains