Hypokalaemia may go unnoticed, but the consequences can be serious. Therefore, it is necessary to supplement potassium deficiencies. Necessarily drugs, not dietary supplements.
What is hypokalemia?
Hypokalemia is an electrolyte disturbance in which potassium deficiency occurs. The human body contains approximately 50 mmol of potassium / kg of body weight. 98 percent of this element is inside cells, and 2 percent. in the intercellular space – in tissue fluids and blood. This is the parameter that we can determine in laboratory tests.
Normokalemia, i.e. the normal level of potassium determined in the blood serum, is between 3,5 and 5 mmol / l. We recognize hypokalemia when the potassium level is below 3,5 mmol / l, although some experts believe that the lower limit is 3,8 mmol / l and this value seems to be the right one.
What favors potassium deficiency?
There are many reasons for this. These include insufficient amounts of potassium in the diet. Sick kidneys promote potassium loss. Vomiting, diarrhea, and taking laxatives are other causes of potassium loss. Potassium can also be lost through the skin through profuse sweating. Chronic use of drugs used in the treatment of hypertension and heart failure, especially diuretics and steroids, is another reason for the loss of this element.
What might be the consequences of uncontrolled, untreated hypokalemia?
The effects of hypokalemia depend not only on the concentration of potassium, but also on the dynamics of its decrease. So whether it is a sudden loss of this element, or it is spread over time. Occasionally, a patient with severe but long-term hypokalaemia is asymptomatic and the disorder is not identified until the follow-up blood electrolyte test.
Low potassium levels mainly affect the work of the heart. The heart muscle is a very sublime muscle that contracts regardless of our will under the influence of the so-called work. the conductive stimulus system. Hypokalemia disrupts the functioning of the conductive system. Low potassium levels generate abnormal heart rhythms that are life-threatening. Hypokalemia increases the risk of developing atrial fibrillation by as much as 63%. This is especially true of patients with the so-called the substrate of the arrhythmia. These are people who are treated for ischemic heart disease, arterial hypertension, and heart failure. In these patients, hypokalaemia can result in sudden cardiac arrest and death. This is why potassium monitoring is so important.
Hypokalemia disturbs the functioning of not only the heart muscle, but also the entire muscular system. It weakens muscles and can even break down muscle cells. It also impairs the functions of the central nervous system, which results in cognitive, orientation and concentration disorders.
Why is it especially important to check potassium levels in the time of the COVID-19 pandemic, which is not over yet?
COVID-19 is a great challenge for scientists and doctors. We learn about this disease all the time. We see that SARS-CoV-2 infected patients are at greater risk of hypokalemia. We do not fully know the mechanisms why this is happening. Certainly, the infected have a loss of potassium due to gastrointestinal symptoms, they have reduced appetite, and therefore a smaller supply of potassium with food. However, the main mechanism is considered to be damage to the renal tubules due to ischemia and nephrotoxicity due to inflammation in the body. The impression is that the SARS-CoV-2 virus also affects the regulatory mechanism of the renin-angiotensin-aldosterone system. Specifically, the enzyme responsible for this system, which causes us to lose potassium through the kidneys. Sodium is retained in the body and the loss of potassium is great.
One study from China showed that only 2 percent of people infected with SARS-CoV-45 and hospitalized for that reason. had normal potassium values, 18 percent. had the so-called severe hypokalemia, i.e. potassium levels below 3 mmol / l, and 36% was hypokalemic with potassium in the order of 3-3,5 mmol / l.
On the other hand, a Spanish study showed profound hypokalemia, i.e. below 3 mmol / l in 6%. people hospitalized due to COVID-19. This is a very big problem, especially in patients who have comorbidities, especially cardiovascular diseases. Therefore, people with a history of COVID-19 infection, even if it was mild, should have their potassium levels checked.
How should hypokalaemia be treated? Why should potassium deficiency be supplemented with drugs and not supplements?
Severe hypokalaemia is treated in hospital with the intravenous administration of potassium and frequent monitoring of potassium levels in the blood. However, the administration of potassium by the intravenous route should be as short as possible. After that, we switch to oral potassium supplementation as soon as possible. Oral therapy should be monitored with blood potassium testing. The doctor decides the frequency of these checks. Monitoring is necessary to avoid hyperkalemia, which is excessively high potassium levels.
For oral potassium supplementation, we use drugs, not dietary supplements. In the case of drugs, we know exactly how much potassium is in the tablet. However, if we take dietary supplements, we do not really know what the content of the element in a given preparation is. So if someone is potassium deficient, I urge them to go to their doctor for a prescription and take the drug, not the supplement.
Should pharmacotherapy be started with all potassium deficiencies?
Yes, any potassium deficiency should be replaced. And above all, the reason for this deficiency should be clarified. Of course, it is up to the patient how he reacts to the drugs. You should take them and check your potassium level regularly. How often – the doctor decides about it. The replacement of potassium deficiency completely cures the hypokalaemia.