Contents
There is still too little talk of an electrolyte disturbance like hypokalaemia. And it turns out that this is a common phenomenon, the consequences of which can be extremely dangerous to health and even life. Moreover, potassium deficiency is often associated with COVID-19 patients and is associated with a worse course of the disease.
What is hypokalemia?
Hypokalaemia is an electrolyte disturbance in which serum potassium levels fall below 3,5 mmol / l. The reason for its development is both the insufficient supply of potassium with food and too rapid loss of potassium from the body. This can happen, among others as a result of dehydration, which often accompanies diarrhea, vomiting, food poisoning, and infections. The body then gets rid of water together with mineral substances.
The disorder is quite common in our population, but many patients are not aware of it. It most often accompanies chronic diseases such as arterial hypertension or heart failure.
The state of potassium deficiency requires immediate treatment. Underestimating the symptoms (including frequent muscle cramps, numbness in the limbs, constipation, arrhythmias, chronic fatigue) can be very dangerous to health, and in extreme cases even life. Therefore, it is necessary to perform regular tests to determine the level of potassium in the blood serum.
The importance of potassium in the human body
Potassium is a valuable element that plays a very important role in the body:
- regulates the water and electrolyte balance,
- modulates blood pressure,
- stimulates the pancreas to secrete insulin,
- activates cell enzymes,
- controls muscle contractions.
Optimal, i.e. normal, potassium concentration (3,6-5,2 mmol / l) improves muscle function, regulates blood sugar levels, and above all protects against the development of cardiovascular diseases, and thus reduces the risk of death.
What are the risk factors for hypokalemia?
The development of hypokalemia is influenced by the coexistence of other conditions, including:
- arterial hypertension,
- diabetes
- kidney failure
- the presence of acid-base disorders, including respiratory alkalosis (e.g. in the course of tetany), or insufficient potassium level after acidosis correction.
Potassium deficiency can cause serious arrhythmias, which in turn can cause ventricular fibrillation (the lower the potassium level, the higher the risk of tachycardia) and even death.
Hypokalemia and arrhythmias
A 2013 study (Rotterdam Study) found that hypokalemia increases the risk of atrial fibrillation. This, in turn, gives you a higher risk of stroke (5x) and heart attack (2x). The disease is the cause of 20-30 percent. ischemic strokes. In Poland, there are approx. 15 thousand. stroke cases. This means that within an hour, 2 patients will have a stroke. 60 percent of them may die within a year.
“Hypokalemia is one of the triggers of arrhythmia in patients. If he has a coronary heart disease, including damage and failure of the heart muscle, the muscle is much more excitable and prone to electrolyte disturbances. We must remember that the less potassium, the greater the risk of ventricular arrhythmias, ventricular fibrillation and sudden cardiac arrest “- explains Prof. extra dr hab. Adrian Doroszko from the Department and Clinic of Internal Diseases, Hypertension and Clinical Oncology (UMW).
In patients with paroxysmal atrial fibrillation, both potassium supplementation and its constant monitoring are necessary. Only in this way can sinus heart rhythm be restored and maintained. Patients suffering from chronic heart failure must undergo therapy with potassium, even if its level is about 4 mmol / l (optimal it is to adjust its concentration to 4,5-5 mmol / l). This is associated with an increased risk of arrhythmias.
Treatment of hypokalemia
Treatment of hypokalaemia is primarily aimed at reducing the risk of a life-threatening arrhythmia. A frequent mistake made by patients is taking potassium in the form of a dietary supplement (without proper medical control), which may result in hyperkalemia (i.e. excess potassium), as well as a rapid relapse of the disease after discontinuation of supplementation.
The key factor in treatment is to find out the exact cause of the deficiency of this element, implement individually selected treatment and monitor its progress. Diet may be effective in mild potassium deficiency, however, pharmacology is required for an advanced disorder. It is worth remembering that drugs, unlike dietary supplements, have been properly tested in terms of composition and purity. This means that they are more effective and safer to take.
Scientific research indicates that an important factor in the treatment of hypokalemia is the process of gradual and controlled release of potassium ions, which is ensured by the technology of micropellet capsule production. They are easy to take even by people who have difficulty swallowing. They also reduce the risk of side effects from the digestive system.
Hypokalemia vs. COVID-19
Since the outbreak of the COVID-19 pandemic, new facts have come to light about the impact of the disease on the functioning of the entire body. It turns out that as many as 62 percent. Hypokalemia is present in patients treated for SARS-CoV-2 infection. This has the effect of worsening the course of the disease.
A 2019 study in Wenzhou (China) showed that:
- 93% of seriously and critically ill patients with COVID-19 had hypokalemia,
- 44% of subjects with mild to moderate COVID-19 disease had hypokalemia.
The virus itself influences the body’s blood pressure and water regulation mechanisms, thereby contributing to the loss of potassium. Symptoms of coronavirus infection, including high fever, vomiting, and diarrhea, also contribute to dehydration.
“Potassium changes in the course of COVID-19 infection may have a multidirectional dimension. This is due to several basic factors. Patients hospitalized due to a severe course of the disease are often treated with steroid therapy, and also require fluid therapy as a result of, for example, dehydration caused by fever. Normal saline is used, causing a large amount of potassium to be lost in the urine and diluting it extra in the blood, with the consequent risk of profound hypokalemia requiring treatment. On the other hand, outpatients (with a milder course of COVID-19) hydrate improperly, i.e. with non-electrolyte fluids (often tea, tap water or mineral water, with a negligible potassium content). And this, plus the symptoms of gastroenteritis, is a simple recipe for hypokalemia ”- explains Prof. extra dr hab. Adrian Doroszko.
Severe cases of hypokalaemia (potassium levels below 3 mmol / L) can contribute to the induction of ventricular arrhythmias and respiratory muscle dysfunction, which in turn directly threaten the life of COVID-19 patients.
“In the course of COVID-19, adrenal gland damage may occasionally occur, and disorders of the renin-angiotensin-aldosterone system due to changes in therapeutic regimens (especially discontinuation of certain cardiological drugs) may lead to the development of transient hypokalemia. Therefore, correcting the potassium level is crucial at every stage of the infection. No less important is its control during the convalescence period and later, in convalescents – adds prof. extra dr hab. Adrian Doroszko – During the convalescence period, dynamic changes occur, not only in the water and electrolyte balance, but also in the hormonal balance. Regaining balance can be a very difficult and lengthy process for the body. Both hyper- and hypokalemia can be fatal, especially in the presence of underlying cardiac problems. ”
Oral drug therapy in COVID-19 patients with hypokalaemia
Oral drug therapy is recommended for people suffering from coronavirus who did not require hospitalization and who have been diagnosed with hypokalemia. Unlike intravenous infusions, they are much more convenient to use, especially due to the sanitary restrictions in force during the pandemic.
It is worth remembering that chronic hypokalemia also occurs in convalescents who have undergone COVID-19 in a mild manner without serious complications. It has been shown that the state of potassium level disturbance may persist for up to several months. According to research, as much as 80 percent. convalescents are experienced by the so-called pocovid syndrome, manifested, inter alia, in chronic fatigue or muscle weakness. In such cases, it is necessary to perform detailed tests for the level of not only potassium, but also other elements, including magnesium, sodium and chlorine.