Hypokalemia, or potassium deficiency, can have a dramatic course and manifest itself in very serious diseases. It is worth taking care of the correct concentration of potassium, especially now, in the era of a pandemic. For the sake of your heart.
Many people have probably not heard of hypokalemia. What is it about?
Hypokalemia, or potassium deficiency, is an electrolyte disturbance in which serum potassium levels fall below 3,5 mmol / l. It can be mild, but also heavy. We doctors dislike hypokalemia with a potassium concentration below 2,5 mmol / l the most, because with each successive decrease in the concentration of this electrolyte, the risk for the patient, including death, increases.
How common are potassium deficiencies?
Hypokalemia is quite common. It accompanies many chronic diseases, such as arterial hypertension, cardiac arrhythmias, diabetes, and kidney failure.
There is talk of research showing that hypokalemia is common in patients treated for COVID-19. What is the relationship between potassium deficiency and SARS-CoV-2 infection?
Hypokalemia is common in patients treated for COVID-19 and is associated with a worse course of the disease. Coronavirus has been shown by research to affect the body’s mechanisms of blood pressure and water excretion, thereby also contributing to the loss of potassium and thus increasing hypokalemia. Severe hypokalemia, below 3 mmol / L, can cause ventricular arrhythmia and respiratory muscle dysfunction, both of which are life-threatening in severely ill patients with SARS-CoV-2 infection. Potassium levels in these patients should be monitored frequently and maintained at 4 and 5,5 mmol / L. People suffering from COVID-19 with concomitant cardiovascular diseases are particularly vulnerable to potentially fatal arrhythmias.
Chronic hypokalemia also occurs when COVID-19 infection is mild and may persist for up to several months. That is why it is so important to regularly check the level of potassium in the blood serum, also in convalescents, and if a deficiency is detected, the implementation of appropriate therapy.
Should we check the potassium concentration as a standard?
Tests to determine the concentration of potassium in the blood should always be performed in the event of certain symptoms, for example, when you experience heart problems or weakness. You should then ask your doctor for a referral for the determination of electrolytes, especially potassium.
It is also good for people who regularly play sports, i.e. are at risk of dehydration. Dehydration is also a threat to us in the course of diseases accompanied by vomiting and diarrhea, which causes significant water loss. Frequent muscle contractions should make us pay attention to potassium levels. Regular potassium level tests should be a constant element of therapy when we suffer from cardiovascular diseases. In the course of hypokalemia, people at risk may develop atrial fibrillation, which significantly increases the risk of stroke and heart attack.
What should be the optimal potassium concentration?
It should be within the accepted standards for the particular laboratory performing the test. Most often, these norms range from 3,5 to 5,1 mmol / l. However, there are specific groups of people for whom the potassium concentration should be within strictly defined limits, for example, for patients with atrial fibrillation, the most favorable potassium concentration is approx. 4,5 mmol / l. The same is true for patients with heart failure.
Why is the correct potassium concentration so important to our health?
Proper potassium levels are important for many reasons. Rapidly developing hypokalemia can have a dramatic course and manifest itself in very serious diseases. For me, a cardiologist, the most important are the dangerous cardiac arrhythmias associated with it, especially the ventricular ones. For the patient it will be very important to weaken the strength of skeletal muscles, and from other ailments – constipation, in extreme cases leading to paralytic intestinal obstruction, urinary retention due to weakening of the urinary bladder muscles or neurological disorders such as paraesthesia (inappropriate sensation of stimuli), nervous hyperactivity, apathy .
And why is potassium deficiency so important in the context of cardiovascular diseases? You mentioned heart rhythm disturbances. Are there any other reasons?
The correct concentration of potassium protects against the development of cardiovascular diseases. Hypokalemia favors the occurrence of atrial fibrillation, and atrial fibrillation in turn causes 20-30%. ischemic strokes (about 15 a year in Poland). This means that two people will have a stroke within an hour. Unfortunately, even 60 percent. of them may die within a year.
Monitoring and supplementation of potassium deficiency should be routine management in patients with paroxysmal atrial fibrillation. Low potassium levels are an independent risk factor for the development of life-threatening ventricular tachycardia. The lower the potassium level, the higher the risk of ventricular tachycardia.
What is important in treating hypokalemia? What should doctors and patients pay attention to?
In my opinion, two things are most important. The first is the awareness that untreated hypokalemia can be dangerous and, in extreme cases, even fatal. The second is to choose the right potassium-containing preparation. We cannot get caught in the trap – we feel that we are supplementing potassium, but we are not actually supplementing it, because some preparations available on the market do not provide the right amount of this electrolyte. It is best that supplementation should take place under the supervision of a doctor. You should not do this on your own. The doctor will calculate exactly how much potassium we need to supplement the deficiencies. It will also indicate the most appropriate preparation. This is important because one issue is the supply of potassium, and the other is its proper penetration into the body.
Preparations that are well absorbed are recommended, because then we can be sure that if we take the dose recommended by the doctor, it will be completely absorbed and not excreted through the alimentary tract. Such availability is ensured by preparations in the form of capsules with prolonged release of potassium ions containing the so-called micropellets. Micropellets are small particles containing the drug and enclosed in a capsule. They ensure a gradual release of the active ingredient as the capsule passes through the gastrointestinal tract. Micropellets are also beneficial because they dissolve in liquid, food. This makes the capsules easy to take for people who have difficulty swallowing. The properties of micropellets also help to reduce the risk of gastrointestinal side effects, such as gastric irritation.
So better not to rely on dietary supplements containing potassium?
It is definitely worth relying on the doctor’s decision and using the prescribed preparation. It must be remembered that a dietary supplement is not a drug, it is not subject to strict standards and quality and safety control.
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