Key messages

• Plasma potassium may bear no relation to total body potassium; hypokalemia may be present in patients with low, normal, or high total body potassium.

• Diuretics increase potassium excretion by increasing delivery of sodium to the distal tubule.

• Severe vomiting and the accompanying hypochloremic alkalosis leads to a shift of potassium into cells and also increased potassium loss from the kidney.

• Acidosis favors potassium shifts from the cell to the extracellular fluid in exchange for hydrogen ions.

• ECG changes of hypokalemia consist of ST depression, flattening of the T wave, and prominent U waves. Subsequently there may be widening of the QRS complex and atrioventricular block.

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