Laboratory Data

1. Serum electrolytes. Identify associated abnormalities that may affect treatment (hypomagnesemia) or exacerbate cardiac disturbances (hypocalcemia).

2. ABGs. Remember, alkalosis can cause intracellular shift of potassium. In addition, many of the renal causes of potassium loss have an associated acid-base disturbance. Finally, an anion gap acidosis may be present in the setting of elevated lactate with severe dehydration, poor cardiac output, or sepsis. Treatment of acidosis produces a "relative alkalosis" and may exacerbate hypokalemia, so prioritize therapy.

3. Urine. Urine sodium, potassium, chloride, and osmolality may assist in diagnosis. Urine drug screening may be useful if amphetamine or other sympathomimetic drug overdose is suspected.

4. Other blood testing. Obtain based on history and index of suspicion.

a. Digoxin level. May be critical in treatment of cardiac disturbances.

b. Adrenocorticotropic hormone, Cortisol, renin, and aldosterone. Assist in determination of underlying adrenal disorders.

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