Challenges in managing profound hypokalaemia

Potentially life threatening profound hypokalaemia with metabolic acidosis may not be adequately dealt with by current treatment recommendations Abnormalities of serum potassium are associated with well described clinical features: lassitude when potassium <3.5 mmol/l, possible muscle necrosis at < 2.5 mmol/l, and a flaccid paralysis with respiratory compromise at <2 mmol/l.1 World wide, hypokalaemia is most often caused by diarrhoea, although specific treatment of hypokalaemia is not mentioned in international guidelines for managing gastroenteritis.2 Furthermore, a recent case made us concerned that the potassium replacement recommended in medical texts (a maximum rate of infusion of 0.3-0.5 mmol/kg/hour and a maximum daily replacement of 3-5 mmol/kg) may be inadequate for profound hypokalaemia (≤1.5 mmol/l). The patient (case 1, table) was an 8 month old child with gastroenteritis who was too weak to respond appropriately to pain, with reduced respiratory effort, metabolic …