DISORDERS OF

POTASSIUM
METABOLISM
COMAHS
3RD YEAR MEDICINE
9200
 OBJECTIVES
 The following should be accomplished by the end of
the lecture:
 general overview of potassium as well as its functions
 normal metabolism of potassium
 problems of potassium metabolism (hypo
&hyperkalemia):
Causes
Manifestations
Management of these disorders
 Lab diagnosis of serum potassium levels
 GENERAL OVERVIEW
 Potassium is the most abundant ion of the ICF
 Its normal range in the ECF= 3.5-5 mmol/L (2% of
it in ECF)
 Its normal range in the ICF= 140-150
mmol/L(98% of it in ICF)
 Total body potassium in an adult male is about
50mEq/kg of body weight and is influenced by
age, sex and muscle mass(since most of the
potassium is found in muscles).
 Potassium level in the blood is controlled by
Aldosterone.
 GENERAL OVERVIEW
 It has the following functions:
It maintains internal environment of the cell
It regulates:
 RMP, AP & neuromuscular function
 Tissue excitability and contraction of skeletal,
cardiac and smooth muscles
 Cardiac impulse
 Acid base balance
 Water and Electrolyte balance
It helps in protein synthesis by ribosomes
Certain enzymes need potassium as cofactor
Facilitate cell growth
NORMAL METABOLISM OF POTASSIUM
EXTERNAL POTASSIUM BALANCE
 This refers to the balance between the amount of
potassium taken in and that taken out. This is
based on the body’s need for potassium.
 The normal daily requirement of intake is about
20mEq/L
 However, one may take up to 50-150 mEq/L
which is far greater than the normal serum
concentration of 3.5-5.5 mEq/L.
 So the body tries to excrete most of what is taken
in. This involves:
NORMAL METABOLISM OF POTASSIUM
 LOSS THROUGH THE KIDNEYS(PRIMARILY)
This involves secretion of excess potassium into the renal tubule and
its excretion via urine. About 50-70 mEq/L(1.5-2 gm/day) of
potassium is lost in urine. Generally, 67% and 20% of k+ is
reabsorbed at the PCT and TAL of the kidney respectively. However
loss of excess potassium is greatly influenced by Aldosterone
secretion which works at the principal cells of DCT to excrete excess
K+.
 LOSS THROUGH GIT
Potassium from diet and GIT is reabsorbed in the small intestine and
secreted in the colon and rectum in exchange for sodium. Eventually,
some amount of potassium (< 10mmol/day) is excreted in the faeces.
 LOSS THROUGH SWEAT
Very small amount is lost in sweat. Though it may vary based on how
excessive the sweating is.
Pictures of aldosterone control of potassium excretion
.
INTERNAL POTASSIUM BALANCE
 This refers to the electrochemical gradient caused by the
difference in concentration of potassium in and out of the
cell.
 This potassium balance is maintained by transcellular
movement of potassium across cell membranes in which:
 Potassium is exchanged with hydrogen(which can be pH
dependent) or with sodium across cell membranes via
Na/K pump or k/H exchanger.
 Also insulin helps uptake of potassium into cells.
 Beta-2 agonists also help uptake of potassium into cells.
Picture showing factors affecting internal K+ balance
DISORDERS OF POTASSIUM METABOLISM
(1.) HYPOKALEMIA
This occurs when the serum concentration of k+ is <3 mmol/L.
MANIFESTATIONS OF HYPOKALEMIA

 Hypokalaemia causes hyperpolarization of cardiac,

skeletal and smooth tissues thereby causing them to
be less reactive to stimuli. This leads to diminished
contraction of:
 Smooth muscles : Thereby causing constipation
 Skeletal muscles : causing weakness, cramps, flaccid
paralysis
 Cardiac muscles : causing arrhythmias with ECG
showing flat T wave, ST depression, U wave, QT
prolongation. Hypokalemia can also cause cardiac arrest.

 Respiratory muscles : causing respiratory depression

 Hypokalaemia also causes inability to concentrate
urine; polyuria.
MANAGEMENT OF HYPOKALEMIA

 MANAGEMENT OF HYPOKALEMIA
 Oral administration of KCL to replace K+ over a few days
 IV infusion of KCL may be indicated in some cases; not
more than 30mmol/hr.
 Chronic mild hypokalaemia can be corrected simply by
ingesting K+ rich foods such as dried fruits, nuts, bran
cereals, bananas, orange juice.
 2. HYPERKALEMIA
 Occurs when the serum K+ level >5 mmol/L
CAUSES
 MANIFESTATIONS OF HYPERKALEMIA
 Hypokalaemia initially causes contractions such as mild cramping
followed by inability to allow another depolarization and contraction of
the different muscles types:
(1.) In Skeletal muscle : this causes weakness, flaccid paralysis(which starts
from the lower extremities and moves upwards)
(2.) In Cardiac muscle : this causes arrhythmias and cardiac arrest.
 Hypokalaemia also causes numbness, tingling, mental confusion, altered
ECG showing peaked T waves, loss of P waves, heart blocks, ventricular
arrhytmias, widening of QRS complexes, asystole.

MANAGEMENT OF HYPERKALEMIA
 For direct antagonism against of hyperkaliaemic effect on cell membrane
polarization, give Calcium gluconate.
 For movement of extracellular K+ into intracellular compartment, give :
Sodium bicarbonate, β2-adrenergic agonists, insulin or glucose.
 Give diuretics (loop) if renal function is adequate
 Hemodialysis can be used if other measures fail.
.
LAB DIAGNOSIS OF SERUM POTASSIUM LEVELS
 In this procedure, blood sample is drawn from the veins of the
patient and is then taken to the lab to determine the serum
potassium level.
PRECAUTIONS SHOULD BE TAKEN IN :
(1.) The collection of the sample
 Use heparinized tube to prevent clotting as well as haemolysis of
the specimen; as clotting releases K+ from platelets and
haemolysis releases potassium from K+ rich RBCs thereby
causing pseudohyperkalaemia.
 Use proper care to draw blood because if a tourniquet is left on
the arm too long during blood collection or
if patients excessively clench their fists or otherwise exercise
their forearms before venipuncture, cells may release potassium into
plasma thereby causing pseudohyperkalaemia.
 Whole blood samples for k+ determinations should be stored at room
temperature (never iced); because storing blood on ice promotes the
release of K+ from cells causing pseudohyperkalaemia

(2.) The type of specimen used for the procedure

 Use of plasma is preferred in carrying out the test in the lab;
Significantly elevated platelet counts may result in the release of K+ during
clotting from rupture of these cells, causing a spurious hyperkalemia.
 .

BANANA TO THE RESCUE!!!

BANANA IS A GOOD SOURCE OF POTASSIUM. CAN BE
USEFUL IN TREATING MILD CHRONIC HYPOKALEMIA
.

Thank You