Hypokalaemia and homoeopathic management

Dr Athulya P Padmanabhan

ABSTRACT
Hypokalaemia, defined as a serum potassium level below 3.5 mmol/L, is a common electrolyte imbalance with diverse aetiologies, including gastrointestinal losses, renal excretion, intracellular shifts, and inadequate intake. Clinically, it manifests as muscle weakness, arrhythmias, and characteristic electrocardiographic (ECG) changes, with severity correlating to the degree of potassium depletion. Prompt recognition and management are crucial to prevent life-threatening complications, particularly cardiac events. Diagnosis typically relies on clinical history and basic laboratory tests. Oral potassium replacement is preferred when feasible, while intravenous administration is reserved for severe or emergency cases.

Keywords: Hypokalaemia, Serum potassium, Electrolyte imbalance, Potassium depletion, Intracellular cation, Intracellular shifts

INTRODUCTION

Potassium (K⁺), the major intracellular cation, plays a vital role in neuromuscular and cardiovascular function. The body contains approximately 3500 mEq (50 mEq/kg), with 90% intracellular, primarily in muscles (70%), while only 2% resides in extracellular fluid (ECF). Tight regulation of potassium balance is maintained through renal excretion and transcellular shifts.

The minimum daily requirement of potassium is 40–50 mEq (1600–2000 mg), varying with diet, age, and ethnicity. Disruptions in potassium homeostasis—due to excessive losses, inadequate intake, or shifts between compartments—can lead to hypokalaemia, posing significant clinical risks.

DEFINITION & PREVALENCE
Hypokalaemia is defined as a serum K⁺ < 3.5 mEq/L.

Epidemiology

• Community settings: Affects ~2.5% of individuals (higher in women and thiazide diuretic users).
• Hospitalized patients: Prevalence rises to ~20%, with 39% observed in emergency department admissions.

ETIOLOGY

Hypokalaemia arises from:

1. Inadequate Dietary Intake
   • Prolonged potassium-deficient diets (e.g., anorexia, alcoholism).
   • Magnesium deficiency exacerbates renal potassium wasting.
2. Intracellular Shifts
   • Physiological: Postprandial insulin and catecholamine release.
   • Pathological: Beta-agonists (e.g., asthma medications), insulinoma, hypokalaemic periodic paralysis.
3. Gastrointestinal Losses
   • Diarrhoea: Causes hypokalaemia + hyperchloraemic metabolic acidosis.
   • Vomiting: Leads to hypokalaemia + metabolic alkalosis (due to secondary hyperaldosteronism).
4. Renal Potassium Wasting
   • Diuretics (thiazides, loop diuretics).
   • Mineralocorticoid excess (e.g., Conn syndrome, Bartter/Gitelman syndromes).
   • Renal tubular acidosis (RTA).

CLINICAL MANIFESTATIONS

Symptoms

• Mild cases: Often asymptomatic.
• Moderate-severe (K⁺ < 3.0 mEq/L):
  • Muscle weakness (proximal > distal), fatigue.
  • Cardiac: Palpitations, arrhythmias.
  • GI: Constipation, ileus.
  • Renal: Polyuria (nephrogenic diabetes insipidus).

ECG Changes

K⁺ Level (mEq/L)	ECG Findings
3.0–3.5	Flattened T waves
2.5–3.0	ST depression, U waves
<2.5	Prolonged QT, ventricular arrhythmias

Note: ECG changes may not always correlate with serum K⁺ levels.

DIAGNOSTIC APPROACH

1. Urine Potassium Excretion
   • 24-hour urine K⁺:
     • <25 mEq/day → non-renal loss (e.g., GI).
     • >25 mEq/day → Renal wasting.
   • Spot urine K⁺/creatinine ratio:
     • <1.5 mEq/mmol → non-renal cause.
     • >1.5 mEq/mmol → Renal loss.
2. Additional Tests
   • Serum electrolytes (Na⁺, Mg²⁺, Ca²⁺, HCO₃⁻).
   • Renin-aldosterone axis (e.g., Conn syndrome: ↓ renin, ↑ aldosterone).

MANAGEMENT

Conventional Treatment

• Oral K⁺ supplementation (mild cases).
• IV K⁺ (severe hypokalaemia or ECG changes).
• Correct hypomagnesaemia (to prevent renal K⁺ wasting).

Homoeopathic Approach

Homoeopathy offers supportive management for symptoms associated with hypokalaemia:

Remedy	Key Indications
Kalium phosphoricum	Muscle weakness, fatigue, neurasthenia.
Kalium carbonicum	Cardiac arrhythmias, profound exhaustion.
China officinalis	Weakness from fluid loss (diarrhoea/vomiting).
Arsenicum album	Restlessness, collapse, dehydration.
Veratrum album	Cold sweats, collapse, severe diarrhoea.
Digitalis purpurea	Irregular pulse, cardiac weakness.

Note: Homoeopathic remedies should complement, not replace, conventional therapy in severe cases.

CONCLUSION
Hypokalaemia is a clinically significant electrolyte disorder requiring prompt intervention. While conventional medicine focuses on potassium repletion and addressing underlying causes, homoeopathy may provide adjunctive symptomatic relief. Further research is warranted to explore integrative approaches in managing electrolyte imbalances.

REFERENCES

• Tinawi M. Hypokalemia: A Practical Approach to Diagnosis and Treatment. Archives of Clinical and Biomedical Research. 2020
• Mandal AK. Hypokalemia and Hyperkalemia. Medical Clinics of North America. 1997
• Davidson’s Principles and Practice of Medicine, 22nd Edition
• Clinical Electrocardiography – A Simplified Approach 7^th adition
• CURRENT Medical Diagnosis and Treatment 2025, 64th Edition (CMDT 2025)

Dr. Athulya P Padmanabhan
MD Scholar Department of Practice Of Medicine
Guide : Dr. M K KAMATH, Father Muller Homoeopathic Medical College, Mangalore
Email: athulya1998pp@gmail.com