β-Adrenergic therapy
+Diuretic therapy
+Lithium therapy
+Poor dietary intake
+Primary aldosteronism
Frequent causes of hypokalemia in ED patients are alkalosis, gastrointestinal loss (vomiting, diarrhea, nasogastric suctioning, etc.), and diuretic therapy. Other less common causes are from sweat loss, other causes of renal loss (primary or secondary aldosteronism, renal tubular acidosis, postobstructive diuresis, licorice ingestion, and osmotic diuresis), extracellular to intracellular potassium shifts such as hypokalemic periodic paralysis, and increased plasma insulin. Symptoms of hypokalemia such as hypertension, orthostatic hypotension, dysrhythmias, weakness, cramps, paralysis, and hyporeflexia usually present when potassium levels are below 2.5 mEq/L. Potassium should be replaced either orally with 20 mEq of K+ every 60 minutes until anticipated results are achieved, or through a peripheral IV. No more than 40 mEq should be added to each liter of IV fluid and infusion rates should be no greater than 20 mEq/hour.