Hypokalemia

The clinical manifestations, etiologies, diagnostic evaluation, and treatment of hypokalemia, including states of mineralocorticoid excess.

[@aymanelsamany9829]

everyday i check the channel for new release ,really u r my medical mentor

[@pheinny]

I would also like to understand the physiopathology of hypokalemia. If you could explain what happens at the cellular level, meaning what happens to the action potential (how it affects the muscle, etc)... I would appreciate it! Ps.: I'm a medical student from Brazil and I love your videos!

[@rralpha2009]

Great! Thank you and keep making excelents classes

[@folumb]

Hi Dr. Strong, the T wave U wave distinction you discussed at the beginning of this video is very confusing to me. Was there anything about that waveform that indicated it was a U wave and not a T wave independent of any knowledge that the patient it belonged to was hypokalemic? (i.e. can you diagnose or at least gain a very high suspicion of hypokalemia only from an ekg?)

[@brandiwebb2898]

Very helpful in helping my friend's and family understand what I'm going through at the moment!

[@mrcharlesjohnson]

These videos are awesome, thank you so much.

[@DanielBender1984]

Users of Eric's Medical Lectures - Petition to nominate Dr. Eric Strong for The Abraham Flexner Award This is the AAMC's most prestigious honor. The Flexner Award recognizes the highest standards in medical education and honors individuals whose impact on medical education is national in scope. -DB

[@teresitaloracontreras7644]

God bless you!!

[@ShadoOoni]

Teresita Lora Contreras today and everyday

[@Himanshusingh-ss2fc]

Well presented

[@robertogiovannini8106]

Hello Mr. Strong! Thank you for your hard work on these arguments! I'm a junior doctor in internal medicine in Italy and I often use your videos as a first step in the argument. I want to ask you what is the mechanism that bring to Metabolic Acidosis in Primary Adrenal Insufficiency.. is the low-flow hypotensive state that create the situation? and in The secondary where there is no hypotension there are also changes in PH? In addition there is a role of T4 or T3 regarding the renal reabsorbtion of electrolites in hypopituitarism or hypothiroidism? Thank u

[@xDomglmao]

Adrenal insufficiency = no aldosterone = no H+ secr. = H+ accumulation I would say?

[@limweiyang2464]

It would be best if yo could describe the inherited renal tubular channelopathies contributing to hypokalemia ie Liddle's and Gittelman's syndrome under this topic too. Thanks

[@dr.anandakrishnanu7333]

Thank you Sir for the video. Sir, what are the reasons for the symptoms of hypokalemia?

[@dharmazech2165]

Excellent sir

[@sunving]

Thank you Dr strong .

[@employeebaghdadad8684]

Thanks very much

[@arcade2002]

Very helpful

[@inseesawangsak5997]

Thank you😊

[@ross1212]

hello Eric What do we do igive for DKA with hyperkalemia ? which one is 1st .. calcium gulconate or normal saline or insulin . thank you in advance

[@koban4max]

Does it cause tachy or Brady? How does it cause tachy if potassium is excitability?

[@superbesli8016]

thanks a lot,

[@StrongMed]

Slides made in PowerPoint. Images and diagrams are mostly made directly in PowerPoint (because it's fast for simple things), but occasionally in Flash or Fireworks or Illustrator for stuff that isn't possible in PowerPoint. Audacity is used for recording narration. Finale is used for the music. Then everything is stitched together in Adobe Premiere (previously used Premiere Elements, but since my previous computer died last month, I'm now using Premiere Pro).

[@Goodfellow62]

Thanks for the great video, but doesn't Congenital Adrenal Hyperplasia (21-B Hydroxylase deficiency) cause hypoaldosteronism?

[@StrongMed]

Sorry, I just watched the relevant stretch of the video and you were right to question what I said - it's wasn't clear at all! Congenital adrenal hyperplasia, as you may know, is actually an umbrella term used to describe a number of different genetic defects in cortisol synthesis by the adrenal glands. The most common form, 21 hydroxylase deficiency does result in hypoaldosteronism, and thus hyperkalemia. Only less common forms of CAH lead to hyperaldosteronism. I've added an annotation to clarify.

[@Goodfellow62]

Eric's Medical Lectures Thank you very much for the clarification and thank your for making such valuable videos available to us for free. Your knowledge and organization deserve a lot of respect. I admire your work.

[@andrewjonczyk3617]

What is the maximum rate per minute of potasium i.v administration? Is 10 mmol KCl / min. diluded in 0.9% NaCl sufficient for patient with 2.4 mmol/l hypokalemia caused by vommiting?

[@andrewjonczyk3617]

'per hour' of course. When to add insuline + glucose?

[@StrongMed]

I am assuming your question is concerning a hypothetical patient, and not one who you are actively treating for hypokalemia... You may want to consult your hospital's pharmacist to make sure the dosing as ordered conforms to your hospital's convention. (i.e. potassium is ordered slightly differently in different hospitals and different parts of the world). The max infusion rate via a peripheral IV is generally considered to be 10 mmol/hr, and the max infusion rate via a central line is generally considered to be 20 mmol/hr. For a patient with a serum K of 2.4 mmol/L, it depends a little on the clinical situation (i.e. presence of symptoms/EKG changes, how rapidly the hypokalemia developed), but I would typically treat that degree of hypokalemia a little more aggressively, and would consider giving 10 mmol/L via a peripheral IV, simultaneously as giving modest amounts via oral route, with frequent (i.e. q6 hrs) potassium checks until it was above 3.0, then back off a little bit. Like I said, every hospital is a little different, but KCl isn't always diluted in 0.9% NaCl since the resulting solution is slightly hypertonic. But to prevent confusion with drug administration, I would stick to whatever solution was most common in your hospital. Regarding insulin + glucose, that's used in the treatment of hyperkalemia, not hypokalemia. Insulin should be given if either EKG changes of hyperkalemia are present, or if the serum K > 6.5 mmol/L. Glucose is given simultaneously to the insulin to prevent hypoglycemia, however, some people hold off on the glucose if the patient's serum glucose is already > 250mg/dL.

[@andrewjonczyk3617]

Eric's Medical Lectures Than your for your comperhensive answer. Of course this is not a real medical case.

[@bettyrose5387]

I never knew I have this, just my dermatologist wanted to put me on spironolactone for my hair loss and she needed to do a test of potassium and other, and I found out that my potassium some how low about 0.31 lower than the normes the minimum is 4.8 i have 4.49 is this a big difference should ai be worried?

[@StrongMed]

I'm sorry, but I can't offer specific, individualized medical advice here. I recommend speaking to your primary care physician.

[@venkybly]

Tq

[@drameerhussain]

Doesn't dka causes hyperkalemia?

[@cmhmck]

Do you bother treating a stable K between 3.0 and 3.5?

[@StrongMed]

Yes, definitely. But I also would investigate why it was persistently low and address the underlying cause.

[@tatycieza]

please un video sobre insuficiencia cardiaca

[@StrongMed]

I'm looking forward to making a series of videos on heart failure, but because it's a large and important topic, I'm waiting until I have a large amount of available time to devote the necessary attention to do a good job with it.

[@tatycieza]

Muchas gracias por responderme, de todos modos agradecerte por tus videos acedémicos exelentes:),

[@delsol7878]

Thanks for the lecture. I wish it had more detail then just listing out things. Very well organized though.

[@StrongMed]

Thanks for the feedback. I've been trying to keep my videos under 20 min or so whenever possible, since it seems that's the inflection point where viewer interest starts to wane. But I agree that this duration cutoff works better for some topics than others.

[@delsol7878]

I am also a teacher on my other side of life and what students lack is explained details. For example, when a book lists out symptoms of a disease, it just lists out. If an author took time and actually explain mechanism of the symptoms why and how it occur, it would have been so much easy learning. Sadly that's not the case. Moreover, that's what all the universities do. Shoot the power point of lecture, read along, fold up the laptop, end of lecture. Students are expected to "memorize" all listed symptoms of disease without understanding why and how symptoms occur. I don't think that's quality learning. I understand your point of putting all in 20 mins. Maybe you want to expand a topic into a series of video clips. Thanks again.

[@StrongMed]

delsol7878 I appreciate your feedback. I think for most topics on my channel, the mechanism behind symptoms or findings is well covered. This particular topic (hypo and hyperkalemia) is challenging because of another limitation of online lectures that has nothing to do with PowerPoint. There is a huge diversity of backgrounds knowledge among the viewers of any one video. For example, some people who are watching this video on hypokalemia may be 2nd year medical students who just have completed a 2 week block on cellular physiology, and I could explain in under 5 minutes why hypokalemia causes arrhythmias with enough detail to satisfy any of them, and to address your concerns. However, most viewers of this video are relatively unfamiliar with ion channels, membrane potential, and action potentials. To get them up to speed enough with those concepts that they can then understand the mechanistic relationship between potassium disorders and arrhythmias would be a huge digression from the original topic, and since they are not a captive audience, they would look elsewhere for the information. One ultimate goal of mine would be to have enough videos that all information relevant to the practice of medicine is covered to some extent. That way, during the video on hypokalemia, I could reference the video on action potentials or the video on cellular mechanisms of arrhythmias. Those students wanting more of that background, or wanting to make cross-subject connections to integrate the material better could pause the video on hypokalemia, watch the additional supplemental video, and then come back and pick up where they left off with potassium. Unfortunately, I'm still a few hundred videos away from that at the moment.

[@vicente11espinal93]

Eric's Medical Lectures

[@eliselling567]

+Strong Medicine There are already quite a few excellent you tube videos on Action Potentials and some of the other topics you mention. Watching them has helped me to better understand some of your videos. Thanks.

[@lydiameraihi763]

thank u very much it really helped e! one question i didn't understand about you exemple u said in practic for 10mEq it raised 0.5 mEq/l, so if you want to add 2.5until 3.5 why 100 mEq/l ans not 30 mEq ?? (the problem maybe i'm not so good in math or in english one of them hahaha) thank u again

[@doclazy623]

He said 0.1 not 0.5.

[@mohammadabdulmuqueet5144]

He said that for every 10mEq of potassium we replenish, it raises serum potassium by about 0.1 mEq/l (that is, by one-hundredth of the given potassium). So, for raising serum potassium by 1 mEq/l (from 2.5 to 3.5 mEq/l), we need hundred times the amount, that is 100mEq :) [ All that, of course assuming no ongoing losses or transcellular redistribution of potassium.]

[@riyazcharaniya4965]

hello sir... well vomiting is obviously a GI symptom, but i think the potassium loss it causes is renal loss, so it should come under renal loss.. correct me if wrong..

[@StrongMed]

+Riyaz Charaniya You're right that the majority of potassium loss during vomiting is from renal loss (due to general increased activity of the RAA axis), though a minor amount is from direct loss via vomiting, plus (if the nausea/vomiting has been going on for a while) poor PO intake to replace what's lost. I suppose it would make more sense to put vomiting under renal/urinary losses, but that usually confuses people if they happen to look at the table in isolation of listening thoroughly to the whole video. I'll add an annotation to clarify.

[@riyazcharaniya4965]

+Strong Medicine Thank you sir, All your videos are of immense help for people like me, a medicine resident from India, plz do continue to add more n more.. Thank you..

[@alrasheidawooda5176]

thanks what is new software do we need to prepare new one

[@StrongMed]

Before I was using an outdated version of Premiere Elements for most of my video editing, but my computer with that installed on it died. Now using Premiere Pro for everything. Although the latter is a much more robust program, it actually takes a little longer to do something as simple as stitching together static pictures with narration. It shouldn't impact your viewing experience at all.

[@alrasheidawooda5176]

thanks my boss

[@Drleelamohan]

how mineralcorticoind excess cause hypokalemia

[@kalldagreat]

Aldosterone secreting tumor in the etiologies by mechanism refers to Conn's Syndrome guys!

[@StrongMed]

Kal. Jr Thanks for mentioning that - I can't believe I forgot to. Interestingly, while Conn's original description of the syndrome referred just to aldosterone secreting tumors, there is more variability in the use of the term Conn's syndrome today. Some people use it only for describing aldosterone-secreting tumors, while others use the eponym for primary hyperaldosteronism of any etiology.

[@chikomendoza9393]

can marijuana help me with this problem?

[@StrongMed]

+chiko mendoza I can't immediately think of any causes of hypokalemia for which marijuana would be a logical treatment option.

[@bettyrose5387]

@@thebear4880 🤣🤣🤣🤣🤣🤣

[@Ani.DR.07]

where the hell is pathophysiology

[@jujoacevedo2695]

i think marijuana make your potassium lower