Hypokalemia: The Daily PANCE Blueprint

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Hypokalemia: The Daily PANCE Blueprint

A 60-year-old male with a history of hypertension, hyperlipidemia, colon cancer (s/p partial colectomy), and chronic diarrhea presents with severe weakness and fatigue. His labs reveal the following: Na 130 mEq/L, K 2.2 mEq/L, BUN 30 mg/dL, creatinine 1.4 mg/dL, CO2 18 mmol/L, Ca 9.0 mg/dL, Cl 90 mmol/L. Which of the following would you most likely see on EKG?

A. Peaked T waves
B. ST elevations in II, III, avF
C. Flat T waves and U waves
D. Diffuse ST elevations in all leads
E. Prolonged PR interval

Answer and topic summary

The answer is C. Flat T waves and U waves

Hypokalemia is defined as a serum potassium level of less than 3.5 mEq/L. There are 3 main causes of hypokalemia: 1) shifting of potassium into cells (insulin, alkalosis, beta-agonists), 2) renal wasting (diuretics, hyperaldosteronism) and 3) extra-renal losses (diarrhea, emesis). Clinical features typically do NOT occur unless K is < 3 mEq/L. Patients may have fatigue, ileum, weakness, paralysis, and EKG changes (U waves, flattened T waves, ST-segment depression, etc). Management is replacing potassium and managing underlying causes.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Renal System ⇒ Fluid and Electrolyte Disorders (PEARLS) ⇒ Hyperkalemia/hypokalemia (Lecture)

Also covered as part of the General Surgery EOR topic lists