Chronic diarrhea is not something anyone wants. Having to stick close to the bathroom can be inconvenient and embarrassing, but there is more to the story. Severe dehydration from prolonged diarrhea and vomiting can be dangerous. You are losing more than moisture as time goes on if you are fighting chronic diarrhea. Along with the fluids you are losing, your body can lose minerals such as potassium. If you lose too much potassium, you end up with a condition called hypokalemia. 

What is Hypokalemia?


Potassium is a naturally occurring mineral that is transferred into the body through certain foods you eat or nutritional supplements you can take if your diet does not have enough foods which contain potassium naturally. Hypokalemia is a condition in which the body’s natural levels of potassium fall to a level that begins to impair the function of nerves and other tissues. When potassium levels are only slightly lower than normal, you may not even notice a problem. At the other end of the spectrum, low potassium levels can interfere with muscular function, and possibly lead to paralysis or heart failure. Hypokalemia is not typically a disease in its own right, but typically occurs as a side effect of other conditions or diseases. 

Potassium is an electrolyte that your body uses to regulate nerve cell function. Maintaining proper levels of potassium is important for all muscle tissue, and it is particularly important for regulating the delicately timed signals that keep your heart muscles contracting in sequence. Severe hypokalemia is a state you can reach if low potassium levels have begun to disrupt your heart rhythm, potentially creating a life-threatening situation. 

Mild hypokalemia can often go unnoticed, and in some cases is never diagnosed. If you do become symptomatic, it may not be immediately obvious what is going on. Symptoms of hypokalemia are wide-ranging and common to other conditions, so you may not immediately realize what is causing your symptoms. Mild cases of hypokalemia can be cured by raising the body’s levels of potassium through the intake of electrolytes or eating foods that are high in potassium, so it is possible some people become hypokalemic without knowing it. 

More severe cases of hypokalemia are another matter. As your potassium levels fall, nerve function is increasingly impaired. Extremely low levels of potassium can be accompanied by low blood pressure, fatigue, muscle cramps, heart palpitations, muscle weakness, and fatigue. If you are experiencing these symptoms, you should consult your doctor or healthcare provider immediately. 

Hypokalemia is most often a symptom or side-effect of other conditions and diseases. Low potassium levels can occur because of genetic conditions, diseases, lifestyle choices, certain kinds of kidney disease, and the intake of many different types of drugs. A shortlist of potential causes is included below:

  • Malnutrition
  • Diabetic ketoacidosis
  • Magnesium deficiency
  • Delirium tremens
  • Barium poisoning
  • Complications from long-term exposure to cortisol
  • Consuming clay (bentonite) or glycyrrhizin in chewing tobacco or natural licorice 
  • Diuretics like Thiazides, loop, and osmotic diuretics
  • Long-term use of laxatives
  • High doses of penicillin
  • Inappropriate IV fluid administration resulting in dilution
  • Problems with your adrenal gland
  • Type I and 2 renal tubular acidosis
  • Poor nutritional absorption
  • Hyperthyroidism
  • Catecholamine surge after a heart attack
  • Insulin and beta 2 agonists used to combat COPD and asthma
  • Familial hypokalemia
  • Gitelman syndrome (a kidney disorder that results in an imbalance of specific ions)
  • Liddle syndrome, a rare disorder that causes hypokalemia and hypertension
  • Bartter syndrome (salt and potassium imbalance from a genetic kidney disorder) 

How is Hypokalemia Diagnosed?


There are several severe symptoms that your doctor will be looking for if he or she suspects you may have hypokalemia. In addition to the symptoms listed above, there are other side effects of low potassium that can be quite severe. As your nerves have a harder and harder time doing their job, muscle impairment will increase to the point paralysis is possible. There is also a chance you may experience respiratory failure.

Irregular heart rhythms are also a sign that your levels of potassium are critically low. These rhythms typically only occur in the most severe cases of hypokalemia and are more often found if you have been taking digitalis medication. Irregularities in your heartbeat caused by hypokalemia can span the spectrum from premature heartbeat or bradycardia (slow heartbeat) to tachycardia (abnormally fast heartbeat) and even arterial and ventral fibrillation. 

The physical symptoms mentioned above are not unique to hypokalemia, so a blood test is needed for your doctor to confirm a diagnosis. Your doctor will look at the level of potassium shown in your blood test to determine if that is the cause of your symptoms. 

Eating a Potassium-rich Diet


Low potassium from an event like a heart attack or caused by being on an IV during a hospitalization is not usually a cause for a change in diet. There are conditions, however, that can cause your body to continue shedding potassium at a higher rate than usual. When this occurs, modifying your diet may be necessary to keep from becoming hypokalemic. 

Many diets for other health conditions focus on what you can’t eat. Hypokalemia is an exception in that you will likely be told to eat more of certain foods to stay healthy. A potassium-rich diet can be essential if you are facing a long-term health condition such as those that affect the kidneys or some electrolyte disorders that demand higher levels of dietary potassium to keep your body in balance.

Foods that are rich in potassium are wide-ranging, and generally safe for many people. Even individuals with allergies and lactose or gluten intolerance can still find items on the list which will help bring up their potassium levels. A shortlist of some foods which are naturally high in potassium is included below:

  • avocados
  • oranges
  • figs
  • bananas
  • kiwi
  • peanut butter
  • tomatoes
  • spinach
  • peas and beans
  • milk
  • bran

How is Hypokalemia Prevented?


Prevention of hypokalemia depends in large part on whether or not you are in a hospital setting. For individuals who are at risk of lowered potassium levels as a result of a genetic condition, medication, malnutrition, or chronic diarrhea, the path to prevention relies on eating a diet high in potassium-rich foods. You may also need to take supplements containing potassium and other minerals to keep your body functioning normally. 

For many people, the greatest risk for hypokalemia occurs after they are admitted to the hospital. Whether you have been admitted for treatment following a heart attack or from a set of other conditions, there are many instances where maintaining proper nutrition is difficult. This can be particularly challenging when kidney function is abnormal or when you are on an IV for long periods of time. The contents of your IV will need to be monitored carefully to ensure you do not experience dilution and imbalances of various minerals in your body.

How is Hypokalemia treated?


Since hypokalemia typically occurs as a side-effect of other conditions or diseases, treatment of hypokalemia can take many different forms. Your doctor or healthcare provider will need to determine the underlying cause of your hypokalemia prior to beginning a program of treatment. This will involve asking you what drugs you are taking and learning about your family and personal medical history. These questions are designed to find out if your potassium loss is from complications with medication, kidney disease or other potential causes. 

If you are diagnosed as having hypokalemia, you may be admitted to the hospital for observation. Your doctor will likely recommend an IV solution designed to bring your electrolyte levels back up to normal while a treatment plan is laid out to solve the underlying cause of your hypokalemia. This IV drip must be done with care, and may take some time, as raising the levels of potassium in the body too quickly can have adverse effects. It is possible that a sudden introduction of too much potassium could result in hyperkalemia, or the presence of too much potassium in your body, which comes with its own set of risks and challenges. 

If it is determined that drugs such as diuretics or laxatives are playing a role in your hypokalemia, your doctor will likely recommend a different course of treatment. This can be complicated depending on your other medical conditions. In some cases, this may lengthen your hospital stay as your doctor may need to manage your treatment to ensure you are still taken care of even if you have to stop taking certain medications. 

In less severe cases of hypokalemia, particularly those that are related to diarrhea or loss of minerals through excessive sweating, you may be able to raise your body’s levels of potassium by drinking beverages containing electrolytes and eating certain foods. Potassium is found in a wide variety of healthy fruits, vegetables, and beans—so unless you have extreme food allergies, it is likely you will be able to find ways to increase your dietary potassium. 

In addition to changing what you eat and drink, your doctor may prescribe a potassium supplement to help you stay healthy. If this happens, you will need to take care that you do not consume too much potassium. Your doctor or dietitian will be able to help you establish a program to ensure you are getting the minerals you need without going overboard. 

Other supplements may also be part of your treatment plan. Having levels of magnesium in the body drop too low can also contribute to hypokalemia, so if your doctor determines this is part of the problem, he or she may prescribe a magnesium supplement as well. 

When to Talk to Your Doctor About Hypokalemia


Since hypokalemia often goes undiagnosed in mild cases and requires hospitalization when symptoms are severe, you may not have a chance to talk to your doctor until you are face-to-face in the hospital. However, if you have risk factors for hypokalemia, it is best to get informed about your risks and how to be proactive about prevention. 

If you have risk factors such as long-term use of diuretics or laxatives, have a condition that causes frequent or long-lasting diarrhea or you have been diagnosed with one of the genetic conditions such as Bartter or Gitelman syndrome, you should seek medical advice about the risks of hypokalemia. Knowing how your risk factors may influence your health, and being able to evaluate early warning signs such as fatigue and muscle cramps can help you manage your risk, actively participate in prevention and get timely treatment if your condition becomes severe. At Carolina Digestive, we are ready to help you understand your risks and take control of your health. Make an appointment today to learn more about what you can do to stay healthy and what to do if you begin experiencing symptoms of hypokalemia.