SOURCE: Pediatrics in Review, September 2008, VOLUME 29 / ISSUE 9 Hypokalemia is defined as a potassium concentration less than 3.5 mEq/L (3.5 mmol/L). The gastrointestinal (GI) tract is a major site of extrarenal potassium loss. Specifically, the most common cause of hypokalemia in children is gastroenteritis with its accompanying fecal loss of potassium. Less commonly, patients who have bulimia and use laxatives may develop hypokalemia. Clinical manifestations of hypokalemia vary with the degree and the rate of potassium loss. Mild potassium deficit manifests as weakness and cramping of skeletal muscles. In more severe depletion, when potassium concentrations are lower than 2.5 mEq/L (2.5 mmol/L), leg, arm, and finally diaphragmatic paralysis may ensue. Other consequences of hypokalemia include constipation or ileus, urinary retention, arrhythmias, and myocardial cell necrosis. An important adjunct to determining serum potassium values is electrocardiography (ECG). Common ECG findings associated with hypokalemia include flattened T waves, depressed ST segments, and prominent U waves. In patients who have underlying heart disease, ventricular fibrillation and torsades de pointes also may occur. MANAGEMENT The management of pediatric hypokalemia includes: ●Identifying and, if possible, treating the underlying cause of hypokalemia (eg, hypomagnesemia). ●Electrocardiographic monitoring for symptomatic children and those in whom there is a concern for cardiac arrhythmia. ●In patients receiving intravenous (IV) fluid, use of saline solution without dextrose. Dextrose-containing solution should be avoided since the administration of dextrose stimulates the release of insulin, which drives extracellular potassium into the cells. In most settings, replacement can be managed less emergently, with oral supplementation using potassium-rich foods or potassium preparations. The regimen is tailored to the cause of the hypokalemia. This approach minimizes the risk of hyperkalemia. URGENT: IV: 0.5 to 1.0 mEq/L per kilogram of potassium chloride intravenously over 1 hour (maximum of 40 mEq and max IV infusion rate 1 mEq/kg/hr) PO: 1-4 mEq/kg/24 hour divided BID-QID GOAL The goal is to raise the potassium level by 0.3 to 0.5 mEq/L
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