Therapeutic approach to hypokalemia.

For successful potassium replacement, one should consider the optimal potassium preparation, route of administration, and the appropriate speed of administration. In the absence of an independent factor causing transcellular potassium shifts, the plasma potassium concentration can be used as a rough index to estimate body potassium stores. Oral KCl replacement therapy is preferable if there are bowel sounds, except in the setting of life-threatening abnormalities such as ventricular arrhythmias, digitalis intoxication, or paralysis. In patients with impaired renal function or those treated with intravenous potassium, the risk of hyperkalemia should be monitored. Since potassium depletion rarely occurs as an isolated phenomenon, associated fluid and electrolyte disorders should be corrected, and the causes of potassium loss should be sought and eliminated to complete the treatment of hypokalemia.