Which physical findings suggest hypokalemia (low potassium level)?

Updated: Dec 06, 2018
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Physical examination findings are often within the reference range. Vital signs generally are normal, except for occasional tachycardia with irregular beats or tachypnea resulting from respiratory muscle weakness. Hypertension may be a clue to primary hyperaldosteronism, renal artery stenosis, licorice ingestion, or the more unusual forms of genetically transmitted hypertensive syndromes, such as congenital adrenal hyperplasia, glucocorticoid-remediable hypertension, or Liddle syndrome.

Relative hypotension should suggest occult laxative use, diuretic use, bulimia, or one of the unusual tubular disorders, such as Bartter syndrome or Gitelman syndrome. Bear in mind that occult diuretic use is far more common than either of those congenital tubular disorders and is, in fact, also called "pseudo-Bartter syndrome."

Muscle weakness and flaccid paralysis may be present. Patients may have depressed or absent deep-tendon reflexes. Hypoactive bowel sounds may suggest hypokalemic gastric hypomotility or ileus.

Severe hypokalemia may manifest as bradycardia with cardiovascular collapse. Cardiac arrhythmias and acute respiratory failure from muscle paralysis are life-threatening complications that require immediate diagnosis.

Tooth erosion may be present in patients with bulimia. This finding has particular significance in patients whose history indicates high risk (eg, obsession with body image or participation in activities such as cheerleading, wrestling, or modeling).

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