Pediatric Hypokalemia

Potassium deficit or hypokalemia is a condition where the serum potassium in the blood becomes lower than its normal value of 3.5 meq/L.  It is common among pediatric patients who are critically ill. It reflects a total body insufficiency of potassium or associated with conditions that promote the shift of extracellular potassium into the intracellular space. This can be due to a variety of conditions such as, vomiting, emesis, gastro intestinal suctioning, prolonged diuretic use, inadequate potassium intake, hyperhidrosis, hypomagnesemia, diarrhea, ileostomy, use of potassium losing diuretics and persistent insulin hypersecretion.


  • Fatigue
  • Anorexia
  • Vomiting
  • Muscle weakness
  • Paresthesias
  • Leg cramps
  • Decreased bowel motility
  • Nausea
  • Dysrhythmias
  • Digitalis sensitivity
  • Excessive thirst
  • Glucose intolerance
  • Kidney problems (unable to concentrate urine)
  • Tachycardia with irregular beats


  • Serum potassium levels is less than 3.5 meq/L
  • ECG tracings reveal flat or inverted T waves
  • ECG tracings reveal depressed ST segments
  • ECG tracings reveal elevated U wave
  • 24 – hour Urinary Potassium Excretion Test (differentiates between  renal and extra – renal losses)

Medical Management

Hypoklemia can be corrected through diet. Food rich in potassium is introduced through the diet. These food groups include fruits such as banana, raisins, oranges; vegetables, legumes, whole grain; milk and meat products.  However, if diet therapy is rather inadequate, oral and intravenous infusions of potassium replacement is introduced. The lost potassium should not be disregarded, instead should be corrected daily. Oral potassium prescriptions are given. In other cases, when severe hypokalemia is detected, IV infusion of potassium supplements are introduced.

Nursing Management

  • Nurses should be very keen in monitoring patients with hypokalemia and especially those children who are at risk onto having this condition. The clinical manifestations mentioned above should be the key in detecting high risk patients.
  • As promoters of health, nurses should be able to encourage these children to consume potassium rich foods. In some cases, food preparation and presentation is relevant so as to entice children to eat this food.
  • If hypokalemia is caused drugs and medication use, parents should be educated and told that taking these medications should first be consulted to a physician since there’s a probability that it may predispose the child into having the electrolyte imbalance.
  • Monitoring of fluid intake and output.
  • Once on potassium replacement, ECG is monitored and changes are noted and referred.
  • Educate patients who are at risk of hypokalemia from sweat losses that their diet should be adequate in potassium and that they should readily hydrate after an activity. Include parents in the plan as well.
  • Parents should be given anticipatory guidance regarding the symptoms of hypokalemia.

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