Clinical Overview and Treatment of Hypokalemia in Pediatric Patients: A Narrative Literature Review

Hypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L. Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including nerve and muscle function, heart rhythm, and acid-base balance. This literature review aimed to describe the clinical and current management aspects of hypokalemia in pediatric patients. The pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including reduced intake of potassium-rich foods, increased loss of potassium, and redistribution of potassium. In children, clinical symptoms of hypokalemia may include weakness and fatigue, abdominal discomfort, cardiac symptoms, respiratory symptoms, neurological symptoms, polyuria, and renal symptoms. There are several diseases and conditions that can cause hypokalemia in children, including renal tubular acidosis, prolonged diarrhea, cystic fibrosis, hyperaldosteronism, malnutrition, medication, type 1 Bartter syndrome, type 2 Bartter syndrome, and Liddle syndrome. Some options for hypokalemia treatment are potassium supplements, a potassium-rich diet, intravenous potassium, and treating underlying conditions. In conclusion, hypokalemia is an overview of the underlying disease and requires immediate management. Understanding the pathophysiology of hypokalemia will increase the accuracy of diagnosis and accelerate hypokalemia intervention in children, as well as prevent complications due to hypokalemia.


t of Hypokale
ia in Pediatric Patients: A Narrative Literature Review


Winda Fauti 
Ragab Begawe Caram General Hospital
MesujiIndonesia

Ragab Begawe Caram General Hospital
MesujiIndonesia

Bioscientia Medicina: Journal of Biomedicine & Translational Research Clinical Overview and Treatment of Hypokalemia in Pediatric Patients: A Narrative Literature Review
41CED5674AD0D38AC061F4C16316460810.37275/bsm.v7i4.813Children Diarrhea Hyperaldosteronism Hypokalemia Potassium


Introduction

Hypokalemia is a condition characterized by a low level of potassium in the bloo

Introduction
Hypokalemia is a condition characterized by a low level of potassium in the blood (less than 3.5 mmol/L) and is a common electrolyte disorder in pediatric and adult patients. 1Potassium is an important mineral that helps regulate muscle and nerve function, maintain proper fluid balance in the body, and support normal heart function. 2In children, hypokalemia can be caused by a variety of factors, such as inadequate potassium intake, excessive loss of potassium through vomiting or diarrhea, certain medications, or underlying medical conditions. 3

(less than 3.5 mmol/L) and is a common electro
yte disorder in pediatric and adult patients. 1Potassium is an important mineral that helps regulate muscle and nerve function, maintain proper fluid balance in the body, and support normal heart function. 2In children, hypokalemia can be caused by a variety o

factors, such as
inadequate potassium intake, excessive loss of potassium through vomiting or diarrhea, certain medications, or underlying medical conditions. 3


Definition and pathophysiology of hypokalemia

Hypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L. 4Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including eISSN (Online): 2598-0580


windafauti123@gmail.com

The author has reviewed and approved the final version of the manuscript.

https://doi.org/10.37275/bsm.v7i4.813


A B S T R A C T

Hypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L.Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including nerve and muscle function, heart rhythm, and acid-base balance.This literature review aimed to describe the clinical and current management aspects of hypokalemia in pediatric patients.The pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including reduced intake of potassium-rich foods, increased loss of potassium, and redistribution of potassium.In children, clinical symptoms of hypokalemia may include weakness and fatigue, abdominal discomfort, cardiac symptoms, respiratory symptoms, neurological symptoms, polyuria, and renal symptoms.There are several diseases and conditions that can cause hypokalemia in children, inc

Definition and pathophysiology of hypokalemia
Hypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L. 4Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including eISSN (Online): 2598-0580

A B S T R A C T
Hypokalemia is a condition in which the blood potassium levels are below the normal range, which is typically between 3.5 and 5.0 mEq/L.Potassium is an essential electrolyte that plays a critical role in many physiological processes in the body, including nerve and muscle function, heart rhythm, and acid-base balance.This literature review aimed to describe the clinical and current management aspects of hypokalemia in pediatric patients.The pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including reduced intake of potassium-rich foods, increased loss of potassium, and redistribution of potassium.In children, clinical symptoms of hypokalemia may include weakness and fatigue, abdominal discomfort, cardiac symptoms, respiratory symptoms, neurological symptoms, polyuria, and renal symptoms.There are several diseases and conditions that can cause hypokalemia in children, including renal tubular acidosis, prolonged diarrhea, cystic fibrosis, hyperaldosteronism, malnutrition, medication, type 1 Bartter syndrome, type 2 Bartter syndrome, and Liddle syndrome.Some options for hypokalemia treatment are potassium supplements, a potassium-rich diet, intravenous potassium, and treating underlying conditions.In conclusion, hypokalemia is an overview of the underlying disease and requires immediate management.Understanding the pathophysiology of hypokalemia will increase the accuracy of diagnosis and accelerate hypokalemia intervention in children, as well as prevent complications due to hypokalemia.
uding renal tubular acidosis, prolonged diarrhea, cystic fibrosis, hyperaldosteronism, malnutrition, medication, type 1 Bartter syndrome, type 2 Bartter syndrome, and Liddle syndrome.Some options for hypokalemia treatment are potassium supplements, a potassium-rich diet, intravenous potassium, and treating underlying conditions.In conclusion, hypokalemia is an overview of the underlying disease and requires immediate management.Understanding the pathophysiology of hy

kalemia will increase th
accuracy of diagnosis and accelerate hypokalemia intervention in children, as well as prevent complications due to hypokalemia.

nerve and muscle function, heart rhythm, and acidbase balance.Potassium's primary role is in its involvement in nerve and muscle function, heart rhythm, and acidbase balance.Potassium's primary role is in its involvement in the Na + -K + -ATPase pathway, an electrogenic enzyme that mediates transcellular ion transport. 5,6e pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including reduced intake of potassium-rich foods, increased loss of potassium, and redistribution of potassium. 7 he Na + -K + -ATPase pathway, an electrogenic enzyme that mediates transcellular ion transport. 5,6e pathophysiology of hypokalemia involves a disturbance in the balance of potassium in the body, which can occur due to several mechanisms, including r duced intake of potassium-rich foods, increased loss of potassium, and redistribution of pota sium. 7


Etiology of hypokalemia

There are several possible etiologies or causes of hypokalemia, which include increased loss of potassium, inadequate intake of po

Etiology of hypokalemia
There are several possible etiologies or causes of hypokalemia, which include increased loss of potassium, inadequate intake of potassium, redistribution of potassium, increased cellular uptake of potassium, renal causes, and genetic causes.
assium, redistribution of potassium, increased cellular up

ke of potassium,
renal causes, and genetic causes.

Increased loss of potassium can be due to excessive sweating, vomiting, diarrhea, or the use of certain medications such as diuretics or laxatives. 14adequate intake of potassium occurs with diets low in potassium or with malabsorption syndromes.

General Increased loss of potassium can be due to excessive sweating, vomiting, diarrhea, or the use of certain medications such as diuretics or laxatives. 14adequate intake of potassium occurs with diets low in potassium or with malabsorption syndromes.
Generally, the daily intake of potassium in children and adults ranges from 80 mmol per day.The digestive system will absorb 75 mmol, and the rest will be excreted in the feces.Nutritional deficiencies are generally not significant in causing hypokalemia.

, the daily
intake of potassium in children and adults ranges from 80 mmol per day.The digestive system will absorb 75 mmol, and the rest will be excreted in the feces.Nutritional deficiencies are generally not significant in causing hypokalemia.

Diarrhea is a common cause of hypokalemia in Diarrhea is a common cause of hypokalemia in children.

Renal tubular acidosis
Renal present) are measures that can be performed in patients with hypokalemia.The treatment options may vary depending on the severity of the condition, the underlying cause, and the patient's overall health. 10,12me options for hypokalemia treatment are potassium supplements, a potassium-rich diet, intravenous potassium, and treating underlying conditions.Oral supplementation is administered to patients with serum potassium levels between 2.5 and 3.5 mmol/L.Oral administration of potassium should be accompanied by much fluid (between 100 and 250 mL of water, depending on the form of potassium tablets) and is better administered with or after meals.
Increasing the intake of potassium-rich foods can help to restore normal potassium levels in the blood.[18] Urgent intravenous potassium is administered if potassium levels are less than 2.
Symptoms of hypokalemia in children may include weakness, fatigue, muscle cramps, constipation, abdominal pain, and irregular heartbeat.Understanding the symptoms, diagnosis, and treatment of hypokalemia is very important in preventing complications or worsening of the patient's condition due to hypokalemia.This literature review aimed to describe the clinical and current management aspects of hypokalemia in pediatric patients.

20 Hyperaldosteronism 21 Drugs 24 Type 1 and type 2
tubular acidosis (RTA) is a condition that occurs when the kidneys are unable to remove acid from the body.This can lead to hypokalemia because potassium is lost in the urine as the kidneys try to remove the excess acid.Distal RTA (d-RTA) is caused by defects in H+ secretion.Genetic mutations in children can cause Cl -HC03 -basolateral exchanger deficiency, apical ATPase H + , and apical ATPase H+ pumps in the distal convoluted tubule (DCT).19Proximal RTA (p-RTA) is caused by a decrease in the absorption threshold of HCO3 − filtered by the proximal tubule.This led to the delivery of a large amount of HCO3− to DCT, exceeding its reabsorption capacity.Gene mutations for Na + -HC03 − exchangers result in isolated p-RTA.Na+ load delivery in DCT enables secondary aldosteronism and K + disposal.19Diarrhea and malnutritionProlonged diarrhea can lead to hypokalemia because the body loses potassium through the stool (K + feses 20-50 mmol/L).Malnutrition can cause hypokalemia because the body may not be receiving enough potassium in the diet.The cause of mortality due to acute malnutrition is especially if it is accompanied by potassium loss due to diarrhea.Nutritional rehabilitation after the anabolic phase of severe malnutrition can result in a potentially fatal refeeding syndrome.The renewed supply of glucose causes hyperglycemia and excessive insulin response.Death from severe hypokalemia can occur as a result of respiratory muscle weakness and ventricular arrhythmias.Hyperaldosteronism is a condition that occurs when the adrenal gland produces too much aldosterone hormone.This hormone can cause the kidneys to excrete potassium, leading to hypokalemia.Aldosterone stimulation is the main physiological mechanism for defending against hypovolemia.A lower glomerular filtration rate (GFR) leads to proximal renal sodium reabsorption.Lower delivery of sodium and chloride to macula densa increases plasma renin secretion, angiotensin II, and aldosterone.Aldosterone activates the epithelial sodium channel (ENaC) in DCT, restoring blood volume.Some medications, such as diuretics, can cause the kidneys to excrete potassium, leading to hypokalemia.Overdosage of certain drugs and toxins can cause severe hypokalemia leading to cardiac arrhythmias and death.β-adrenergic agonist drugs, theophylline, and caffeine increase endogenous catecholamines, potassium release by the sarcolemma.Hypokalemia may result from the therapeutic use of insulin or after overdosage in a suicide attempt.Hypoglycemia potentiates cellular potassium uptake by stimulating catecholamine release.Overdosage of barium chloride in a suicide attempt can lead to severe hypokalemia and fatal ventricular arrhythmias.There have also been reports of incidental hypokalemia following widespread food poisoning due to industrial barium contamination of table salt.In addition to its hypokalaemic effect, chloroquine potentiates cardiac arrhythmias by inhibiting atrioventricular conduction.Penicillins cause a dose-dependent hypokalaemic side effect.A nonabsorbable anion, penicillin, promotes the exchange of potassium for Na+ in the distal convoluted tubule (DCT). 22-Bartter syndrome Type 1 and type 2 Bartter syndrome (BS) is a rare genetic disorder that affects the kidneys.Children with this condition can develop hypokalemia because the kidneys excrete too much potassium.BS type I occurs due to a mutation of the gene that encodes NKCC2, while BS type II is due to a mutation of the gene that produces the ROMK channel.Types I and II are the most severe forms of BS and are characterized by polyhydramniosLiddle syndrome is a rare genetic disorder that affects the kidneys.Children with this condition can develop hypokalemia because the kidneys excrete too much potassium.Liddle syndrome causes hypertension and hypokalemic alkalosis, but plasma renin and serum aldosterone levels decrease.This condition is caused by an autosomal dominant (AD) mutation of ENaC in DCT. 25 Diagnosis of hypokalemia in children Hypokalemia is a condition where there is a low level of potassium in the blood.It can be caused by a variety of factors, including certain medications, vomiting, diarrhea, and kidney problems.The diagnosis of hypokalemia can be established by detailed anamnesis regarding the child's disease history.Clinical symptoms such as weakness, fatigue, muscle cramps, and irregular heartbeat, as well as any recent illnesses or medications, can help clinicians establish a diagnosis of hypokalemia.Physical examination related to hypokalemia symptoms in the form of limb reflex examination and irregular heartbeat. 9Laboratory evaluation in the form of routine blood tests (blood potassium levels), urine tests, and electrocardiograms (ECG).A normal range of potassium in the blood for children is typically between 3.4 to 4.7 millimoles per liter (mmol/L).A low level of potassium in the blood may indicate hypokalemia.Urine tests may also be done to check the levels of potassium in the urine.This can help determine whether hypokalemia is caused by a problem with the kidneys.An ECG check is aimed at evaluating the heart's rhythm and looking for signs of irregular heartbeat, which can be a symptom of hypokalemia. 9,10Management of hypokalemia in children Treatment typically of hypokalemia involves addressing the underlying cause of the condition and replenishing potassium levels through dietary changes or supplements.Treatment of hypokalemia has four objectives; reduction of potassium loss, replenishment of potassium reserves, evaluation of potential toxicity, and determination of the cause in order to prevent future episodes.Discontinuation of laxatives, the use of potassium-neutral or potassium-sparing diuretics (if diuretic therapy is required, as in heart failure), treatment of diarrhea or vomiting, the use of H2 blockers in patients with nasogastric suction and effective control of hyperglycemia (if glycosuria is

Clinical symptoms of hypokalemia in children
16,17edistribution of potassium occurs when potassium is shifted from the extracellular fluid to the intracellular fluid due to insulin therapy, alkalosis, or excessive beta-adrenergic stimulation.Increased cellular uptake of potassium occurs with increased insulin levels or in response to beta-agonist medications.Certain kidney diseases can cause hypokalemia by impairing potassium reabsorption in the kidneys.Excessive adrenocorticotropic hormone (ACTH) stimulation due to pituitary adenoma and carcinoid tumors causes refractory hypokalemia and hypertension.Some genetic disorders, such as Bartter's syndrome or Gitelman's syndrome, can cause hypokalemia due to abnormalities in the kidney's ability to reabsorb potassium.16,17