Manifestation (s) of hypokalemia includes-
Correct Answer: Rhabdomyolysis
Description: Hypokalemia has prominent effects on cardiac, skeletal, and intestinal muscle cells. In paicular, hypokalemia is a major risk factor for both ventricular and atrial arrhythmias. Hypokalemia predisposes to digoxin toxicity by a number of mechanisms, including reduced competition between K+ and digoxin for shared binding sites on cardiac Na+/K+-ATPase subunits. Electrocardiographic changes in hypokalemia include broad flat T waves, ST depression, and QT prolongation; these are most marked when serum K+ is <2.7 mmol/L. Hypokalemia can thus be an impoant precipitant of arrhythmia in patients with additional genetic or acquired causes of QT prolongation. Hypokalemia also results in hyperpolarization of skeletal muscle, thus impairing the capacity to depolarize and contract; weakness and even paralysis may ensue. It also causes a skeletal myopathy and predisposes to rhabdomyolysis. Finally, the paralytic effects of hypokalemiaon intestinal smooth muscle may cause intestinal ileus. The functional effects of hypokalemia on the kidney can include Na+-Cl- and HCO3- retention, polyuria, phosphaturia, hypocitraturia, and an activation of renal ammoniagenesis. Bicarbonate retention andother acid-base effects of hypokalemia can contribute to the generation of metabolic alkalosis. Hypokalemic polyuria is due to a combination of central polydipsia and an AVP-resistant renal concentrating defect. Structural changes in the kidney due to hypokalemia include a relatively specific vacuolizing injury to proximal tubular cells, interstitial nephritis, and renal cysts. Hypokalemia also predisposes to acute kidney injury and can lead to end-stage renal disease in patients with longstanding hypokalemia due to eating disorders and/or laxative abuse. Hypokalemia and/or reduced dietary K+ are implicated in the pathophysiology and progression of hypeension, hea failure, and stroke. For example, sho-term K+ restriction in healthy humans and patients with essential hypeension induces Na+-Cl- retention and hypeension. Correction of hypokalemia is paicularly impoant in hypeensive patients treated with diuretics, in whom blood pressure improves with the establishment of normokalemia. (ref : harrisons , 19E pg- 307)
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