Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Serum potassium levels above 3.0 mEq/liter are not considered dangerous or of
great concern; they can be treated with potassium replacement by mouth. Levels
lower than 3.0 mEq/liter may require intravenous replacement. Decisions are
patient-specific and depend upon the diagnosis, the circumstances of the
illness, and the patient's ability to tolerate fluid and medication by mouth.
Over the short term, with self-limited illnesses like gastroenteritis with
vomiting and diarrhea, the body is able to regulate and restore potassium levels
on its own. However, if the hypokalemia is severe, or the losses of potassium
are predicted to be ongoing, potassium replacement or supplementation may be
required.
In those patients taking diuretics, often a small amount of oral potassium
may be prescribed since the loss will continue as long as the medication is
prescribed. Oral supplements may be in pill or liquid form, and the dosages are
measured in mEq. Common doses are 10-20mEq per day. Alternatively, consumption
of foods high in potassium may be suggested for replacement. Bananas, apricots,
oranges, and tomatoes are high in potassium content. Since potassium is excreted
in the kidney, blood tests that monitor kidney function may be ordered to
predict and prevent potassium levels from rising too high.
When potassium needs to be given intravenously, it must be given slowly.
Potassium is irritating to the vein and must be given at a rate of approximately
10 mEq per hour. As well, infusing potassium too quickly can cause heart
irritation and promote potentially dangerous rhythms like ventricular
tachycardia.
A Special Situation: Periodic Paralysis
Rarely, a special situation will occur when all the potassium in the body
shifts from the serum into the cells of the body. This drops the serum potassium
levels to 1.0 mEq/liter or lower. This causes immediate muscle weakness to the
point that the patient cannot move. Arms and legs are most affected. Rarely,
breathing and swallowing muscles can be involved.
Periodic paralysis may be hereditary and may be precipitated by excessive
exercise, a high carbohydrate or high salt meal, or may occur without apparent
cause.
Treatment by potassium replacement intravenously is effective, and recovery
occurs within 24 hours.
Muscle cramps are involuntarily and forcibly contracted muscles that do not relax. Extremely common, any muscles that have voluntary control, including some organs, are subject to cramp. Since there is such variety in the types of muscle cramps that can occur, many causes and preventative medications are known. Stretching is the most common way to stop or prevent most muscle cramps.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Hyperkalemia is an abnormally high level of potassium in the blood. Symptoms of hyperkalemia include nausea, fatigue, tingling sensations, or muscle weakness. Hyperkalemia may also cause no symptoms. Slow heartbeat and weak pulse are more serious symptoms. Causes of hyperkalemia include kidney dysfunction, medications, adrenal gland diseases, and potassium shifts. Treatment of hyperkalemia is dependant upon the cause.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
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