During therapy, monitor for changes associated with over-correction and hyperkalemia including prolonged QRS, peaked T waves, bradyarrhythmia, sinus node dysfunction, and asystole. Amphetamines and other sympathomimetic stimulants can cause hypokalemia. Other drugs that can cause hypokalemia include verapamil overdose, theophylline, amphotericin B, aminoglycosides, and cisplatin. Obtain a brain MRI if a brain or pituitary tumor is suspected as a cause of hypercortisolism. Since hyperinsulinism can cause transient hypokalemia, elevated serum insulin without appropriately elevated C-peptide suggests exogenous insulin administration, which may represent Munchausen by proxy syndrome.
Treatment depends on severity and etiology.
Unlike hyponatremia, in which total body sodium deficit can be readily estimated, serum potassium may not reflect total body stores accurately. Indeed, during diabetic ketoacidosis, serum potassium levels are usually initially elevated even in the face of severe, total body potassium depletion. Correction of acidosis in diabetic ketoacidosis may cause a precipitous drop in serum potassium levels. Transient, asymptomatic, or mild hypokalemia may resolve spontaneously or may be treated with enteral potassium supplements. Symptomatic or severe hypokalemia should be corrected with intravenous potassium solution.