Hypokalemia — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Severity & urgent features
   Severity and any urgent features? (Hypokalemia = serum K <3.5 mmol/L (mild 3.0–3.5, moderate 2.5–3.0, severe <2.5). Urgent features: K ≤2.5, ECG changes (U waves, ST depression, flat/inverted T, QT prolongation), neuromuscular symptoms (weakness, paralysis, palpitations). In coronary disease/heart failure/MI, maintain K 4–5.)
   • Severe or urgent features → Severe / urgent
   • Mild–moderate, no urgent features → Mild–moderate
2. [End] Mild–moderate
   Prefer oral potassium chloride, 20–40 mEq per dose, total ~40–100 mEq/day; find and treat the cause (diuretics, vomiting/diarrhea, intracellular shift); always measure and replace magnesium (potassium repletion fails with concurrent hypomagnesemia); ensure urine output before replacing, recheck potassium.
3. [End] Severe / urgent
   Severe (K ≤2.5)/ECG changes/neuromuscular symptoms/unable to take oral: IV potassium — peripheral ≤10–20 mEq/h, up to 40 mEq/h via a central line with continuous ECG monitoring; measure and replace magnesium first (hypomagnesemia causes refractory hypokalemia, increases ventricular arrhythmia/torsades risk); recheck frequently, after each dose, ensure urine output. Correct the cause, do not give rapid IV push. (Note: Conditions like DKA need potassium repletion to target (K >3.3) before starting insulin.)

Source guidelines & references

• Viera AJ, Wouk N. Potassium disorders: hypokalemia and hyperkalemia. Am Fam Physician 2015/2023

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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