Management of profound hypokalaemia should be revised

doi:10.1136/bmj.324.7332.0c

Management of profound hypokalaemia should be revised

Current guidelines for potassium replacement may not deal adequately with rare but life threatening profound hypokalaemiaassociated with metabolic acidosis. Welfare and colleagues (p269) identified 13 children admitted to a Kenyan hospital withpotassium concentrations <1.5mmol/l and found a significant correlationbetween late phase change in potassium and the average rate ofpotassium replacement over 24 hours. In developing countries,many children with gastroenteritis receive intravenous fluidsthat have little or no potassium, such as 0.9% saline, Ringer'slactate, or Hartmann's. The authors say that this may worsen thesituation, causing a further lowering in serumpotassium.