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Hypokalemia

(Low Potassium)

Low potassium levels can cause symptoms like fatigue and frequent urination. Increasing your intake of potassium-rich foods, like fruits, vegetables, beans, and nuts, may help.
Potassium is an essential mineral that plays many roles in the body. It helps regulate muscle contractions, maintain healthy nerve function, and regulate fluid balance.
Despite its importance, it’s estimated that most adults don’t meet their daily needs. This is likely due to the Western-style diet, which favors processed foods over whole plant foods that are high in potassium — such as fruits, vegetables, beans, and nuts.
Low potassium, or potassium deficiency, is when your blood potassium level is below 3.5 mmol per liter. In the medical community, it’s known as hypokalemia.
Keep reading to learn more about potassium deficiency, including its causes and symptoms.

Symptoms of potassium deficiency

Here are 7 signs and symptoms of potassium deficiency.
Weakness and fatigue

Weakness and fatigue are common signs of potassium deficiency for a few reasons:

when blood potassium levels are low, your muscles produce weaker contractions

a deficiency may affect how your body uses nutrients in a way that can result in fatigue

For example, some evidence shows that a deficiency could impair insulin production. This can result in high blood sugar levels and less available glucose, which functions as energy for your cells.
Muscle weakness and cramps

Muscle cramps are sudden, uncontrolled contractions of the muscles. They can occur when blood potassium levels are low and can be painful.
Within skeletal muscle, potassium helps relay signals from your brain to stimulate contractions. It also helps end these contractions by leaving the muscle cells. When blood potassium levels are low, your brain cannot relay these signals as effectively.
This results in more prolonged contractions and is thought to contribute to muscle cramps. Cramps are unlikely to occur with mild or moderate hypokalemia, but they may happen with severe hypokalemia of less than 2.5 mmol/L of potassium.
Digestive problems

While digestive problems have many causes, they may occur with severe hypokalemia.
Potassium helps relay signals from your brain to muscles located in the digestive system known as smooth muscle. These signals stimulate contractions that help your digestive system churn and propel food, so it can be digested.
With low potassium levels, contractions in the digestive system may become weaker and slow the movement of food. This could cause digestive problems like bloating and constipation.
Abnormal heartbeat

Potassium also plays a vital role in maintaining healthy heart muscle contractions.
This is because the flow of potassium in and out of heart cells helps regulate your heartbeat. Low blood potassium levels can alter this flow, resulting in abnormal heart rhythms known as heart arrhythmia.
Heart arrhythmias can also be a sign of a serious heart condition. If you notice any abnormal changes to your heart rate, seek immediate medical attention.
Tingling and numbness

Though more common in people with high potassium, or hyperkalemia, those with potassium deficiency may also experience persistent tingles and numbness.
This is known as paresthesia and usually occurs in the hands, arms, legs, and feet.
Potassium is important for healthy nerve function. Low blood levels can weaken nerve signals and result in tingling and numbness.
While occasionally experiencing these symptoms is harmless — like if your foot falls asleep from lack of movement or sitting in an awkward position — persistent tingles and numbness may be a sign of an underlying condition.
If you experience this, it’s can be helpful to speak with doctor.
Polyuria (frequent urination)

Polyuria is a condition where you pee more than usual.
The kidneys are responsible for balancing your body’s fluid and electrolyte levels and removing any waste through the urine.
Low potassium levels may impair your kidneys’ ability to concentrate urine and balance the blood’s electrolyte levels, leading to increased urination. You may also notice increased thirst, known as polydipsia.
Excessive urination may lead to lower levels of potassium. Therefore, it’s important to speak with a doctor if you notice a sudden change in how often you urinate.
High blood pressure

Having the perfect balance of electrolytes is important for maintaining healthy blood pressure.
You may be aware that consuming too much sodium can increase blood pressure in some people. Yet, few people know that too little potassium in the diet can have the same effect.
Potassium helps your kidneys get rid of excess sodium via urine. If there isn’t enough potassium in the blood, the kidneys reabsorb sodium back into the bloodstream, potentially leading to high blood pressure over time.
This most often occurs with a low dietary intake of potassium — and specifically with hypokalemia.
Therefore, getting enough potassium in your diet may help maintain healthy blood pressure in some individuals.

Causes of potassium deficiency

Most often, potassium levels get low when you lose it through your pee after you take medications such as diuretics (water pills) for heart disease or high blood pressure.
While it’s generally rare to develop potassium deficiency, certain illnesses or other factors can cause it, including:

chronic diarrhea, which can be caused by the overuse of diuretics or laxatives, irritable bowel disease, or infections

certain medications, such as diuretic drugs

eating disorders, such as anorexia nervosa, purging, or laxative abuse

under-eating or malnutrition

Cushing’s syndrome

hyperaldosteronism, where there is excess aldosterone, a steroid hormone, in the blood

kidney failure

kidney disorders, such as Bartter syndrome, Gitelman syndrome, and Fanconi syndrome.

hypomagnesemia (low magnesium levels)

excessive sweating

If you’re taking certain medications for kidney disease, such as diuretics, and you suspect your potassium is low, consider speaking with a healthcare professional. They can review your blood tests and adjust your medications or diet as needed.
If you’ve experienced chronic fluid loss or have misused any medications, seek immediate medical attention.

Hypokalemia Diagnosis

To determine if you have hypokalemia, your doctor will do a potassium blood test to measure the levels of potassium in your blood. They may do this as part of a comprehensive metabolic panel, a series of blood tests that look at how well your kidneys are working and whether levels of minerals called electrolytes are in balance.

Doctors measure potassium by millimoles per liter (mmol/L) or milliequivalents per liter (mEq/L).

Normal potassium levels

Potassium levels for an adult ranges from 3.5 to 5.2 mEq/L (3.5 to 5.2 mmol/L) are considered normal for adults.

Low potassium levels

If the potassium in your blood serum is below 3.5 mmol/L, you have hypokalemia. If your level is in the range of 3 and 3.5 mEq/L (3 to 3.5 mmol/L), you have mild hypokalemia, and if your level is lower than 3 mmol/L, you have moderate hypokalemia. If your potassium level is below 3 mEq/L (3 mmol/L), you have severe hypokalemia.

To find out the cause of your low blood potassium, your doctor will ask you about your health history. For instance, they’ll want to know if you’ve had any illnesses that involved vomiting or diarrhea. They’ll also ask about any conditions you might have and any medications you take.

You may take a urine test so your doctor can find out if you’re losing potassium when you pee.

As low potassium sometimes can affect your blood pressure, your doctor will check that, too. They also may want to do an electrocardiogram (EKG) if they think you may have arrhythmia. This is one of the more serious side effects and might change the way your doctor chooses to treat the problem.

How to treat hypokalemia

In most cases, hypokalemia will need to be treated by a healthcare professional.
Mild to moderate hypokalemia is typically treated with oral potassium supplements. In some cases, a healthcare professional may also need to adjust any other medications or treat underlying causes, like diarrhea, vomiting, or eating disorders.
A potassium-rich diet is usually not enough to treat hypokalemia, since most potassium in food is paired with phosphate, not potassium chloride. Hypokalemia often also involves a chloride deficiency, so it’s best to treat both deficiencies with potassium chloride supplements.
Usually, 60–80 mmol of supplements per day for a few days to weeks is sufficient for treating mild to moderate hypokalemia. That said, it’s important to always follow the recommendations of a healthcare professional.
In severe hypokalemia cases, intravenous (IV) treatment may be recommended. This should be strictly monitored by a healthcare professional due to the high risk of rebound hyperkalemia, or high potassium, which can be fatal.
Should you take potassium supplements?

Self-treatment of hypokalemia with over-the-counter (OTC) potassium supplements is not recommended.

This is because taking too much potassium can cause excess amounts of the mineral to build up in the blood, resulting in complications like heart arrhythmia.

Unless they’re prescribed by a healthcare professional, and you’re being closely monitored, you should avoid taking potassium supplements.
You may need to get potassium by IV in the hospital in some cases, such as:

When your potassium level is dangerously low (you have severe hypokalemia)

If taking supplements by mouth doesn't raise your potassium levels

If your low potassium levels cause abnormal heart rhythms

Sources of potassium

If you have diarrhea or are vomiting, drink plenty of fluids. If you're losing lots of fluid through diarrhea and vomiting for more than 1-2 days, talk to your doctor. They may want to test your levels of potassium and other electrolytes.

Avoid drinking too much alcohol (8-15 drinks per week or 4-5 drinks over 2-3 hours, depending on your size and gender).

A diet high in potassium may help prevent hypokalemia. In the U.S., the recommended daily intake of potassium for most adults is between 2,600 and 3,400 milligrams.

Here’s a table of foods that are excellent sources of potassium:

Food	Serving size	Potassium content	Daily Value (DV) %
Dried apricots	1 cup (130 grams)	1,511 mg	32%
Cooked lentils	1 cup (198 grams)	731 mg	16%
Cooked acorn squash	1 cup (205 grams)	896 mg	19%
Cooked potato	1 medium (136 grams)	515 mg	11%
Canned kidney beans	1 cup (180 grams)	779 mg	17%
Orange juice	1 cup (249 mL)	443 mg	9%
Banana	1 medium (118 grams)	422 mg	9%
Milk (1% fat)	1 cup (244 mL)	388 mg	8%
Tomato	1 medium (100 grams)	260 mg	6%
Brewed coffee	1 cup (240 mL)	118 mg	3%
Dried Prunes	1/2 Cup	635 mg	14%

While increasing your potassium intake won’t likely raise your low potassium levels, eating a potassium-rich diet is still beneficial to your health.

Hypokalemia FAQs

What blocks potassium absorption?

Aside from diuretics and laxatives, some other medicines, such as steroids and some antacids, may either block your ability to absorb potassium or cause you to lose more when you pee and poop. Too much sodium in your diet may cause you to lose more potassium when you pee. Eating a lot of licorice can cause hypokalemia, as well.

What are the risk factors for hypokalemia?

People with some medical conditions, such as inflammatory bowel disease, don't absorb potassium as well as others. Also, people with inflammatory bowel disease usually have chronic diarrhea, which can further decrease potassium levels. Those with pica, a condition where people eat non-food items, have a higher risk of hypokalemia, especially if they eat clay. Clay binds to potassium in your digestive tract, which causes you to lose potassium through your poop.

The bottom line

Few people meet the daily recommended potassium intake, which is 3,400 mg for males and 2,600 mg for females. Nevertheless, hypokalemia is rarely caused by dietary deficiency alone. It can be caused by a number of factors, including fluid loss, malnutrition, shock, using certain medications, and medical conditions like kidney failure. Common signs and symptoms of potassium deficiency include:

weakness and fatigue

muscle cramps

stiffness

tingles and numbness

If you think you may be deficient, it’s important to speak with a healthcare professional. Potassium deficiency can have serious health consequences. If you notice any sudden changes in your breathing or heartbeat, seek immediate medical attention.

Just one thing

Try this today: Aim to have 2–3 potassium-rich foods each day. For example, a banana for breakfast, 1/2 cup (130 grams) of kidney beans at lunch, and white potatoes on your dinner plate.

Takeaways

You have hypokalemia when you have low potassium levels in your blood. This could be for a number of reasons, but often it's because you lose potassium through your pee after you take medications such as a diuretic. Unless your potassium levels are dangerously low, you usually treat low potassium with potassium supplements. To help avoid hypokalemia, drink plenty of fluids when you take a medicine that makes you pee a lot or if you have an illness that makes you vomit or have diarrhea.

If you think you have low blood potassium, talk to your doctor.

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