Persistent Hypokalemia: Case Report and Literature Review

"Introduction. Hypokalemia is a common clinical disorder. The most common causes of hypokalemia are decreased intake, intracellular shift and increased loss of potassium. In clinical practice, most frequently patients present with hypokalemia due to increased loss of potassium, especially renal loss. Case presentation. A 62-year-old woman, known with hypothyroidism under treatment with Euthyrox, diagnosed with COVID-19 four months before, presented for nausea and vomiting, headache, generalised muscular hypotony and palpitations, with the onset three weeks before. On physical examination, the blood pressure was 140/90 mmHg, regular pulse frequency of 96/min, the patient had pale skin and mucosa and abolition of osteotendinous reflexes at the inferior members. The laboratory tests revealed severe hypokalemia and moderate normocytic normochromic anemia, mixed alkalosis. The patient had no history of treatment with diuretics or penicilines, or any other condition that could have explained the severe hypokalemia. The patient was admitted in the Internal Medicine Clinic and treatment with high doses of intravenous potassium chloride, potassium - sparing diuretic (Spironolactone) and supplements of potassium and magnesium was initiated, with partial correction of the serum potasssium level. The patient was extensively investigated, to establish the etiology of kypokalemia. Finally, the only identified cause was a nephropathy with losses of potassium. Conclusions. Hypokalemia can be determined by multiple factors, such as digestive or renal losses, during a long term hospitalization. Proper treatment of substitution may lead to normal values of serum potassium and a better life quality."