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Disorders of Potassium Balance

  • Chapter
  • First Online:
Fluid and Electrolytes in Pediatrics

Part of the book series: Nutrition and Health ((NH))

Key Points

Potassium homeostasis:

 • K+ is the most essential intracellular cation, generating the resting potential in neuronal and muscle cells.

 • Extracellular K+ levels are tightly regulated.

 • Any disturbances of serum K+ levels can affect the resting potential and lead to arrhythmias or muscular abnormalities.

Renal K+ handling and changes during maturation:

 • The kidneys are primarily responsible for excreting excess K+.

 • The goal of adult kidneys is to maintain a zero K+ balance, while newborn kidneys retain K+ to allow somatic growth.

 • Premature infants are prone to develop hyperkalemia, because they cannot rapidly eliminate exogenous excess K+.

Disturbances in K+ balance:

 • Serum K+ levels can be abnormal due to abnormal intake or abnormal excretion of K+, but can also be caused by abnormal distribution of K+ between the extra- and intracellular space.

 • Clinical symptoms vary and do not allow distinguishing between hypo- and hyperkalemia.

Hypokalemia:

 • Mild hypokalemia is a common finding in clinical practice.

 • Administration of diuretics is the most common acquired cause of hypokalemia.

 • Decreased intake of K+ can lead to total body K+ depletion and hypokalemia.

Hyperkalemia:

 • Hyperkalemia is rare in individuals with normal renal function.

 • ECG findings with hyperkalemia occur individually and cannot be correlated with the serum K+ level per se.

 • Medications are a common cause of hyperkalemia in susceptible individuals

This chapter is dedicated to my beloved parents, Florenza and Yoan Goilav-Glück.

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Authors and Affiliations

  1. Albert Einstein College of Medicine of Yeshiva University Schneider Children’s Hospital, New Hyde Park, New York, USA

    Beatrice Goilav MD (Assistant Professor of Pediatrics) & Howard Trachtman MD (Professor of Pediatrics)

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  1. Beatrice Goilav MD
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  1. Levine Children's Hospital, Carolinas Medical Center, Charlotte, North Carolina, USA

    Leonard G. Feld

  2. Children's Hospital at Montefiore, Dept. Pediatrics, Albert Einstein College of Medicine, Brainbridge Ave. 3415, Bronx, 10467, New York, USA

    Frederick J. Kaskel

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Goilav, B., Trachtman, H. (2010). Disorders of Potassium Balance. In: Feld, L., Kaskel, F. (eds) Fluid and Electrolytes in Pediatrics. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-225-4_3

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