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Abstract: TH-PO370

Life-Threatening Hypokalemia: Incidence, Risk Factors, and Clinical Outcomes

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Abdalla, Alaeldin, Beaumont Hospital, Dublin, Ireland
  • Fathi, Sultan, Beaumont Hospital, Dublin, Ireland
  • Mansi, Ruaa ABDULLAH S, Beaumont Hospital, Dublin, Ireland
  • De Buitleir, Ciara, Beaumont Hospital, Dublin, Ireland
  • Abdalla, Yusuf E., Beaumont Hospital, Dublin, Ireland
  • Srinivasan, Shari, Beaumont Hospital, Dublin, Ireland
  • Conlon, Peter J., Beaumont Hospital, Dublin, Ireland

Hypokalemia is one of the most common electrolyte disturbances encountered in clinical practice, and it can be fatal. Extremely low potassium levels (less than 2.5 mmol/L) can cause muscle necrosis, paralysis, cardiac arrhythmias, respiratory failure, and sudden death. In addition to decreased intake and trans-cellular shifts, the most common etiological factors in clinical practice are medication use, renal and gastrointestinal losses. To prevent serious complications, it is essential to conduct a thorough evaluation to determine the cause, correct it rapidly and closely monitor the patient's serum potassium levels.


In this retrospective analysis, we aimed to determine the incidence, risk factors, clinical manifestations, and outcomes of life-threatening hypokalemia in patients admitted to Beaumont Hospital between January 2018 and December 2023. A serum potassium concentration of less than 2.0 mmol/L was defined as life-threatening hypokalemia. The information was extracted from the laboratory information system, electronic patient records and medical charts.


A total of 2,058,608 samples were analyzed for potassium during the study period. Among these, 208 (<0.01%) instances demonstrated life-threatening hypokalemia in an aggregate of 53 patients. Mean age at presentation (+SD) was 63 ± 21 years, with the majority (35/53, 66.3%) being females. Non-surgical causes were the most prevalent primary diagnosis, in which gastrointestinal and renal losses accounted for 35% of the cases in the setting of sepsis as a prevalent precipitating etiology in 18.9%. Long-standing gastrointestinal conditions such as Ulcerative colitis, Crohn's disease, and Gastritis [23% (n=12)], chronic alcohol use [21%], and chronic kidney diseases [9% (n=5)] are important risk factors. In approximately 2% of the cases, hypokalemia was caused by medication. Majority of patients required intravenous potassium replacement to a maximum of 560mmols, under close monitoring in ICU or CCU. In 4% of patients, life-threatening hypokalemia precipitated cardiac arrest. Over all, in-hospital mortality was observed in 17% of patients.


Severe life-threatening hypokalemia is uncommon, but associated with significant morbidity, and can be fatal. Gastrointestinal and renal losses are significant contributors.