Profound hypokalemia: unusual presentation and management in a 12-year-old boy

Hypokalemia is a frequent electrolyte abnormality that rarely requires more than oral supplementation to correct. We describe a case of profound hypokalemia and cardiac arrhythmia requiring unusually large amounts of "bolused" potassium to restore to normal sinus rhythm. Our patient presented with significant dehydration and electrolyte abnormalities after several days of emesis. Most alarming of these findings was a serum potassium level of 1.2 mEq/L. The electrocardiogram showed changes consistent with hypokalemia that rapidly degraded into pulseless ventricular tachycardia. Potassium chloride of 140 mEq was hand-pushed during the resuscitation with return of spontaneous rhythm. The patient was discharge 11 days later in his prearrest state.