Potassium homeostasis and hypokalemia

Potassium, largely an intracellular cation, contributes to the regulation of cellular volume, to tissue growth and metabolic synthesis of proteins and nucleic acids, and to the integrity of electrical properties of excitable tissues as well as nonexcitable, transporting epithelia. Potassium balance is closely regulated by a variety of nonrenal and renal mechanisms. When potassium losses are sufficient to induce hypokalemia, either through nonrenal or renal causes, profound adverse effects on neuromuscular, cardiac, vascular, and renal tissues may ensue. The diagnostic approach is straightforward, and therapy must be directed to replenish losses without inducing a rapid, excessive, and potentially fatal increase in the potassium concentration of the serum.