Nephrologist Elects Not To Medicate Athlete With Severe Potassium Deficiency

This case involves an otherwise healthy 16-year-old crew team athlete who experienced persistent inexplicable muscle spasms and was hospitalized. While hospitalized, the patient was discovered to have very low potassium levels and abnormal EKGs. He was referred to a nephrologist who elected to treat the patient by changing his diet. No medication or IV treatment was given to the patient. The patient’s potassium levels appeared to be improving after several days, at which time he was discharged from the hospital. The following night, the patient passed away in his sleep.

Question(s) For Expert Witness

1. How ofter do you treat patients with hypokalemia?

2. What are the most common causes of hypokalemia?

3. In the presence of a 16-year-old patient with hypokalemia, what kind of workup is needed?

Expert Witness Response E-009201

Hypokalemia is a life-threatening disorder that requires aggressive management if severe. Diagnosis of underlying disorder is important, as it will guide the most appropriate way to correct the hypokalemia and prevent recurrence. It is essential therefore that a workup is performed. Workup will vary depending on history and other lab findings. Based on the information provided, a diagnosis was not made and inadequate potassium resuscitation may have occurred resulting in sudden death. As a nephrologist, I frequently evaluate hypokalemia though I infrequently see a young otherwise healthy person with this problem. If hypertensive would consider excess mineralocorticoid or corticosteroid disorders, alkalosis would occur with several of the hypertensive disorders but could also indicate volume depletion (contraction), diuretic use, laxative use, vomiting. Genetic disorders resulting in hypokalemia such as Gitelman syndrome could present at this age though unusual. Acidosis might suggest renal tubular acidosis with potassium loss (several disorders could cause this). Hypomagnesemia would need to be ruled out. Depending on the circumstances other diagnoses could be considered.