HISTORY. Question the patient about dietary habits, recent illnesses, recent medical or surgical interventions, and medication use (prescribed or over-the-counter), especially the use of diuretics and corticosteroids. Patients with hypokalemia may complain of anorexia, nausea and vomiting, fatigue, drowsiness, lethargy, muscle weakness, and leg cramps. Knowledge of the patient's usual mental status and mood is helpful. Changes in cognitive ability, behavior, and level of consciousness are not uncommon in hypokalemic patients.

PHYSICAL EXAMINATION. Symptoms vary greatly from patient to patient but usually do not occur unless the potassium drops below 3 mEq/L. Assess the patient's level of consciousness and orientation. Hypokalemic patients may be confused, apathetic, anxious, irritable, or in severe cases, even comatose. Assess the rate and depth of respirations and the color of nail beds and mucous membranes. Note cardiovascular changes, such as weak and thready peripheral pulses and heart rate variability. The apical pulse may be excessively slow or excessively rapid, depending on the type of dysrhythmia present. Check the patient's blood pressure when she or he is lying, sitting, and standing to assess for postural hypotension. These changes occur in early stages, and the patient's symptoms deteriorate to a generalized hypotensive state in advanced stages of hypokalemia. Note the presence of skeletal muscle weakness, as evidenced by bilateral weak hand grasps, inability to stand, hyporeflexia, and profound flaccid paralysis in severe hypokalemic states. Gastrointestinal function is altered during hypokalemia, and the patient may have abdominal distension and hypoactive bowel sounds.

PSYCHOSOCIAL. Although it is seldom long-term and can be easily corrected, hypokalemia can lead to life-threatening complications. Typically, the patient is dealing not only with the hypokalemic state but also with the underlying cause of the hypokalemia. Assess the patient's ability to cope.

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