Nephrologist Elects Not To Medicate Athlete With Severe Potassium Deficiency

Case Overview

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.

Questions to the Nephrology expert and their responses

How often do you treat patients with hypokalemia?

As a nephrologist, I frequently evaluate hypokalemia though I infrequently see a young otherwise healthy person with this problem.

What are the most common causes of hypokalemia?

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.

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

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. Depending on the circumstances other diagnoses could be considered.

About the expert

This highly qualified expert has over 20 years of experience in nephrology. He received his BS in mathematics from the University of Miami and his MD from Johns Hopkins University. He went on to complete a residency in internal medicine and a fellowship in nephrology at Johns Hopkins University. He is board certified in nephrology and is a member of several professional organizations including the American Society of Nephrology, the National Kidney Foundation, the International AIDS Society, and the American College of Rheumatology. This expert has contributed over 50 publications to his field and serves on the editorial board for the Advances in Chronic Kidney Disease Journal and the Clinical Journal of the American Society of Nephrology. He formerly served as an assistant professor of medicine at Johns Hopkins University and as the medical director of the Johns Hopkins Davita Bond Street Unit. In addition, he formerly served as the nephrology fellowship director at Johns Hopkins. He currently serves as an associate professor of medicine at a medical school in Maryland and as the medical director of a university-affiliated nephrology clinic in Maryland.