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Overview of Disorders of Potassium Metabolism in Animals


Peter D. Constable

, BVSc (Hons), MS, PhD, DACVIM, College of Veterinary Medicine, University of Illinois at Urbana-Champaign

Reviewed/Revised Jun 2021 | Modified Nov 2022

Potassium homeostasis is mainly determined by the balance between absorption of potassium from the GI tract and subsequent excretion by the kidneys (all animals) and saliva (in adult ruminants). Transport of potassium is passive in the small intestine and active in the colon under the influence of aldosterone. The most important hormone affecting renal and salivary potassium excretion is aldosterone, which is released from the zona glomerulosa of the adrenal gland in response to hyperkalemia and other factors. One of aldosterone’s primary actions is to enhance the secretion of potassium ions in the distal renal tubules and collecting ducts.

At least 95% of whole body potassium is intracellular, with skeletal muscle containing 60%–75% of the intracellular potassium. Marked changes in serum or plasma potassium concentrations alter the resting membrane potential of cells, because the potassium gradient generated by Na+/K+-ATPase is the main cause for the negative electric potential across cell membranes. Therefore, hypokalemia or hyperkalemia alters the resting membrane potential, resulting in clinically important changes in cellular and organ function. Hypokalemia usually indicates whole body depletion of potassium, unless identified in animals with hyperinsulinemia due to hyperglycemia, in which case potassium may have translocated intracellularly. Whole-body potassium status in hyperkalemia cannot be inferred because many animals with hyperkalemia have concurrent acidemia and whole-body potassium depletion.

Hypokalemia Hypokalemia in Adult Cattle Marked hypokalemia (serum or plasma potassium concentration <2.5 mmol/L) is common in inappetant, lactating dairy cows and ketotic dairy cows receiving multiple treatments of isoflupredone... read more can occur in any animal receiving large volumes of IV fluid or having a marked and sustained reduction in feed intake. Clinical signs in most animals with mild to moderate hypokalemia are mild and nonspecific. Severe hypokalemia is associated with ventroflexion of the head or recumbency due to generalized muscle weakness and cardiac arrhythmias, including both atrial and ventricular premature complexes that may lead to more complex cardiac arrhythmias. Prolonged and profound hypokalemia can result in a myopathy difficult to treat. Cats can be affected by a feline hypokalemic polymyopathy Feline Hypokalemic Polymyopathy Feline hypokalemic polymyopathy is a generalized metabolic muscle weakness disorder in cats secondary to hypokalemia associated with excessive urinary depletion or inadequate dietary intake... read more , and Burmese cats have an autosomal recessive disorder that leads to hypokalemic myopathy Small Animals .

Hyperkalemia Hyperkalemia in Ruminants Hyperkalemia (plasma potassium concentration >5.5 mmol/L) is common in animals with inadequate urine excretion, particularly when they are also acidemic (blood pH <7.2). Affected animals... read more usually results from inadequate urinary excretion of ingested potassium and is common in monogastric animals with urinary tract obstruction and bladder rupture. Hyperkalemia in horses and ruminants can also result from exertional rhabdomyolysis Exertional Myopathies in Horses Exertional myopathy in horses is a syndrome of muscle fatigue, pain, or cramping associated with exercise. Less common exertional myopathies that cause exercise intolerance without muscle necrosis... read more Exertional Myopathies in Horses , because skeletal muscle contains a large percentage of whole body potassium. Hyperkalemia also occurs in heavily muscled Quarter horses and related breeds as a genetic disorder (hyperkalemic periodic paralysis Hyperkalemic Periodic Paralysis In angular limb deformities, which are congenital or acquired skeletal defects, the distal portion of a limb deviates laterally or medially early in neonatal life. In utero malposition, hypothyroidism... read more Hyperkalemic Periodic Paralysis ). Hyperkalemia frequently occurs in dogs with hypoadrenocorticism Addison Disease Addison disease (hypoadrenocorticism) results from the lack of glucocorticoids, mineralocorticoids, or both. Isolated aldosterone insufficiency appears to be very rare, whereas isolated glucocorticoid... read more . Severe hyperkalemia is associated with generalized muscle weakness, depression, and cardiac conduction disturbances that may lead to lethal cardiac arrhythmias. Pseudohyperkalemia in serum can occur in animals with thrombocytosis as a result of the excessive release of intracellular potassium stores from platelets during clotting. Pseudohyperkalemia in serum and plasma occurs when extensive hemolysis is present because of the high potassium concentration in RBCs in most species, although some species have genetic differences in their erythrocytic potassium concentration.

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