Treatment strategies of hypokalemia in heart failure

Sudden cardiac death is estimated to affect approximately three million people worldwide each year. Substrates and triggers often play a complex role in these deaths. Among the heart cells, disturbed potassium homeostasis is one such trigger. Hypokalemia and transient drops in potassium concentration are significant issues. Heart failure (HF) therapy is increasingly complicated by maintaining normal serum potassium (K+) homeostasis. As a result of the use of loop diuretics hypokalemia has become a severe and feared side effect of treatment. Hypokalemia in HF also indicates greater neurohormonal activity and progression of disease. Personalized drug use and monitoring of electrolytes are crucial for successful treatment. The lowest dose of diuretic necessary to maintain euvolemia should be prescribed to HF patients with symptoms (New York Heart Association Class III-IV). Aldosterone receptor antagonists, spironolactone can be used to treat mild hypokalemia. For more severe, K + supplement is recommended. Levels should be routinely monitored and kept between 4.0 and 5.5 mEq/l.