Veterinary Guide to Canine Hypokalemia (Low Potassium) 2025 🐶🩺

By Dr. Duncan Houston BVSc

🧬 What Is Hypokalemia?

Hypokalemia is defined as abnormally low blood potassium—usually <3.5 mmol/L in dogs. It disrupts nerve, muscle, and heart function due to altered cell membrane potentials.

👥 Who’s at Risk?

• Dogs with chronic kidney disease due to excessive urinary potassium loss.
• Cases with vomiting, diarrhea, or prolonged anorexia leading to GI losses.
• On medications: diuretics, insulin/dextrose, or receiving IV fluids without added potassium.
• Endocrine disorders (e.g., hyperaldosteronism), alkalosis, or redistribution into cells.

⚠️ Clinical Signs

• Muscle weakness—difficulty walking or rising (“drunk-like” gait).
• Lethargy, inappetence, weight loss, constipation.
• PU/PD from decreased urine concentrating ability.
• Severe cases: respiratory muscle paralysis, collapse, cardiac arrhythmias.

🔍 Diagnostic Approach

1. History & exam: note fluid loss, medication use, appetite, PU/PD signs.
2. Bloodwork: serum potassium (<3.5 mmol/L), CBC/chem for kidney, GI or endocrine disease.
3. Urinalysis & UPC: assessing kidney function and potassium excretion.
4. ECG: to detect arrhythmias and U-waves early.
5. Evaluate underlying causes: imaging, endocrine tests, and assess acid-base status.

🛠️ Treatment & Management

1. Emergency IV Potassium Replacement

• For moderate to severe hypokalemia (<3 mmol/L) with signs: use intravenous KCl slowly—max 0.5 mEq/kg/hr—to avoid arrhythmias.
• Administer with ECG and vital monitoring; avoid too rapid infusion.
• Supplement IV fluids to support perfusion and electrolyte balance.

2. Oral Potassium Supplementation

• For mild–moderate cases or maintenance after IV therapy: potassium gluconate or citrate added to food.
• Dosing tailored by veterinarian; monitor serum levels to prevent overcorrection.

3. Treat the Underlying Cause

• Manage kidney disease, GI issues, electrolyte disturbances.
• Stop or adjust diuretics; add potassium to IV fluids if ongoing losses.
• In case of insulin therapy, monitor and supplement due to intracellular shifts.
• Address endocrine causes (like hyperaldosteronism) appropriately.

4. Monitoring & Nutritional Support

• Recheck serum K every 6–24 hours initially, then weekly until stable.
• Urine checks as needed for ongoing losses.
• Diet: quality protein, potassium-rich foods; fluid therapy optimization.

📈 Prognosis

• Generally excellent when cause is treated and potassium is normalized.
• Cases with respiratory or cardiac muscle involvement need prompt ICU care.
• If the underlying disease persists (e.g., CKD), long-term supplementation may be required.
• Untreated cases risk life-threatening arrhythmias or paralysis.

📱 Ask A Vet Telehealth Support

• 📸 Upload bloodwork, ECG strips, and clinical videos for remote review.
• 🔔 Get dosage reminders for IV fluids, oral K supplements, and recheck labs.
• 🩺 Virtual consultations to monitor weakness, breathing, and arrhythmia signs.

🎓 Case Spotlight: “Bailey” the Senior Labrador

Bailey, a 12-year-old Labrador, presented with muscle weakness, PU/PD, and ECG showing U-waves. Labs revealed K 2.8 mmol/L, creatinine elevated. Emergency treatment included IV KCl, fluids with added K, followed by oral potassium gluconate. Chronic kidney disease management was optimized. Ask A Vet facilitated lab reviews, supplement delivery, and virtual follow-ups. Within a week, Bailey regained strength and normalized K—ongoing supplementation continues monthly 🐾.

🔚 Key Takeaways

1. Hypokalemia is common in dogs with kidney, GI disease or medication therapy.
2. Signs range from mild weakness to paralysis and arrhythmia—prompt detection is critical.
3. Diagnosis requires serum K, ECG, and underlying disease investigation.
4. Treatment includes IV/oral potassium, correction, and monitoring.
5. Ask A Vet telehealth supports dosing, delivery, remote assessment, and recovery tracking 📲🐕

Dr Duncan Houston BVSc, founder of Ask A Vet. Download the Ask A Vet app for expert telehealth in managing hypokalemia—helping with lab interpretation, dosage planning, supplement delivery, and remote monitoring to ensure your dog recovers safely 🐶📲