In Reply: Finding the cause of severe hypokalemia

We appreciate the thoughtful comments from Drs. Mehler and Gibson, which complement the diagnostic approach to hypokalemia presented in our article. In reply, we reinforce the association between electrolyte disturbances and eating disorders, highlight the electrolyte pattern that should raise suspicion for purgative behaviors, emphasize the need to address contraction alkalosis rather than treating hypokalemia in isolation, and note the importance of associated abnormalities such as hypomagnesemia that can complicate the management of hypokalemia.

We hope these clarifications further strengthen the practical approach to hypokalemia outlined in our original article.

• Copyright © 2026 The Cleveland Clinic Foundation. All Rights Reserved.