Hyperkalemia differential diagnosis: Difference between revisions
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| | | [[File:Siren.gif|link=hyperkalemia resident survival guide|41x41px]] | ||
| [[Hyperkalemia resident survival guide|Resident <br> Survival | | | ||
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| [[Hyperkalemia resident survival guide|Resident<br>Survival<br>Guide]] | |||
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{{CMG}};{{AE}}{{SMP}} | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hyperkalemia]] | ||
{{CMG}}; {{AE}} {{SMP}} | |||
==Overview== | ==Overview== | ||
Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia. | Hyperkalemia is a [[laboratory]] finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="2" | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Organ system | ||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Conditions | |||
! style="background:#4479BA; color: #FFFFFF; | ! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Distinguishing features | ||
! style="background:#4479BA; color: #FFFFFF;" align="center | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Additional findings | ||
|- | |- | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms | ||
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! style="background:#4479BA; color: #FFFFFF;" align="center" |Labs | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Labs | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center | | rowspan="3" style="background:#DCDCDC;" align="center" |'''Renal''' | ||
| style="background:#DCDCDC;" align="center" |Acute kidney injury<ref name="pmid17331245">{{cite journal |vauthors=Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A |title=Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury |journal=Crit Care |volume=11 |issue=2 |pages=R31 |year=2007 |pmid=17331245 |pmc=2206446 |doi=10.1186/cc5713 |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Acute kidney injury]]<ref name="pmid17331245">{{cite journal |vauthors=Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A |title=Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury |journal=Crit Care |volume=11 |issue=2 |pages=R31 |year=2007 |pmid=17331245 |pmc=2206446 |doi=10.1186/cc5713 |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Recently developed symptoms | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Recently developed symptoms | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |Chronic kidney disease<ref name="pmid12138150">{{cite journal |vauthors=Rodríguez Soriano J |title=Renal tubular acidosis: the clinical entity |journal=J. Am. Soc. Nephrol. |volume=13 |issue=8 |pages=2160–70 |year=2002 |pmid=12138150 |doi= |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Chronic kidney disease]]<ref name="pmid12138150">{{cite journal |vauthors=Rodríguez Soriano J |title=Renal tubular acidosis: the clinical entity |journal=J. Am. Soc. Nephrol. |volume=13 |issue=8 |pages=2160–70 |year=2002 |pmid=12138150 |doi= |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Chronic underlying disease ([[Diabetes mellitus|DM]], [[Hypertension|HTN]]), duration of symptoms ≥ 3 months | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Chronic underlying disease ([[Diabetes mellitus|DM]], [[Hypertension|HTN]]), duration of symptoms ≥ 3 months | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |[[Renal tubular acidosis|Renal tubular acidosis type-4]]<ref name="pmid15262664">{{cite journal |vauthors=Hsu CY, Vittinghoff E, Lin F, Shlipak MG |title=The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency |journal=Ann. Intern. Med. |volume=141 |issue=2 |pages=95–101 |year=2004 |pmid=15262664 |doi= |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Renal tubular acidosis|Renal tubular acidosis type-4]]<ref name="pmid15262664">{{cite journal |vauthors=Hsu CY, Vittinghoff E, Lin F, Shlipak MG |title=The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency |journal=Ann. Intern. Med. |volume=141 |issue=2 |pages=95–101 |year=2004 |pmid=15262664 |doi= |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Usually asyptomatic | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Usually asyptomatic | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Signs of underlying disease | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Signs of underlying disease | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of [[diabetes mellitus]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of [[diabetes mellitus]] | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center | | rowspan="4" style="background:#DCDCDC;" align="center" |'''Endocrine''' | ||
| style="background:#DCDCDC;" align="center" |[[Diabetic ketoacidosis|DKA]]<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Diabetic ketoacidosis|DKA]]<ref name="pmid19564476">{{cite journal |vauthors=Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN |title=Hyperglycemic crises in adult patients with diabetes |journal=Diabetes Care |volume=32 |issue=7 |pages=1335–43 |year=2009 |pmid=19564476 |pmc=2699725 |doi=10.2337/dc09-9032 |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Rapidly developing [[polyuria]], [[polydipsia]], and [[weight loss]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Rapidly developing [[polyuria]], [[polydipsia]], and [[weight loss]] | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |[[Hyperosmolar hyperglycemic state|HHS]]<ref name="pmid5013637">{{cite journal |vauthors=Arieff AI, Carroll HJ |title=Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases |journal=Medicine (Baltimore) |volume=51 |issue=2 |pages=73–94 |year=1972 |pmid=5013637 |doi= |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Hyperosmolar hyperglycemic state|HHS]]<ref name="pmid5013637">{{cite journal |vauthors=Arieff AI, Carroll HJ |title=Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases |journal=Medicine (Baltimore) |volume=51 |issue=2 |pages=73–94 |year=1972 |pmid=5013637 |doi= |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Polyuria]], [[polydipsia]], and [[weight loss]] develop more insidious | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Polyuria]], [[polydipsia]], and [[weight loss]] develop more insidious | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |[[Congenital adrenal hyperplasia]] (CAH)<ref name="pmid20823466">{{cite journal |vauthors=Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC |title=Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=95 |issue=9 |pages=4133–60 |year=2010 |pmid=20823466 |pmc=2936060 |doi=10.1210/jc.2009-2631 |url=}}</ref><ref name="pmid19955259">{{cite journal |vauthors=Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B |title=Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies |journal=Eur. J. Endocrinol. |volume=162 |issue=3 |pages=597–602 |year=2010 |pmid=19955259 |doi=10.1530/EJE-09-0884 |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Congenital adrenal hyperplasia]] (CAH)<ref name="pmid20823466">{{cite journal |vauthors=Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC |title=Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=95 |issue=9 |pages=4133–60 |year=2010 |pmid=20823466 |pmc=2936060 |doi=10.1210/jc.2009-2631 |url=}}</ref><ref name="pmid19955259">{{cite journal |vauthors=Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B |title=Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies |journal=Eur. J. Endocrinol. |volume=162 |issue=3 |pages=597–602 |year=2010 |pmid=19955259 |doi=10.1530/EJE-09-0884 |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Poor feeding]], [[failure to thrive]], [[precocious puberty]], short statue, [[hirsutism]], [[weight loss]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Poor feeding]], [[failure to thrive]], [[precocious puberty]], short statue, [[hirsutism]], [[weight loss]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ambiguous genitalia]], [[hypotension]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ambiguous genitalia]], [[hypotension]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Salt wasting | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Salt wasting | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |[[Addison's disease]] | | style="background:#DCDCDC;" align="center" |[[Addison's disease|'''Addison's disease''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Skin [[hyperpigmentation]], [[fatigue]], salt craving, [[nausea and vomiting]], [[amenorrhea]], [[depression]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Skin [[hyperpigmentation]], [[fatigue]], salt craving, [[nausea and vomiting]], [[amenorrhea]], [[depression]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperpigmentation]], [[hypotension]], pubic and axillary hair loss | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperpigmentation]], [[hypotension]], pubic and axillary hair loss | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diagnosis by cosyntropin test | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diagnosis by cosyntropin test | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center | | rowspan="2" style="background:#DCDCDC;" align="center" |'''Tissue break down''' | ||
| style="background:#DCDCDC;" align="center" |[[Tumor lysis syndrome]]<ref name="pmid18509186">{{cite journal |vauthors=Coiffier B, Altman A, Pui CH, Younes A, Cairo MS |title=Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review |journal=J. Clin. Oncol. |volume=26 |issue=16 |pages=2767–78 |year=2008 |pmid=18509186 |doi=10.1200/JCO.2007.15.0177 |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Tumor lysis syndrome]]<ref name="pmid18509186">{{cite journal |vauthors=Coiffier B, Altman A, Pui CH, Younes A, Cairo MS |title=Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review |journal=J. Clin. Oncol. |volume=26 |issue=16 |pages=2767–78 |year=2008 |pmid=18509186 |doi=10.1200/JCO.2007.15.0177 |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fever]], [[weight loss]], symptoms related to underlying malignancy | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fever]], [[weight loss]], symptoms related to underlying malignancy | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Altered mental status]], [[lymphadenopathy]], [[muscle weakness]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Altered mental status]], [[lymphadenopathy]], [[muscle weakness]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of underlying malignancy | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of underlying malignancy | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" |[[Rhabdomyolysis]]<ref name="pmid6282181">{{cite journal |vauthors=Knochel JP |title=Rhabdomyolysis and myoglobinuria |journal=Annu. Rev. Med. |volume=33 |issue= |pages=435–43 |year=1982 |pmid=6282181 |doi=10.1146/annurev.me.33.020182.002251 |url=}}</ref> | | style="background:#DCDCDC;" align="center" |'''[[Rhabdomyolysis]]<ref name="pmid6282181">{{cite journal |vauthors=Knochel JP |title=Rhabdomyolysis and myoglobinuria |journal=Annu. Rev. Med. |volume=33 |issue= |pages=435–43 |year=1982 |pmid=6282181 |doi=10.1146/annurev.me.33.020182.002251 |url=}}</ref>''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myalgia]], [[fatigue]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myalgia]], [[fatigue]] |
Latest revision as of 23:08, 29 April 2020
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia.
Differential Diagnosis
Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia
References
- ↑ Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury". Crit Care. 11 (2): R31. doi:10.1186/cc5713. PMC 2206446. PMID 17331245.
- ↑ Rodríguez Soriano J (2002). "Renal tubular acidosis: the clinical entity". J. Am. Soc. Nephrol. 13 (8): 2160–70. PMID 12138150.
- ↑ Hsu CY, Vittinghoff E, Lin F, Shlipak MG (2004). "The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency". Ann. Intern. Med. 141 (2): 95–101. PMID 15262664.
- ↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
- ↑ Arieff AI, Carroll HJ (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine (Baltimore). 51 (2): 73–94. PMID 5013637.
- ↑ Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC (2010). "Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline". J. Clin. Endocrinol. Metab. 95 (9): 4133–60. doi:10.1210/jc.2009-2631. PMC 2936060. PMID 20823466.
- ↑ Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B (2010). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". Eur. J. Endocrinol. 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.
- ↑ Coiffier B, Altman A, Pui CH, Younes A, Cairo MS (2008). "Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review". J. Clin. Oncol. 26 (16): 2767–78. doi:10.1200/JCO.2007.15.0177. PMID 18509186.
- ↑ Knochel JP (1982). "Rhabdomyolysis and myoglobinuria". Annu. Rev. Med. 33: 435–43. doi:10.1146/annurev.me.33.020182.002251. PMID 6282181.