Hyperkalemia differential diagnosis: Difference between revisions

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! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Additional findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Additional findings
|-
|-
!Symptoms
!align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
!Signs
!align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
!Labs
!align="center" style="background:#4479BA; color: #FFFFFF;" |Labs
|-
|-
| rowspan="3" |Renal
| rowspan="3" align="center" style="background:#DCDCDC;"|Renal
|[[Acute kidney injury]]
|align="center" style="background:#DCDCDC;"|[[Acute kidney injury]]
|[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]]
|[[Tremor]], [[confusion]], [[edema]]  
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]]  
|[[Hyperkalemia]], [[Azotemia|increased BUN and Cr]], [[metabolic acidosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], [[Azotemia|increased BUN and Cr]], [[metabolic acidosis]]
|Recently developed symptoms
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Recently developed symptoms
|-
|-
|[[Chronic kidney disease]]
|align="center" style="background:#DCDCDC;"|[[Chronic kidney disease]]
|[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Nausea]], [[vomiting]], decreased [[urine output]], [[fatigue]], [[dyspnea]], [[edema]]
|[[Tremor]], [[confusion]], [[edema]]  
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tremor]], [[confusion]], [[edema]]  
|[[Hyperkalemia]], [[Azotemia|increased BUN and Cr]], [[metabolic acidosis]], [[hypocalcemia]], [[hyperphosphatemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], [[Azotemia|increased BUN and Cr]], [[metabolic acidosis]], [[hypocalcemia]], [[hyperphosphatemia]]
|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
|-
|-
|[[Renal tubular acidosis|Renal tubular acidosis type-4]]
|align="center" style="background:#DCDCDC;"|[[Renal tubular acidosis|Renal tubular acidosis type-4]]
|Usually asyptomatic
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Usually asyptomatic
|Signs of underlying disease
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Signs of underlying disease
|[[Hyperkalemia]], normal anion gap metabolic acidosis, urine PH< 5.5
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], normal anion gap metabolic acidosis, urine PH< 5.5
|History of [[diabetes mellitus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of [[diabetes mellitus]]
|-
|-
| rowspan="4" |Endocrine
| rowspan="4" align="center" style="background:#DCDCDC;"|Endocrine
|[[Diabetic ketoacidosis|DKA]]  
|align="center" style="background:#DCDCDC;"|[[Diabetic ketoacidosis|DKA]]  
|[[Change in mental status]], [[abdominal pain]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]]
|Decreased skin turgor, dry oral mucosa, [[tachycardia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]]
|[[Hyperglycemia]], increased anion gap [[metabolic acidosis]], [[ketonemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperglycemia]], increased anion gap [[metabolic acidosis]], [[ketonemia]]
|Rapidly developing [[polyuria]], [[polydipsia]], and [[weight loss]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Rapidly developing [[polyuria]], [[polydipsia]], and [[weight loss]]
|-
|-
|[[Hyperosmolar hyperglycemic state|HHS]]
|align="center" style="background:#DCDCDC;"|[[Hyperosmolar hyperglycemic state|HHS]]
|[[Change in mental status]], [[abdominal pain]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Change in mental status]], [[abdominal pain]]
|Decreased skin turgor, dry oral mucosa, [[tachycardia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Decreased skin turgor, dry oral mucosa, [[tachycardia]]
|Severe [[hyperglycemia]], normal anion gap, increased serum osmolality
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Severe [[hyperglycemia]], normal anion gap, increased serum osmolality
|[[Polyuria]], [[polydipsia]], and [[weight loss]] develop more insidious
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Polyuria]], [[polydipsia]], and [[weight loss]] develop more insidious
|-
|-
|[[Congenital adrenal hyperplasia]] (CAH)
|align="center" style="background:#DCDCDC;"|[[Congenital adrenal hyperplasia]] (CAH)
|[[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]]
|[[Ambiguous genitalia]], [[hypotension]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ambiguous genitalia]], [[hypotension]]
|[[Hyperkalemia]], increased [[17-alpha-hydroxyprogesterone|17 hydroxyprogestrone]], [[hyponatremia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], increased [[17-alpha-hydroxyprogesterone|17 hydroxyprogestrone]], [[hyponatremia]]
|Salt wasting
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Salt wasting
|-
|-
|[[Addison's disease]]
|align="center" style="background:#DCDCDC;"|[[Addison's disease]]
|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]]
|[[Hyperpigmentation]], [[hypotension]], pubic and axillary hair loss
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperpigmentation]], [[hypotension]], pubic and axillary hair loss
|[[Hyperkalemia]], decreased serum cortisol level
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], decreased serum cortisol level
|Diagnosis by cosyntropin test
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diagnosis by cosyntropin test
|-
|-
| rowspan="2" |Tissue break down
| rowspan="2" align="center" style="background:#DCDCDC;"|Tissue break down
|[[Tumor lysis syndrome]]
|align="center" style="background:#DCDCDC;"|[[Tumor lysis syndrome]]
|[[Fever]], [[weight loss]], symptoms related to underlying malignancy
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fever]], [[weight loss]], symptoms related to underlying malignancy
|[[Altered mental status]], [[lymphadenopathy]], [[muscle weakness]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Altered mental status]], [[lymphadenopathy]], [[muscle weakness]]
|[[Hyperkalemia]], [[hyperphosphatemia]], [[hypocalcemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], [[hyperphosphatemia]], [[hypocalcemia]]
|History of underlying malignancy
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of underlying malignancy
|-
|-
|[[Rhabdomyolysis]]
|align="center" style="background:#DCDCDC;"|[[Rhabdomyolysis]]
|[[Myalgia]], [[fatigue]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myalgia]], [[fatigue]]
|[[Altered mental status]], [[hypotension]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Altered mental status]], [[hypotension]]
|[[Hyperkalemia]], increased muscle enzymes (CK, aldolase)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyperkalemia]], increased muscle enzymes (CK, aldolase)
|History of [[seizure]], [[drug overdose]], or [[trauma]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |History of [[seizure]], [[drug overdose]], or [[trauma]]
|}
|}



Revision as of 19:13, 30 May 2017



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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.



Organ system Conditions Distinguishing features Additional findings
Symptoms Signs Labs
Renal Acute kidney injury Nausea, vomiting, decreased urine output, fatigue, dyspnea, edema Tremor, confusion, edema Hyperkalemia, increased BUN and Cr, metabolic acidosis Recently developed symptoms
Chronic kidney disease Nausea, vomiting, decreased urine output, fatigue, dyspnea, edema Tremor, confusion, edema Hyperkalemia, increased BUN and Cr, metabolic acidosis, hypocalcemia, hyperphosphatemia Chronic underlying disease (DM, HTN), duration of symptoms ≥ 3 months
Renal tubular acidosis type-4 Usually asyptomatic Signs of underlying disease Hyperkalemia, normal anion gap metabolic acidosis, urine PH< 5.5 History of diabetes mellitus
Endocrine DKA Change in mental status, abdominal pain Decreased skin turgor, dry oral mucosa, tachycardia Hyperglycemia, increased anion gap metabolic acidosis, ketonemia Rapidly developing polyuria, polydipsia, and weight loss
HHS Change in mental status, abdominal pain Decreased skin turgor, dry oral mucosa, tachycardia Severe hyperglycemia, normal anion gap, increased serum osmolality Polyuria, polydipsia, and weight loss develop more insidious
Congenital adrenal hyperplasia (CAH) Poor feeding, failure to thrive, precocious puberty, short statue, hirsutism, weight loss Ambiguous genitalia, hypotension Hyperkalemia, increased 17 hydroxyprogestrone, hyponatremia Salt wasting
Addison's disease Skin hyperpigmentation, fatigue, salt craving, nausea and vomiting, amenorrhea, depression Hyperpigmentation, hypotension, pubic and axillary hair loss Hyperkalemia, decreased serum cortisol level Diagnosis by cosyntropin test
Tissue break down Tumor lysis syndrome Fever, weight loss, symptoms related to underlying malignancy Altered mental status, lymphadenopathy, muscle weakness Hyperkalemia, hyperphosphatemia, hypocalcemia History of underlying malignancy
Rhabdomyolysis Myalgia, fatigue Altered mental status, hypotension Hyperkalemia, increased muscle enzymes (CK, aldolase) History of seizure, drug overdose, or trauma

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