Hypokalemia differential diagnosis: Difference between revisions

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Hypokalemia must be differentiated from other causes of diabetes insipidus.
== Overview ==
{| class="wikitable"
 
!Type of DI
== Differentiating Causes of Hypokalemia ==
!Subclass
 
!Disease
=== Differentiating the diseases that can cause hypokalemia is as following: ===
!Defining signs and symptoms
{|
!Lab/Imaging findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="5" |Diseases
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hypertension/ Hypotension
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin lesions
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Edema
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Polyuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Oliguria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia
|-
! rowspan="7" |[[Renal]] and [[adrenal disorders]]
![[Bartter syndrome]]
!
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![[Gitelman syndrome]]
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![[Liddle syndrome]]
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![[Diuretic use]]
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|-
| rowspan="5" |Central
![[Hemodialysis]]
| rowspan="3" |Acquired
!
|[[Histiocytosis]]
!
|
!
* Bone lysis and [[Bone fracture|fracture]]
!
* Purulent [[otitis media]]
!
* [[Diabetes insipidus]] and delayed puberty
!
* [[Maxillary]], [[mandibular]], and [[gingival]] disease
!
* [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions
!
* Scaly, [[erythematous]] scalp patches
!
* [[Lung]] involvement
!
* [[GI bleeding]]
!
* [[Lymphadenopathy|Lymph node enlargement]]<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034  }} </ref>
!
|
!
* CD1a and CD45 +
!
* Interleukin-17 (ILITA)
!
[[Image:Langerhans Skull X ray.jpg|center|300px|thumb|Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459]]
!
!
|-
|-
|[[Craniopharyngioma]]
![[Primary hyperaldosteronism]]
|
!
* [[Headache]]
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* [[Endocrine disorders|Endocrine dysfunction]]
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** [[Diabetes insipidus]]
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** [[Hypothyroidism]]
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** [[Adrenal failure]]
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** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination)
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** Growth failure and [[delayed puberty]]
!
|
!
* [[Suprasellar]] calcified cyst on [[MRI]]
!
[[Image:Craniopharyngioma-papillary-1.jpg|center|300px|thumb|Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812]]
!
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|-
|-
|[[Sarcoidosis]]
![[Cushing syndrome]]
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!
* Systemic complaints
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** [[Fever]]
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** [[Anorexia]]
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** [[Arthralgias]]
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* Pulmonary complaints
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** [[Dyspnea on exertion]]
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** [[Cough]]
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** Chest pain,
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** [[Hemoptysis]] (rare)
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* [[Diabetes mellitus]]
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!
* [[Hypercalcemia]]
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* [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]])
!
* Elevated [[alkaline phosphatase]]
!
* [[Serum amyloid A]] (SAA)
!
* [[Angiotensin-converting enzyme|ACE]] levels may be elevated
!
[[Image:Neurosarcoidosis.jpg|center|300px|thumb|Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930]]
|-
|-
| rowspan="2" |Congenital
! rowspan="5" |[[Gastrointestinal disorders]]
|[[Hydrocephalus]]
![[Gastrointestinal bleeding|GI bleeding]]
|
!
* Cognitive deterioration
!
* [[Headaches]]
!
* [[Neck pain]]
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* [[Blurred vision]]
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* [[Unsteady gait]]
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* [[Incontinence]] such as [[polyuria]]
!
|Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]]
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[[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
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|[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
![[Vomiting]]
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* [[Diabetes insipidus|Diabetes Insipidus]]
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* [[Diabetes mellitus|Diabetes Mellitus]]
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* [[Optic atrophy|Optic Atrophy]]
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* [[Deafness]]
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|
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* Negative [[islet cell]] antibodies
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* [[Optic atrophy]] on [[electroretinogram]]
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* [[Deafness]] on [[audiogram]]
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* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
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| rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
!Severe [[diarrhea]]
| rowspan="5" |[[Acquired disorder|Acquired]]
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|Drug-induced ([[demeclocycline]], [[lithium]])
!
|
!
* [[Polyuria]]
!
* [[Polydipsia]]
!
* [[Nocturia]]
!
|
!
* [[Urine osmolality]] <100 mmol/
!
* [[Arginine vasopressin]] level >4.6 pmol/
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* Little or no response to administration of  exogenous [[arginine vasopressin]]
!
!
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!
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!
|-
|-
|[[Hypercalcemia]]
![[Villous adenoma]]
|
!
* [[Polyuria]]
!
* [[Polydipsia]]
!
* [[Gastrointestinal]] disturbances
!
* [[Bone fracture|Pathological fractures]]
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* [[Confusion]]
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* [[Palpitations]] and [[cardiac arrhythmias]]
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|
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* Ca levels greater than 11 meq/L
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|-
|-
|[[Hypokalemia]]
![[VIPoma]]
|
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* [[Polyuria]]
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* [[Hyporeflexia]]
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* [[Palpitations]] and [[cardiac arrhythmias]]
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* K levels less than 3meq/L on CBC
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|-
|-
|[[Multiple myeloma]]
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
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![[Hypokalemic periodic paralysis]]
* Pathologic [[bone fractures]]
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* [[Bleeding]]
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* [[Hypercalcemia]] leading to [[polyuria]]
!
* [[Infection]]
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* [[Hyperviscosity]]
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* [[Anemia]]
!
|
!
* [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]]
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* [[Monoclonal antibody|Monoclonal M spike]]
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* Disordered [[plasma cell]] proliferation on [[bone marrow biopsy]]
!
[[Image:Multiple-myeloma-skeletal-survey.jpg|center|300px|thumb|Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682]]
!
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|-
|-
|[[Sickle-cell disease|Sickle cell disease]]
![[Central diabetes insipidus]]
|
!
* [[Chronic pain]]
!
* [[Anemia]]
!
* [[Aplastic crisis]]
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* Splenic sequestration
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* [[Infection]]
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* [[Isosthenuria]] presenting with [[polyuria]]
!
|
!
* [[Hemoglobin]] level is 5-9 g/dL
!
* [[Hematocrit]] is decreased to 17-29%
!
* [[Peripheral blood smear|Peripheral blood smears]] demonstrate [[Target cell|target cells]], elongated cells, and characteristic sickle erythrocytes
!
* MRI can demonstrate [[avascular necrosis]] of the [[femoral]] and [[humeral]] heads
!
[[Image:Sickle cells.jpg|center|300px|thumb|Blood film showing the sickle cells - By Dr Graham Beards - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18421017]]
!
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!
!
!
|-
|-
| colspan="2" |Primary polydipsia
![[Bulimia nervosa]]
|[[Psychogenic]]
!
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* [[Polyuria]]
!
* [[Polydipsia]]
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* [[Nocturia]]
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* Dry mucus membrane
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* History of [[psychiatric disorders]]
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|-
|-
| colspan="3" |Gestational diabetes insipidus
![[Anorexia nervosa]]
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* [[Polyuria]]  
!
* [[Polydipsia]]
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* [[Nocturia]]
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* [[Pregnancy]]
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* Dry mucus membranes
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* [[Pregnancy]]
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|-
|-
| colspan="3" |[[Diabetes mellitus]]
![[Polydipsia|Primary polydipsia]]
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* [[Polyuria]]  
!
* [[Polydipsia]]
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* [[Nocturia]]
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* [[Weight gain (patient information)|Weight gain]]
!
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* Elevated blood sugar levels >126
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* Elevated [[HbA1c]] > 6.5
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! rowspan="7" |[[Systemic diseases]]
![[Hypothermia]]
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![[Alcoholism]]
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![[Diabetic ketoacidosis]]
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![[Hypothermia]]
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![[Hypomagnesemia]]
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![[Burns]]
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![[Cystic fibrosis]]
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|}
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 16:11, 17 May 2018

Hypokalemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Causes of Hypokalemia

Differentiating the diseases that can cause hypokalemia is as following:

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Fatigue Fever Urinary symptoms Hypertension/ Hypotension Skin lesions Edema Other CBC Electrolytes Urinalysis Ultrasonography CT scan Other
Polyuria Oliguria Nocturia
Renal and adrenal disorders Bartter syndrome
Gitelman syndrome
Liddle syndrome
Diuretic use
Hemodialysis
Primary hyperaldosteronism
Cushing syndrome
Gastrointestinal disorders GI bleeding
Vomiting
Severe diarrhea
Villous adenoma
VIPoma
Neuropsychiatric disorders Hypokalemic periodic paralysis
Central diabetes insipidus
Bulimia nervosa
Anorexia nervosa
Primary polydipsia
Systemic diseases Hypothermia
Alcoholism
Diabetic ketoacidosis
Hypothermia
Hypomagnesemia
Burns
Cystic fibrosis

References


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