Hypokalemia differential diagnosis: Difference between revisions

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=== Differentiating the diseases that can cause hypokalemia is as following table: ===
=== Differentiating the diseases that can cause hypokalemia is as following table: ===
{|
{| class="wikitable"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="5" |Diseases
! colspan="2" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! colspan="8" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="8" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
Line 38: Line 38:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia
|-
|-
! rowspan="7" |[[Renal]] and [[adrenal disorders]]
! rowspan="7" style="background: #DCDCDC; text-align: center;" |[[Renal]] and [[adrenal disorders]]
![[Bartter syndrome]]<ref name="pmid12920401">{{cite journal |vauthors=Hebert SC |title=Bartter syndrome |journal=Curr. Opin. Nephrol. Hypertens. |volume=12 |issue=5 |pages=527–32 |date=September 2003 |pmid=12920401 |doi=10.1097/01.mnh.0000088732.87142.43 |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Diuretic use]]<ref name="pmid8199766">{{cite journal |vauthors=Bourke E, Delaney V |title=Prevention of hypokalemia caused by diuretics |journal=Heart Dis Stroke |volume=3 |issue=2 |pages=63–7 |date=1994 |pmid=8199766 |doi= |url=}}</ref>
!+
!+/-
!-
!-
!+
!+
!-
!-
!+/-
!+/-
!Normal or
!↓
!-
!-
!-
!+
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↑[[Ca]], ↑[[Chloride|Cl]]
!↑[[Potassium|K]]
!↑[[Sodium|Na]]
!-
!-
!-
!-
!History
!-
!-
!Laboratory findings
![[Mental retardation]], [[Sensorineural hearing loss]]
|-
|-
![[Gitelman syndrome]]<ref name="pmid18667063">{{cite journal| author=Knoers NV, Levtchenko EN| title=Gitelman syndrome. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue= | pages= 22 | pmid=18667063 | doi=10.1186/1750-1172-3-22 | pmc=2518128 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667063 }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Primary hyperaldosteronism]]<ref name="pmid28101185">{{cite journal| author=Wu C, Xin J, Xin M, Zou H, Jing L, Zhu C et al.| title=Hypokalemic myopathy in primary aldosteronism: A case report. | journal=Exp Ther Med | year= 2016 | volume= 12 | issue= 6 | pages= 4064-4066 | pmid=28101185 | doi=10.3892/etm.2016.3864 | pmc=5228118 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28101185 }}</ref>
!+
!+
!-
!-
Line 62: Line 62:
!-
!-
!+
!+
!Normal
!-
!-
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Ca]], ↑[[Chloride|Cl]]
!-
!-
!-
!Laboratory findings
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
|-
![[Liddle syndrome]]<ref name="pmid29534496">{{cite journal |vauthors=Tetti M, Monticone S, Burrello J, Matarazzo P, Veglio F, Pasini B, Jeunemaitre X, Mulatero P |title=Liddle Syndrome: Review of the Literature and Description of a New Case |journal=Int J Mol Sci |volume=19 |issue=3 |pages= |date=March 2018 |pmid=29534496 |pmc=5877673 |doi=10.3390/ijms19030812 |url=}}</ref>
!-
!-
!+/-
!-
!-
!↑
!↑
![[Facial flushing]]
!-
!-
!+/-
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↓'''[[Plasma renin activity|PRA]]''', '''[[Aldosterone|PAC]]'''
!↓'''[[Plasma renin activity|PRA]]''', '''[[Aldosterone|PAC]], ↓[[Sodium|Na]]'''
!-
!Unilateral [[adrenal hyperplasia]]
!-
!Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) 
!Laboratory findings
!'''[[Aldosterone|PAC]]:[[Plasma renin activity|PRA]] ratio'''
![[Pseudohyperaldosteronism]]
![[Mood disturbances|Mood disturbance]], [[Paresthesia]], [[Muscle cramps]]
|-
|-
![[Diuretic use]]<ref name="pmid8199766">{{cite journal |vauthors=Bourke E, Delaney V |title=Prevention of hypokalemia caused by diuretics |journal=Heart Dis Stroke |volume=3 |issue=2 |pages=63–7 |date=1994 |pmid=8199766 |doi= |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Cushing syndrome]]<ref name="pmid12381548">{{cite journal |vauthors=Torpy DJ, Mullen N, Ilias I, Nieman LK |title=Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases |journal=Ann. N. Y. Acad. Sci. |volume=970 |issue= |pages=134–44 |date=September 2002 |pmid=12381548 |doi= |url=}}</ref>
!+
!+/-
!+/-
!+/-
!-
!-
!+
!-
!+/-
!↓
!-
!-
!↑
![[Plethora|Facial plethora]], [[Striae|Purple striae]]
!+
!+
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Potassium|K]]
![[Glucosuria]]
!↑[[Sodium|Na]]
!↑[[Blood sugar|BS]]
!-
!Unilateral [[adrenal hyperplasia]]
!-
!History
!-
!-
!'''Urinary free [[cortisol]] (24-hour)'''
!Dorsicocervical [[fat pad]], [[Obesity]], [[Hirsutism]]
|-
|-
![[Hemodialysis]]<ref name="pmid23946760">{{cite journal| author=Choi HY, Ha SK| title=Potassium balances in maintenance hemodialysis. | journal=Electrolyte Blood Press | year= 2013 | volume= 11 | issue= 1 | pages= 9-16 | pmid=23946760 | doi=10.5049/EBP.2013.11.1.9 | pmc=3741441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23946760  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Hemodialysis]]<ref name="pmid23946760">{{cite journal| author=Choi HY, Ha SK| title=Potassium balances in maintenance hemodialysis. | journal=Electrolyte Blood Press | year= 2013 | volume= 11 | issue= 1 | pages= 9-16 | pmid=23946760 | doi=10.5049/EBP.2013.11.1.9 | pmc=3741441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23946760  }}</ref>
!+/-
!+/-
!+/-
!+/-
Line 124: Line 107:
![[Carpal tunnel syndrome]]
![[Carpal tunnel syndrome]]
|-
|-
![[Primary hyperaldosteronism]]<ref name="pmid28101185">{{cite journal| author=Wu C, Xin J, Xin M, Zou H, Jing L, Zhu C et al.| title=Hypokalemic myopathy in primary aldosteronism: A case report. | journal=Exp Ther Med | year= 2016 | volume= 12 | issue= 6 | pages= 4064-4066 | pmid=28101185 | doi=10.3892/etm.2016.3864 | pmc=5228118 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28101185 }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Bartter syndrome]]<ref name="pmid12920401">{{cite journal |vauthors=Hebert SC |title=Bartter syndrome |journal=Curr. Opin. Nephrol. Hypertens. |volume=12 |issue=5 |pages=527–32 |date=September 2003 |pmid=12920401 |doi=10.1097/01.mnh.0000088732.87142.43 |url=}}</ref>
!+
!-
!+
!-
!+/-
!Normal or ↓
!-
!-
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↑[[Ca]], ↑[[Chloride|Cl]]
!-
!-
!-
!Laboratory findings
![[Mental retardation]], [[Sensorineural hearing loss]]
|-
! style="background: #DCDCDC; text-align: center;" |[[Gitelman syndrome]]<ref name="pmid18667063">{{cite journal| author=Knoers NV, Levtchenko EN| title=Gitelman syndrome. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue= | pages= 22 | pmid=18667063 | doi=10.1186/1750-1172-3-22 | pmc=2518128 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667063 }}</ref>
!+
!+
!-
!-
Line 130: Line 130:
!-
!-
!+
!+
!
!Normal
![[Facial flushing]]
!-
!-
!-
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K]], ↓[[Ca]], ↑[[Chloride|Cl]]
!↓'''[[Plasma renin activity|PRA]]''', ↑'''[[Aldosterone|PAC]], ↓[[Sodium|Na]]'''
!-
!Unilateral [[adrenal hyperplasia]]
!-
!Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) 
!-
!'''[[Aldosterone|PAC]]:[[Plasma renin activity|PRA]] ratio'''
!Laboratory findings
![[Mood disturbances|Mood disturbance]], [[Paresthesia]], [[Muscle cramps]]
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
|-
|-
![[Cushing syndrome]]<ref name="pmid12381548">{{cite journal |vauthors=Torpy DJ, Mullen N, Ilias I, Nieman LK |title=Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases |journal=Ann. N. Y. Acad. Sci. |volume=970 |issue= |pages=134–44 |date=September 2002 |pmid=12381548 |doi= |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Liddle syndrome]]<ref name="pmid29534496">{{cite journal |vauthors=Tetti M, Monticone S, Burrello J, Matarazzo P, Veglio F, Pasini B, Jeunemaitre X, Mulatero P |title=Liddle Syndrome: Review of the Literature and Description of a New Case |journal=Int J Mol Sci |volume=19 |issue=3 |pages= |date=March 2018 |pmid=29534496 |pmc=5877673 |doi=10.3390/ijms19030812 |url=}}</ref>
!+
!-
!+/-
!-
!+/-
!+/-
!-
!-
!-
!-
!↑
!↑
![[Plethora|Facial plethora]], [[Striae|Purple striae]]
!-
!+
!+/-
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Glucosuria]]
![[Potassium|K]], ↓[[Sodium|Na]]
![[Blood sugar|BS]]
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!Unilateral [[adrenal hyperplasia]]
!-
!-
!-
!'''Urinary free [[cortisol]] (24-hour)'''
!Laboratory findings
!Dorsicocervical [[fat pad]], [[Obesity]], [[Hirsutism]]
![[Pseudohyperaldosteronism]]
|-
|-
! rowspan="5" |[[Gastrointestinal disorders]]
! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal disorders]]
![[Gastrointestinal bleeding|GI bleeding]]<ref name="pmid22901631">{{cite journal| author=Asmar A, Mohandas R, Wingo CS| title=A physiologic-based approach to the treatment of a patient with hypokalemia. | journal=Am J Kidney Dis | year= 2012 | volume= 60 | issue= 3 | pages= 492-7 | pmid=22901631 | doi=10.1053/j.ajkd.2012.01.031 | pmc=4776048 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22901631  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal bleeding|GI bleeding]]<ref name="pmid22901631">{{cite journal| author=Asmar A, Mohandas R, Wingo CS| title=A physiologic-based approach to the treatment of a patient with hypokalemia. | journal=Am J Kidney Dis | year= 2012 | volume= 60 | issue= 3 | pages= 492-7 | pmid=22901631 | doi=10.1053/j.ajkd.2012.01.031 | pmc=4776048 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22901631  }}</ref>
!+
!+
!-
!-
Line 176: Line 176:
![[Orthostatic hypotension]], [[Bradycardia]]
![[Orthostatic hypotension]], [[Bradycardia]]
|-
|-
![[Vomiting]]<ref name="pmid22169581">{{cite journal |vauthors=Cheungpasitporn W, Suksaranjit P, Chanprasert S |title=Pathophysiology of vomiting-induced hypokalemia and diagnostic approach |journal=Am J Emerg Med |volume=30 |issue=2 |pages=384 |date=February 2012 |pmid=22169581 |doi=10.1016/j.ajem.2011.10.005 |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Vomiting]]<ref name="pmid22169581">{{cite journal |vauthors=Cheungpasitporn W, Suksaranjit P, Chanprasert S |title=Pathophysiology of vomiting-induced hypokalemia and diagnostic approach |journal=Am J Emerg Med |volume=30 |issue=2 |pages=384 |date=February 2012 |pmid=22169581 |doi=10.1016/j.ajem.2011.10.005 |url=}}</ref>
!+
!+
!-
!-
Line 193: Line 193:
!Dry [[mucous membranes]], [[Lethargy]]
!Dry [[mucous membranes]], [[Lethargy]]
|-
|-
!Severe [[diarrhea]]<ref name="pmid28580600">{{cite journal |vauthors=Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M |title=Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature |journal=Neurogastroenterol. Motil. |volume=29 |issue=11 |pages= |date=November 2017 |pmid=28580600 |doi=10.1111/nmo.13120 |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |Severe [[diarrhea]]<ref name="pmid28580600">{{cite journal |vauthors=Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M |title=Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature |journal=Neurogastroenterol. Motil. |volume=29 |issue=11 |pages= |date=November 2017 |pmid=28580600 |doi=10.1111/nmo.13120 |url=}}</ref>
!+
!+
!-
!-
Line 210: Line 210:
!Dry [[mucous membranes]], [[Lethargy]]
!Dry [[mucous membranes]], [[Lethargy]]
|-
|-
![[Villous adenoma]]<ref name="pmid24199207">{{cite journal| author=Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP et al.| title=Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. | journal=Can J Gastroenterol | year= 2013 | volume= 27 | issue= 11 | pages= 621-2 | pmid=24199207 | doi= | pmc=3816940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24199207  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Villous adenoma]]<ref name="pmid24199207">{{cite journal| author=Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP et al.| title=Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. | journal=Can J Gastroenterol | year= 2013 | volume= 27 | issue= 11 | pages= 621-2 | pmid=24199207 | doi= | pmc=3816940 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24199207  }}</ref>
!+
!+
!-
!-
Line 227: Line 227:
![[Hematochezia]]
![[Hematochezia]]
|-
|-
![[VIPoma]]<ref name="pmid3035922">{{cite journal |vauthors=Krejs GJ |title=VIPoma syndrome |journal=Am. J. Med. |volume=82 |issue=5B |pages=37–48 |date=May 1987 |pmid=3035922 |doi= |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[VIPoma]]<ref name="pmid3035922">{{cite journal |vauthors=Krejs GJ |title=VIPoma syndrome |journal=Am. J. Med. |volume=82 |issue=5B |pages=37–48 |date=May 1987 |pmid=3035922 |doi= |url=}}</ref>
!+
!+
!+/-
!+/-
Line 244: Line 244:
![[Weight loss]]
![[Weight loss]]
|-
|-
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Neuropsychiatric|Neuropsychiatric disorders]]
![[Hypokalemic periodic paralysis]]<ref name="urlHypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/6729/hypokalemic-periodic-paralysis |title=Hypokalemic periodic paralysis &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Polydipsia|Primary polydipsia]]<ref name="pmid25688318">{{cite journal| author=Gill M, McCauley M| title=Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication. | journal=Case Rep Psychiatry | year= 2015 | volume= 2015 | issue=  | pages= 846459 | pmid=25688318 | doi=10.1155/2015/846459 | pmc=4320790 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25688318  }}</ref>
!+
!-
!-
!-
!-
!+
!-
!-
!+/-
!+
!Normal or ↓
!Normal
!-
!-
!+/-
!+/-
![[Metabolic alkalosis]]
!Normal
![[Potassium|K]]<20 mEq/L
![[Osmolarity|Urine osmolarity]]
![[Thyrotoxicosis]], ↓[[Magnesium|Mg]], ↓[[Phosphor|Ph]]
!↓[[Sodium|Na]]
!-
!-
!-
!-
!Laboratory findings
!'''Water restriction test'''
![[Paralysis|Paralytic episodes]], [[Arrhythmias]]
![[Psychosis]]
|-
|-
![[Central diabetes insipidus]]<ref name="pmid24707338">{{cite journal| author=Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A| title=A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus. | journal=Neurohospitalist | year= 2014 | volume= 4 | issue= 2 | pages= 90-3 | pmid=24707338 | doi=10.1177/1941874413495702 | pmc=3975788 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24707338  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Central diabetes insipidus]]<ref name="pmid24707338">{{cite journal| author=Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A| title=A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus. | journal=Neurohospitalist | year= 2014 | volume= 4 | issue= 2 | pages= 90-3 | pmid=24707338 | doi=10.1177/1941874413495702 | pmc=3975788 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24707338  }}</ref>
!+
!+
!-
!-
Line 279: Line 279:
![[Encephalopathy|Ischemic encephalopathy]]
![[Encephalopathy|Ischemic encephalopathy]]
|-
|-
![[Bulimia nervosa]]<ref name="pmid15213788">{{cite journal| author=Rushing JM, Jones LE, Carney CP| title=Bulimia Nervosa: A Primary Care Review. | journal=Prim Care Companion J Clin Psychiatry | year= 2003 | volume= 5 | issue= 5 | pages= 217-224 | pmid=15213788 | doi= | pmc=419300 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213788  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Bulimia nervosa]]<ref name="pmid15213788">{{cite journal| author=Rushing JM, Jones LE, Carney CP| title=Bulimia Nervosa: A Primary Care Review. | journal=Prim Care Companion J Clin Psychiatry | year= 2003 | volume= 5 | issue= 5 | pages= 217-224 | pmid=15213788 | doi= | pmc=419300 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15213788  }}</ref>
!-
!-
!-
!-
Line 296: Line 296:
! [[Parotid gland]] enlargement, [[Lanugo]]-like hair
! [[Parotid gland]] enlargement, [[Lanugo]]-like hair
|-
|-
![[Anorexia nervosa]]<ref name="pmid21670105">{{cite journal| author=Liang CC, Yeh HC| title=Hypokalemic nephropathy in anorexia nervosa. | journal=CMAJ | year= 2011 | volume= 183 | issue= 11 | pages= E761 | pmid=21670105 | doi=10.1503/cmaj.101790 | pmc=3153553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670105  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Anorexia nervosa]]<ref name="pmid21670105">{{cite journal| author=Liang CC, Yeh HC| title=Hypokalemic nephropathy in anorexia nervosa. | journal=CMAJ | year= 2011 | volume= 183 | issue= 11 | pages= E761 | pmid=21670105 | doi=10.1503/cmaj.101790 | pmc=3153553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670105  }}</ref>
!+
!+
!-
!-
Line 313: Line 313:
![[Orthostatic hypotension]], [[Bradycardia]]
![[Orthostatic hypotension]], [[Bradycardia]]
|-
|-
![[Polydipsia|Primary polydipsia]]<ref name="pmid25688318">{{cite journal| author=Gill M, McCauley M| title=Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication. | journal=Case Rep Psychiatry | year= 2015 | volume= 2015 | issue=  | pages= 846459 | pmid=25688318 | doi=10.1155/2015/846459 | pmc=4320790 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25688318  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Hypokalemic periodic paralysis]]<ref name="urlHypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/6729/hypokalemic-periodic-paralysis |title=Hypokalemic periodic paralysis &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
!+
!-
!-
!-
!-
!+
!-
!-
!+
!+/-
!Normal
!Normal or ↓
!-
!-
!+/-
!+/-
!Normal
![[Metabolic alkalosis]]
![[Osmolarity|Urine osmolarity]]
![[Potassium|K]]<20 mEq/L
!↓[[Sodium|Na]]
![[Thyrotoxicosis]], ↓[[Magnesium|Mg]], ↓[[Phosphor|Ph]]
!-
!-
!-
!-
!'''Water restriction test'''
!Laboratory findings
![[Psychosis]]
![[Paralysis|Paralytic episodes]], [[Arrhythmias]]
|-
|-
! rowspan="6" |[[Systemic diseases]]
! rowspan="6" style="background: #DCDCDC; text-align: center;" |[[Systemic diseases]]
![[Hypothermia]]<ref name="pmid9795553">{{cite journal |vauthors=Zydlewski AW, Hasbargen JA |title=Hypothermia-induced hypokalemia |journal=Mil Med |volume=163 |issue=10 |pages=719–21 |date=October 1998 |pmid=9795553 |doi= |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Hypothermia]]<ref name="pmid9795553">{{cite journal |vauthors=Zydlewski AW, Hasbargen JA |title=Hypothermia-induced hypokalemia |journal=Mil Med |volume=163 |issue=10 |pages=719–21 |date=October 1998 |pmid=9795553 |doi= |url=}}</ref>
!-
!-
!-
!-
Line 348: Line 348:
![[Loss of consciousness|Impaired mental state]]
![[Loss of consciousness|Impaired mental state]]
|-
|-
![[Alcoholism]]<ref name="pmid12189007">{{cite journal |vauthors=Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K |title=Hypokalaemia in alcoholic patients |journal=Drug Alcohol Rev |volume=21 |issue=1 |pages=73–6 |date=March 2002 |pmid=12189007 |doi=10.1080/09595230220119282 |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Alcoholism]]<ref name="pmid12189007">{{cite journal |vauthors=Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K |title=Hypokalaemia in alcoholic patients |journal=Drug Alcohol Rev |volume=21 |issue=1 |pages=73–6 |date=March 2002 |pmid=12189007 |doi=10.1080/09595230220119282 |url=}}</ref>
!+
!+
!+/-
!+/-
Line 365: Line 365:
![[Digital clubbing]], [[Gynecomastia]]
![[Digital clubbing]], [[Gynecomastia]]
|-
|-
![[Diabetic ketoacidosis]]<ref name="pmid25430801">{{cite journal| author=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM| title=Profound hypokalemia associated with severe diabetic ketoacidosis. | journal=Pediatr Diabetes | year= 2016 | volume= 17 | issue= 1 | pages= 61-5 | pmid=25430801 | doi=10.1111/pedi.12246 | pmc=4896141 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25430801  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Diabetic ketoacidosis]]<ref name="pmid25430801">{{cite journal| author=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM| title=Profound hypokalemia associated with severe diabetic ketoacidosis. | journal=Pediatr Diabetes | year= 2016 | volume= 17 | issue= 1 | pages= 61-5 | pmid=25430801 | doi=10.1111/pedi.12246 | pmc=4896141 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25430801  }}</ref>
!+
!+
!+/-
!+/-
Line 382: Line 382:
!Dry [[mucous membranes]], [[Shock]]
!Dry [[mucous membranes]], [[Shock]]
|-
|-
![[Hypomagnesemia]]<ref name="pmid17804670">{{cite journal |vauthors=Huang CL, Kuo E |title=Mechanism of hypokalemia in magnesium deficiency |journal=J. Am. Soc. Nephrol. |volume=18 |issue=10 |pages=2649–52 |date=October 2007 |pmid=17804670 |doi=10.1681/ASN.2007070792 |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Hypomagnesemia]]<ref name="pmid17804670">{{cite journal |vauthors=Huang CL, Kuo E |title=Mechanism of hypokalemia in magnesium deficiency |journal=J. Am. Soc. Nephrol. |volume=18 |issue=10 |pages=2649–52 |date=October 2007 |pmid=17804670 |doi=10.1681/ASN.2007070792 |url=}}</ref>
!+
!+
!-
!-
Line 399: Line 399:
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]]
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]]
|-
|-
![[Burns]]<ref name="pmid27183443">{{cite journal| author=Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG| title=Burns: Pathophysiology of Systemic Complications and Current Management. | journal=J Burn Care Res | year= 2017 | volume= 38 | issue= 1 | pages= e469-e481 | pmid=27183443 | doi=10.1097/BCR.0000000000000355 | pmc=5214064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27183443  }}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Burns]]<ref name="pmid27183443">{{cite journal| author=Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG| title=Burns: Pathophysiology of Systemic Complications and Current Management. | journal=J Burn Care Res | year= 2017 | volume= 38 | issue= 1 | pages= e469-e481 | pmid=27183443 | doi=10.1097/BCR.0000000000000355 | pmc=5214064 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27183443  }}</ref>
!+/-
!+/-
!-
!-
Line 416: Line 416:
![[Dehydration]]
![[Dehydration]]
|-
|-
![[Cystic fibrosis]]<ref name="pmid9048354">{{cite journal |vauthors=Bates CM, Baum M, Quigley R |title=Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent |journal=J. Am. Soc. Nephrol. |volume=8 |issue=2 |pages=352–5 |date=February 1997 |pmid=9048354 |doi= |url=}}</ref>
! style="background: #DCDCDC; text-align: center;" |[[Cystic fibrosis]]<ref name="pmid9048354">{{cite journal |vauthors=Bates CM, Baum M, Quigley R |title=Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent |journal=J. Am. Soc. Nephrol. |volume=8 |issue=2 |pages=352–5 |date=February 1997 |pmid=9048354 |doi= |url=}}</ref>
!+/-
!+/-
!+/-
!+/-

Revision as of 15:17, 30 May 2018

Hypokalemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Differentiating Causes of Hypokalemia

Differentiating the diseases that can cause hypokalemia is as following table:

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Fatigue Fever Urinary symptoms Blood Pressure Skin lesions Edema ABG Urinalysis Other Ultrasonography CT scan
Polyuria Oliguria Nocturia
Renal and adrenal disorders Diuretic use[1] +/- - + - +/- - + Metabolic alkalosis K Na - - History -
Primary hyperaldosteronism[2] + - + - + Facial flushing - Metabolic alkalosis K, ↓Na PRA, ↑PAC, ↓Na Unilateral adrenal hyperplasia Hypodense unilateral adrenal macroadenoma (>1 cm)  PAC:PRA ratio Mood disturbance, Paresthesia, Muscle cramps
Cushing syndrome[3] + +/- +/- - - Facial plethora, Purple striae + Metabolic alkalosis Glucosuria BS Unilateral adrenal hyperplasia - Urinary free cortisol (24-hour) Dorsicocervical fat pad, Obesity, Hirsutism
Hemodialysis[4] +/- +/- +/- - - Normal Pustular lesions - Metabolic alkalosis Normal Na - - History Carpal tunnel syndrome
Bartter syndrome[5] + - + - +/- Normal or ↓ - - Metabolic alkalosis K, ↑Ca, ↑Cl - - - Laboratory findings Mental retardation, Sensorineural hearing loss
Gitelman syndrome[6] + - + - + Normal - - Metabolic alkalosis K, ↓Ca, ↑Cl - - - Laboratory findings Growth retardation, Tetany, Muscle cramp
Liddle syndrome[7] - - +/- - - - +/- Metabolic alkalosis K, ↓Na PRA, ↓PAC - - Laboratory findings Pseudohyperaldosteronism
Gastrointestinal disorders GI bleeding[8] + - - + - - - Normal Normal Anemia - - Clinical findings Orthostatic hypotension, Bradycardia
Vomiting[9] + - - + - - - Metabolic alkalosis Cl <20 mEq/L - - - Clinical findings Dry mucous membranes, Lethargy
Severe diarrhea[10] + - - + - - - Metabolic alkalosis K<20 mEq/L - - - Clinical findings Dry mucous membranes, Lethargy
Villous adenoma[11] + - - + - - - Normal K and Cl <20 mEq/L Anemia - - Colonoscopy Hematochezia
VIPoma[12] + +/- - + - Facial flushing, Skin rash + Normal K<20 mEq/L Stool osmolar gap <50 mOsm/kg Endoscopic ultrasound for VIPomas of 2-3 mm Pancreatic VIPomas >3 cm Laboratory findings Weight loss
Neuropsychiatric disorders Primary polydipsia[13] - - + - + Normal - +/- Normal Urine osmolarity Na - - Water restriction test Psychosis
Central diabetes insipidus[14] + - + - + Normal or ↓ - - Normal Urine osmolarity Na - - Water restriction test Ischemic encephalopathy
Bulimia nervosa[15] - - - +/- - Normal or ↓ Asteatotic skin Carotenodermia - Normal K, ↓Cl - - - Psychological interview  Parotid gland enlargement, Lanugo-like hair
Anorexia nervosa[16] + - - +/- - Xerosis, Hair effluvium - Normal K, ↓Cl - - - Psychological interview Orthostatic hypotension, Bradycardia
Hypokalemic periodic paralysis[17] + - - - +/- Normal or ↓ - +/- Metabolic alkalosis K<20 mEq/L Thyrotoxicosis, ↓Mg, ↓Ph - - Laboratory findings Paralytic episodes, Arrhythmias
Systemic diseases Hypothermia[18] - - - +/- - Normal Frostbite - Normal Normal - - - Clinical findings Impaired mental state
Alcoholism[19] + +/- + - + Normal or ↓ Icterus, Caput medusa + Metabolic alkalosis Ketonuria Anemia - - Clinical findings Digital clubbing, Gynecomastia
Diabetic ketoacidosis[20] + +/- + - + Xerosis - Metabolic acidosis Ketonuria ↑Serum ketone, ↑Blood glucose - - Laboratory findings Dry mucous membranes, Shock
Hypomagnesemia[21] + - - +/- - Normal - +/- Metabolic alkalosis - Ca - - Laboratory findings Trousseau and Chvostek signs
Burns[22] +/- - - + - Vesicle and bullae, Erythema + Normal - Acute phase reactant - - Clinical findings Dehydration
Cystic fibrosis[23] +/- +/- - +/- - Early aquagenic skin wrinkling +/- Normal - - Pancreatitis Pulmonary infiltration Sweat chloride test Pancreatic insufficiency

References

  1. Bourke E, Delaney V (1994). "Prevention of hypokalemia caused by diuretics". Heart Dis Stroke. 3 (2): 63–7. PMID 8199766.
  2. Wu C, Xin J, Xin M, Zou H, Jing L, Zhu C; et al. (2016). "Hypokalemic myopathy in primary aldosteronism: A case report". Exp Ther Med. 12 (6): 4064–4066. doi:10.3892/etm.2016.3864. PMC 5228118. PMID 28101185.
  3. Torpy DJ, Mullen N, Ilias I, Nieman LK (September 2002). "Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases". Ann. N. Y. Acad. Sci. 970: 134–44. PMID 12381548.
  4. Choi HY, Ha SK (2013). "Potassium balances in maintenance hemodialysis". Electrolyte Blood Press. 11 (1): 9–16. doi:10.5049/EBP.2013.11.1.9. PMC 3741441. PMID 23946760.
  5. Hebert SC (September 2003). "Bartter syndrome". Curr. Opin. Nephrol. Hypertens. 12 (5): 527–32. doi:10.1097/01.mnh.0000088732.87142.43. PMID 12920401.
  6. Knoers NV, Levtchenko EN (2008). "Gitelman syndrome". Orphanet J Rare Dis. 3: 22. doi:10.1186/1750-1172-3-22. PMC 2518128. PMID 18667063.
  7. Tetti M, Monticone S, Burrello J, Matarazzo P, Veglio F, Pasini B, Jeunemaitre X, Mulatero P (March 2018). "Liddle Syndrome: Review of the Literature and Description of a New Case". Int J Mol Sci. 19 (3). doi:10.3390/ijms19030812. PMC 5877673. PMID 29534496.
  8. Asmar A, Mohandas R, Wingo CS (2012). "A physiologic-based approach to the treatment of a patient with hypokalemia". Am J Kidney Dis. 60 (3): 492–7. doi:10.1053/j.ajkd.2012.01.031. PMC 4776048. PMID 22901631.
  9. Cheungpasitporn W, Suksaranjit P, Chanprasert S (February 2012). "Pathophysiology of vomiting-induced hypokalemia and diagnostic approach". Am J Emerg Med. 30 (2): 384. doi:10.1016/j.ajem.2011.10.005. PMID 22169581.
  10. Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M (November 2017). "Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature". Neurogastroenterol. Motil. 29 (11). doi:10.1111/nmo.13120. PMID 28580600.
  11. Sanchez Garcia S, Villarejo Campos P, Manzanares Campillo Mdel C, Gil Rendo A, Muñoz Atienza V, García Santos EP; et al. (2013). "Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome". Can J Gastroenterol. 27 (11): 621–2. PMC 3816940. PMID 24199207.
  12. Krejs GJ (May 1987). "VIPoma syndrome". Am. J. Med. 82 (5B): 37–48. PMID 3035922.
  13. Gill M, McCauley M (2015). "Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication". Case Rep Psychiatry. 2015: 846459. doi:10.1155/2015/846459. PMC 4320790. PMID 25688318.
  14. Nguyen FN, Kar JK, Verduzco-Gutierrez M, Zakaria A (2014). "A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus". Neurohospitalist. 4 (2): 90–3. doi:10.1177/1941874413495702. PMC 3975788. PMID 24707338.
  15. Rushing JM, Jones LE, Carney CP (2003). "Bulimia Nervosa: A Primary Care Review". Prim Care Companion J Clin Psychiatry. 5 (5): 217–224. PMC 419300. PMID 15213788.
  16. Liang CC, Yeh HC (2011). "Hypokalemic nephropathy in anorexia nervosa". CMAJ. 183 (11): E761. doi:10.1503/cmaj.101790. PMC 3153553. PMID 21670105.
  17. "Hypokalemic periodic paralysis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
  18. Zydlewski AW, Hasbargen JA (October 1998). "Hypothermia-induced hypokalemia". Mil Med. 163 (10): 719–21. PMID 9795553.
  19. Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K (March 2002). "Hypokalaemia in alcoholic patients". Drug Alcohol Rev. 21 (1): 73–6. doi:10.1080/09595230220119282. PMID 12189007.
  20. Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
  21. Huang CL, Kuo E (October 2007). "Mechanism of hypokalemia in magnesium deficiency". J. Am. Soc. Nephrol. 18 (10): 2649–52. doi:10.1681/ASN.2007070792. PMID 17804670.
  22. Nielson CB, Duethman NC, Howard JM, Moncure M, Wood JG (2017). "Burns: Pathophysiology of Systemic Complications and Current Management". J Burn Care Res. 38 (1): e469–e481. doi:10.1097/BCR.0000000000000355. PMC 5214064. PMID 27183443.
  23. Bates CM, Baum M, Quigley R (February 1997). "Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent". J. Am. Soc. Nephrol. 8 (2): 352–5. PMID 9048354.


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