Hypokalemia differential diagnosis: Difference between revisions

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Revision as of 15:57, 17 October 2017

Hypokalemia must be differentiated from other causes of diabetes insipidus.

Type of DI	Subclass	Disease	Defining signs and symptoms	Lab/Imaging findings
Central	Acquired	Histiocytosis	Bone lysis and fracture Purulent otitis media Diabetes insipidus and delayed puberty Maxillary, mandibular, and gingival disease Rash and maculoerythematous skin lesions Scaly, erythematous scalp patches Lung involvement GI bleeding Lymph node enlargement^[1]	CD1a and CD45 + Interleukin-17 (ILITA) Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459
		Craniopharyngioma	Headache Endocrine dysfunction Diabetes insipidus Hypothyroidism Adrenal failure Diabetes insipidus (e.g., excessive fluid intake and urination) Growth failure and delayed puberty	Suprasellar calcified cyst on MRI Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812
		Sarcoidosis	Systemic complaints Fever Anorexia Arthralgias Pulmonary complaints Dyspnea on exertion Cough Chest pain, Hemoptysis (rare) Diabetes mellitus	Hypercalcemia Hypercalciuria (noncaseating granulomas) Elevated alkaline phosphatase Serum amyloid A (SAA) ACE levels may be elevated Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930
	Congenital	Hydrocephalus	Cognitive deterioration Headaches Neck pain Blurred vision Unsteady gait Incontinence such as polyuria	Dilated ventricles on CT and MRI Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453
	Congenital	Wolfram Syndrome (DIDMOAD)	Diabetes Insipidus Diabetes Mellitus Optic Atrophy Deafness	Negative islet cell antibodies Optic atrophy on electroretinogram Deafness on audiogram Atrophy of brain stem on MRI
Nephrogenic	Acquired	Drug-induced (demeclocycline, lithium)	Polyuria Polydipsia Nocturia	Urine osmolality <100 mmol/ Arginine vasopressin level >4.6 pmol/ Little or no response to administration of exogenous arginine vasopressin
		Hypercalcemia	Polyuria Polydipsia Gastrointestinal disturbances Pathological fractures Confusion Palpitations and cardiac arrhythmias	Ca levels greater than 11 meq/L
		Hypokalemia	Polyuria Hyporeflexia Palpitations and cardiac arrhythmias	K levels less than 3meq/L on CBC
		Multiple myeloma	Pathologic bone fractures Bleeding Hypercalcemia leading to polyuria Infection Hyperviscosity Anemia	IgG or IgA spike on serum protein electrophoresis Monoclonal M spike Disordered plasma cell proliferation on bone marrow biopsy Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682
		Sickle cell disease	Chronic pain Anemia Aplastic crisis Splenic sequestration Infection Isosthenuria presenting with polyuria	Hemoglobin level is 5-9 g/dL Hematocrit is decreased to 17-29% Peripheral blood smears demonstrate target cells, elongated cells, and characteristic sickle erythrocytes MRI can demonstrate avascular necrosis of the femoral and humeral heads 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
Primary polydipsia		Psychogenic	Polyuria Polydipsia Nocturia	Dry mucus membrane History of psychiatric disorders
Gestational diabetes insipidus			Polyuria Polydipsia Nocturia Pregnancy	Dry mucus membranes Pregnancy
Diabetes mellitus			Polyuria Polydipsia Nocturia Weight gain	Elevated blood sugar levels >126 Elevated HbA1c > 6.5

References

↑ Ghosh KN, Bhattacharya A (1992). "Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory". Rev Inst Med Trop Sao Paulo. 34 (2): 181–2. PMID 1340034.

Template:WH Template:WS

[pmid1340034-1] Ghosh KN, Bhattacharya A (1992). "Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory". Rev Inst Med Trop Sao Paulo. 34 (2): 181–2. PMID 1340034.

[1]

@@ Line 2: / Line 2: @@
 {{Hypokalemia}}
-Please help WikiDoc by adding content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+Hypokalemia must be differentiated from other causes of diabetes insipidus.
+{| class="wikitable"
+!Type of DI
+!Subclass
+!Disease
+!Defining signs and symptoms
+!Lab/Imaging findings
+|-
+| rowspan="5" |Central
+| 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]]
+|
+* [[Headache]]
+* [[Endocrine disorders|Endocrine dysfunction]]
+** [[Diabetes insipidus]]
+** [[Hypothyroidism]]
+** [[Adrenal failure]]
+** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination)
+** 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]]
+|-
+|[[Sarcoidosis]]
+|
+* Systemic complaints
+** [[Fever]]
+** [[Anorexia]]
+** [[Arthralgias]]
+* Pulmonary complaints
+** [[Dyspnea on exertion]]
+** [[Cough]]
+** Chest pain,
+** [[Hemoptysis]] (rare)
+* [[Diabetes mellitus]]
+|
+* [[Hypercalcemia]]
+* [[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
+|[[Hydrocephalus]]
+|
+* Cognitive deterioration
+* [[Headaches]]
+* [[Neck pain]]
+* [[Blurred vision]]
+* [[Unsteady gait]]
+* [[Incontinence]] such as [[polyuria]]
+|Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]]
+[[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
+|-
+|[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
+|
+* [[Diabetes insipidus|Diabetes Insipidus]]
+* [[Diabetes mellitus|Diabetes Mellitus]]
+* [[Optic atrophy|Optic Atrophy]]
+* [[Deafness]]
+|
+* Negative [[islet cell]] antibodies
+* [[Optic atrophy]] on [[electroretinogram]]
+* [[Deafness]] on [[audiogram]]
+* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
+|-
+| rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
+| rowspan="5" |[[Acquired disorder|Acquired]]
+|Drug-induced ([[demeclocycline]], [[lithium]])
+|
+* [[Polyuria]]
+* [[Polydipsia]]
+* [[Nocturia]]
+|
+* [[Urine osmolality]] <100 mmol/
+* [[Arginine vasopressin]] level >4.6 pmol/
+* Little or no response to administration of  exogenous [[arginine vasopressin]]
+|-
+|[[Hypercalcemia]]
+|
+* [[Polyuria]]
+* [[Polydipsia]]
+* [[Gastrointestinal]] disturbances
+* [[Bone fracture|Pathological fractures]]
+* [[Confusion]]
+* [[Palpitations]] and [[cardiac arrhythmias]]
+|
+* Ca levels greater than 11 meq/L
+|-
+|[[Hypokalemia]]
+|
+* [[Polyuria]]
+* [[Hyporeflexia]]
+* [[Palpitations]] and [[cardiac arrhythmias]]
+|
+* K levels less than 3meq/L on CBC
+|-
+|[[Multiple myeloma]]
+|
+* Pathologic [[bone fractures]]
+* [[Bleeding]]
+* [[Hypercalcemia]] leading to [[polyuria]]
+* [[Infection]]
+* [[Hyperviscosity]]
+* [[Anemia]]
+|
+* [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]]
+* [[Monoclonal antibody|Monoclonal M spike]]
+* 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]]
+|-
+|[[Sickle-cell disease|Sickle cell disease]]
+|
+* [[Chronic pain]]
+* [[Anemia]]
+* [[Aplastic crisis]]
+* Splenic sequestration
+* [[Infection]]
+* [[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]]
+|-
+| colspan="2" |Primary polydipsia
+|[[Psychogenic]]
+|
+* [[Polyuria]]
+* [[Polydipsia]]
+* [[Nocturia]]
+|
+* Dry mucus membrane
+* History of [[psychiatric disorders]]
+|-
+| colspan="3" |Gestational diabetes insipidus
+|
+* [[Polyuria]]
+* [[Polydipsia]]
+* [[Nocturia]]
+* [[Pregnancy]]
+|
+* Dry mucus membranes
+* [[Pregnancy]]
+|-
+| colspan="3" |[[Diabetes mellitus]]
+|
+* [[Polyuria]]
+* [[Polydipsia]]
+* [[Nocturia]]
+* [[Weight gain (patient information)|Weight gain]]
+|
+* Elevated blood sugar levels >126
+* Elevated [[HbA1c]] > 6.5
+|}
 ==References==

Hypokalemia differential diagnosis: Difference between revisions

Revision as of 15:57, 17 October 2017

References

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