Hypokalemia differential diagnosis

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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]

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	Bartter syndrome	+	-	+	-	+/-	Normal or ↓	-	-	Metabolic alkalosis	↑K, ↑Ca, ↑Cl	-	Normal			Mental retardation, Sensorineural hearing loss
	Gitelman syndrome	+	-	+	-	+	Normal	-	-	Metabolic alkalosis	↑K, ↓Ca, ↑Cl	-	Normal			Growth retardation, Tetany, Muscle cramp
	Liddle syndrome	-	-	+/-	-	-	↑	-	+/-	Metabolic alkalosis	↑K, ↓Na	↓PRA, ↓PAC				Pseudohyperaldosteronism
	Diuretic use	+/-	-	+	-	+/-	↓	-	+	Metabolic alkalosis	↑K	↑Na	Normal	Normal	History	-
	Hemodialysis	+/-	+/-	+/-	-	-	Normal	Pustular lesions	-	Metabolic alkalosis	Normal	↓Na	Normal	Normal	History	Carpal tunnel syndrome
	Primary hyperaldosteronism	+	-	+	-	+	↑	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	+	+/-	+/-	-	-	↑	Facial plethora, Purple striae	+	Metabolic alkalosis	Glucosuria	↑BS	Unilateral adrenal hyperplasia	-	Urinary free cortisol (24-hour)	Dorsicocervical fat pad, Obesity, Hirsutism
Gastrointestinal disorders	GI bleeding	+	-	-	+	-	↓	-	-
	Vomiting	+	-	-	+	-	↓	-	-
	Severe diarrhea	+	-	-	+	-	↓	-	-
	Villous adenoma	+	-	-	+	-	↓		-
	VIPoma	+	+/-	-	+	-	↓	Facial flushing, Skin rash	+
Neuropsychiatric disorders	Hypokalemic periodic paralysis	+	-	-	-	+/-	Normal or ↓	-	+/-
	Central diabetes insipidus	+	-	+	-	+	Normal or ↓	-	-
	Bulimia nervosa	-	-	-	+/-	-	Normal or ↓	Asteatotic skin Carotenodermia	-
	Anorexia nervosa	+	-	-	+/-	-	↓	Xerosis, Hair effluvium	-
	Primary polydipsia	-	-	+	-	+	Normal	-	+/-
Systemic diseases	Hypothermia	-	-	-	+/-	-	Normal	Erythema	-
	Alcoholism	+	+/-	+	-	+	Normal or ↓	Icterus, Caput medusa	+
	Diabetic ketoacidosis	+	+/-	+	-	+	↓	Xerosis	-
	Hypomagnesemia	+	-	-	+/-	-	Normal	-	+/-
	Burns	+/-	-	-	+	-	↓	Vesicle and bullae, Erythema	+
	Cystic fibrosis	+/-	+/-	-	+/-	-	↓	Early aquagenic skin wrinkling	+/-

References

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