Hypokalemia differential diagnosis: Difference between revisions

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! rowspan="7" |[[Renal]] and [[adrenal disorders]]
! rowspan="7" |[[Renal]] and [[adrenal disorders]]
![[Bartter syndrome]]
![[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>
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!+
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!-
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!↑[[Potassium|K]], ↑[[Ca]], ↑[[Chloride|Cl]]
!↑[[Potassium|K]], ↑[[Ca]], ↑[[Chloride|Cl]]
!-
!-
!Normal
!-
!
!-
!
!Laboratory findings
![[Mental retardation]], [[Sensorineural hearing loss]]
![[Mental retardation]], [[Sensorineural hearing loss]]
|-
|-
![[Gitelman syndrome]]
![[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>
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!+
!-
!-
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!↑[[Potassium|K]], ↓[[Ca]], ↑[[Chloride|Cl]]
!↑[[Potassium|K]], ↓[[Ca]], ↑[[Chloride|Cl]]
!-
!-
!Normal
!-
!
!-
!
!Laboratory findings
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
|-
|-
![[Liddle syndrome]]
![[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>
!-
!-
!-
!-
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!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!
!-
!
!-
!
!Laboratory findings
![[Pseudohyperaldosteronism]]
![[Pseudohyperaldosteronism]]
|-
|-
![[Diuretic use]]
![[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>
!+/-
!+/-
!-
!-
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!↑[[Potassium|K]]
!↑[[Potassium|K]]
!↑[[Sodium|Na]]
!↑[[Sodium|Na]]
!Normal
!-
!Normal
!-
!History
!History
!-
!-
|-
|-
![[Hemodialysis]]
![[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>
!+/-
!+/-
!+/-
!+/-
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!Normal
!Normal
!↓[[Sodium|Na]]
!↓[[Sodium|Na]]
!Normal
!-
!Normal
!-
!History
!History
![[Carpal tunnel syndrome]]
![[Carpal tunnel syndrome]]
|-
|-
![[Primary hyperaldosteronism]]
![[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>
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!+
!-
!-
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![[Mood disturbances|Mood disturbance]], [[Paresthesia]], [[Muscle cramps]]
![[Mood disturbances|Mood disturbance]], [[Paresthesia]], [[Muscle cramps]]
|-
|-
![[Cushing syndrome]]
![[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>
!+
!+
!+/-
!+/-
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|-
|-
! rowspan="5" |[[Gastrointestinal disorders]]
! rowspan="5" |[[Gastrointestinal disorders]]
![[Gastrointestinal bleeding|GI bleeding]]
![[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>
!+
!+
!-
!-
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!-
!-
!-
!-
!
!Normal
!
!Normal
!
![[Anemia]]
!
!-
!
!-
!
!Clinical findings
!
![[Orthostatic hypotension]], [[Bradycardia]]
|-
|-
![[Vomiting]]
![[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>
!+
!+
!-
!-
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!-
!-
!-
!-
!
![[Metabolic alkalosis]]
!
![[Chloride|Cl]] <20 mEq/L
!
!-
!
!-
!
!-
!
!Clinical findings
!
!Dry [[mucous membranes]], [[Lethargy]]
|-
|-
!Severe [[diarrhea]]
!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>
!+
!+
!-
!-
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!-
!-
!-
!-
!
![[Metabolic alkalosis]]
!
![[Potassium|K]]<20 mEq/L
!
!-
!
!-
!
!-
!
!Clinical findings
!
!Dry [[mucous membranes]], [[Lethargy]]
|-
|-
![[Villous adenoma]]
![[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>
!+
!+
!-
!-
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!-
!-
!↓
!↓
!
!-
!-
!
!-
!
!Normal
!
![[Potassium|K]] and [[Chloride|Cl]] <20 mEq/L
!
![[Anemia]]
!
!-
!
!-
!
![[Colonoscopy]]
![[Hematochezia]]
|-
|-
![[VIPoma]]
![[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>
!+
!+
!+/-
!+/-
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![[Facial flushing]], [[Skin rash]]
![[Facial flushing]], [[Skin rash]]
!+
!+
!
!Normal
!
![[Potassium|K]]<20 mEq/L
!
!'''[[Osmolarity|Stool osmolar gap]] '''<50 mOsm/kg
!
!'''[[Endoscopic ultrasound]] for''' [[VIPoma|VIPomas]] of 2-3 mm
!
![[Pancreatic]] [[VIPoma|VIPomas]] >3 cm
!
!Laboratory findings
!
![[Weight loss]]
|-
|-
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
![[Hypokalemic periodic paralysis]]
![[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>
!+
!+
!-
!-
Line 254: Line 254:
!-
!-
!+/-
!+/-
!
![[Metabolic alkalosis]]
!
![[Potassium|K]]<20 mEq/L
!
![[Thyrotoxicosis]], ↓[[Magnesium|Mg]], ↓[[Phosphor|Ph]]
!
!-
!
!-
!
!Laboratory findings
!
![[Paralysis|Paralytic episodes]], [[Arrhythmias]]
|-
|-
![[Central diabetes insipidus]]
![[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>
!+
!+
!-
!-
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!-
!-
!-
!-
!
!Normal
!
!↓[[Osmolarity|Urine osmolarity]]
!
!↑[[Sodium|Na]]
!
!-
!
!-
!
!'''Water restriction test'''
!
![[Encephalopathy|Ischemic encephalopathy]]
|-
|-
![[Bulimia nervosa]]
![[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>
!-
!-
!-
!-
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![[Asteatotic Dermatitis|Asteatotic '''skin''']] '''[[Carotenodermia|C]]'''[[Carotenodermia|arotenodermia]]
![[Asteatotic Dermatitis|Asteatotic '''skin''']] '''[[Carotenodermia|C]]'''[[Carotenodermia|arotenodermia]]
!-
!-
!
!Normal
!
!↑[[Potassium|K]], ↓[[Chloride|Cl]]
!
!-
!
!-
!
!-
!
![[Psychological analysis|Psychological interview]]
!
! [[Parotid gland]] enlargement, [[Lanugo]]-like hair
|-
|-
![[Anorexia nervosa]]
![[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 305: Line 305:
![[Xerosis]], [[Telogen effluvium|Hair effluvium]]
![[Xerosis]], [[Telogen effluvium|Hair effluvium]]
!-
!-
!
!Normal
!
!↑[[Potassium|K]], ↓[[Chloride|Cl]]
!
!-
!
!-
!
!-
!
![[Psychological analysis|Psychological interview]]
!
![[Orthostatic hypotension]], [[Bradycardia]]
|-
|-
![[Polydipsia|Primary polydipsia]]
![[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>
!-
!-
!-
!-
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!-
!-
!+/-
!+/-
!
!Normal
!
!↓[[Osmolarity|Urine osmolarity]]
!
!↓[[Sodium|Na]]
!
!-
!
!-
!
!'''Water restriction test'''
!
![[Psychosis]]
|-
|-
! rowspan="6" |[[Systemic diseases]]
! rowspan="6" |[[Systemic diseases]]
![[Hypothermia]]
![[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>
!-
!-
!-
!-
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!-
!-
!Normal
!Normal
![[Erythema]]
![[Frostbite]]
!-
!Normal
!Normal
!-
!-
!-
!
!-
!
!Clinical findings
!
![[Loss of consciousness|Impaired mental state]]
!
!
!
!
|-
|-
![[Alcoholism]]
![[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>
!+
!+
!+/-
!+/-
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![[Icterus]], [[Caput medusae|Caput medusa]]
![[Icterus]], [[Caput medusae|Caput medusa]]
!+
!+
!
![[Metabolic alkalosis]]
!
![[Ketonuria]]
!
![[Anemia]]
!
!-
!
!-
!
!Clinical findings
!
![[Digital clubbing]], [[Gynecomastia]]
|-
|-
![[Diabetic ketoacidosis]]
![[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 374: Line 374:
![[Xerosis]]
![[Xerosis]]
!-
!-
!
![[Metabolic acidosis]]
!
![[Ketonuria]]
!
!↑Serum [[ketone]], ↑[[Blood glucose]]
!
!-
!
!-
!
!Laboratory findings
!
!Dry [[mucous membranes]], [[Shock]]
|-
|-
![[Hypomagnesemia]]
![[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 391: Line 391:
!-
!-
!+/-
!+/-
!
![[Metabolic alkalosis]]
!
!-
!
!↓[[Calcium|Ca]]
!
!-
!
!-
!
!Laboratory findings
!
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]]
|-
|-
![[Burns]]
![[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 408: Line 408:
![[Vesicle]] and bullae, [[Erythema]]
![[Vesicle]] and bullae, [[Erythema]]
!+
!+
!
!Normal
!
!-
!
![[Acute phase reactant]]
!
!-
!
!-
!
!Clinical findings
!
![[Dehydration]]
|-
|-
![[Cystic fibrosis]]
![[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>
!+/-
!+/-
!+/-
!+/-
Line 425: Line 425:
![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]]
![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]]
!+/-
!+/-
!
!Normal
!
!-
!
!-
!
![[Pancreatitis]]
!
![[Pulmonary]] infiltration
!
!'''[[Sweat chloride test]]'''
!
![[Pancreatic insufficiency]]
|}
|}
==References==
==References==

Revision as of 19:47, 29 May 2018

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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 Bartter syndrome[1] + - + - +/- Normal or ↓ - - Metabolic alkalosis K, ↑Ca, ↑Cl - - - Laboratory findings Mental retardation, Sensorineural hearing loss
Gitelman syndrome[2] + - + - + Normal - - Metabolic alkalosis K, ↓Ca, ↑Cl - - - Laboratory findings Growth retardation, Tetany, Muscle cramp
Liddle syndrome[3] - - +/- - - - +/- Metabolic alkalosis K, ↓Na PRA, ↓PAC - - Laboratory findings Pseudohyperaldosteronism
Diuretic use[4] +/- - + - +/- - + Metabolic alkalosis K Na - - History -
Hemodialysis[5] +/- +/- +/- - - Normal Pustular lesions - Metabolic alkalosis Normal Na - - History Carpal tunnel syndrome
Primary hyperaldosteronism[6] + - + - + 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[7] + +/- +/- - - 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[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 Hypokalemic periodic paralysis[13] + - - - +/- Normal or ↓ - +/- Metabolic alkalosis K<20 mEq/L Thyrotoxicosis, ↓Mg, ↓Ph - - Laboratory findings Paralytic episodes, Arrhythmias
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
Primary polydipsia[17] - - + - + Normal - +/- Normal Urine osmolarity Na - - Water restriction test Psychosis
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

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