Hypokalemia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Aditya Govindavarjhulla, M.B.B.S. [3], Aida Javanbakht, M.D.; Assistant Editor(s)-In-Chief: Jack Khouri


The etiology of hypokalemia can be quite difficult to diagnose. As a matter of fact, many organ systems are involved in the regulation of potassium level and any derangement to their normal function can cause hypokalemia. Drugs, diarrhea, kidney disease, endocrine diseases and many others are potential culprits. Hypokalemia can be the consequence of decreased ingestion, increased losses (renal, GI or excessive sweating) or transcellular shift from the extracellular to the intracellular compartment. The most common causes are diarrhea, vomiting and diuretic use (mostly loop and thiazide diuretics).


Hypokalemia might be the result of excessive K loss (renal or extra-renal losses), insufficient intake, or increased transcellular shift of the potassium to the intracellular space.[1]

  • Perhaps the most obvious cause is insufficient consumption of potassium (that is, a low-potassium diet). However, without excessive potassium loss from the body, this is a rare cause of hypokalemia. Alcoholism, anorexia nervosa, dental problems and dysphagia can all impair food intake and cause hypokalemia. In the hospital setting, hypokalemia can present in patients on total parenteral nutrition or potassium-free IV fluids.
  • Excessive loss of potassium, often associated with excess water loss, which "flushes" potassium out of the body. Typically, this is a consequence of GI losses (vomiting and diarrhea), or excessive perspiration.
  • Transcellular potassium shift to the intracellular space:
    • Increased extracellular pH (each 0.11 unit increase in pH corresponds to a 0.4 meq/l decrease in potassium level)
    • Elevated insulin
    • Elevated beta-adrenergic activity (stress, beta-agonist intake, etc)
    • Rare hereditary defects of muscular ion channels and transporters that cause hypokalemic periodic paralysis can precipitate occasional attacks of severe hypokalemia and muscle weakness. These defects cause a heightened sensitivity to catechols and/or insulin and/or thyroid hormone that lead to sudden influx of potassium from the extracellular fluid into the muscle cells.
    • Hypothermia
    • Thyrotoxicosis
    • Theophylline
    • Rapid expansion of cell mass (eg, during refeeding after prolonged starvation, when patients with pernicious anemia are treated with vitamin B12 and with tumors having rapid cell turnover)

Common Causes

Causes by Organ System

Cardiovascular Heart failure, Hypertension
Chemical / poisoning Ackee Fruit Food poisoning, Aloe poisoning, Amitraz, Cascara sagrada, Herbal Agent overdose, Licorice, Mayapple poisoning, Organophosphates, Phenolphthalein
Dermatologic No underlying causes
Drug Side Effect Abiraterone, Acetaminophen, Ammonium Chloride, Amikacin, Aminophylline, Amlodipine and Benazepril, Amphotericin B, Anidulafungin, Arsenic trioxide, Artemether and lumefantrin, Bendrofluazide, Bufotenine poisoning, Bumetanide, Calcium resonium, Carbenoxolone, Caspofungin, Capreomycin sulfate, Cetuximab, Cyanocobalamin, Chlorothiazide, Chlortalidone, Clopamide, Corticosteroid medications, Cyclopenthiazide, Cytarabine Dexlansoprazole,Dolasetron mesylate, Diuretic use, Eribulin, Etacrynic acid, Ethacrynic Acid, Febuxostat, Felbamate, Formoterol, Frusemide, Gentamicin, Galantamine hydrobromide, Glycyrrhizic acid, Hydrochlorothiazide, Hydroflumethiazide, Imatinib mesylate, Indapamide, Ixabepilone, Kanamycin, Levalbuterol, Lithium, Losartan and Hydrochlorothiazide, Meropenem, Methyclothiazide, Metolazone, Mifepristone, Netilmicin, Nilotinib,Olodaterol, Ondansetron, Oxcarbazepine, Pamidronic acid, Panitumumab, Pramipexole, Para amino salicylic acid, Penicillin, Polythiazide, Pertuzumab, Prednisolone, Prednisone, Reproterol, Ritodrine, Salbutamol, Sorafenib, Sirolimus, Tacrolimus, Thiazides, Tiagabine, Toluene, Trichlormethiazide, Vancomycin, Voriconazole
Ear Nose Throat No underlying causes
Endocrine Aldosteronism, Congenital adrenal hyperplasia, Cushing's Syndrome, Diabetes, Glucocorticoid resistance, Hyperaldosteronism, Primary aldosteronism, Secondary aldosteronism, SIADH, Thyrotoxicosis, VIPoma
Environmental No underlying causes
Gastroenterologic Acute liver failure, Bowel fistulae, Bowel obstruction, Chloridorrhea, Colonic villous adenomata, Congenital chloride diarrhea, Diarrhea, Gastric fistula, Liver Cirrhosis
Genetic Cortisol 11 beta ketoreductase deficiency, Fanconi renotubular syndrome, Hypokalemic periodic paralysis, Liddle syndrome, Lightwood Albright syndrome
Hematologic Acute myeloid leukemia
Iatrogenic Insulin, IV fluids, Post operative , Sodium polystyrene sulfonate, Steroids, Ureterosigmoidostomy
Infectious Disease Diarrhea, Cholera, Pyelonephritis
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic Acid Base Imbalance, Alcoholism, Alkalosis, Beer drinker syndrome, Diabetic ketoacidosis, Inadequate potassium in diet, Licorice, Refeeding syndrome, Vomiting
Obstetric/Gynecologic No underlying causes
Oncologic Acute myeloid leukemia, Functioning pancreatic endocrine tumor, Gastro enteropancreatic neuroendocrine tumor, Tumors
Opthalmologic No underlying causes
Overdose / Toxicity Iodine overuse, Laxative abuse, Mineralocorticoid excess
Psychiatric Anorexia nervosa, Bulimia nervosa, Eating disorder
Pulmonary No underlying causes
Renal / Electrolyte Apparent mineralocorticoid excess, Chronic pyelonephritis, Bartter's syndrome, Classic Distal Renal Tubular Acidosis, Conn's Syndrome, Gitelman syndrome, Gullner Syndrome, Hyperreninemic Hypoaldosteronism, Hypokalaemic distal renal tubular acidosis, Hypomagnesemia, Liddle syndrome, Proximal renal tubular acidosis, Renal tubular acidosis, Sodium polystyrene sulfonate, Ureterosigmoidostomy, Urinary tract obstruction
Rheum / Immune / Allergy Sjogren's Syndrome
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Drip arm sample, Excessive sweating, Hypothermia

Causes in Alphabetical Order [2] [3] [4] [5] [6] [7] [8] [9] [10]

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  1. Palmer, Biff F.; Clegg, Deborah J. (2016). "Physiology and pathophysiology of potassium homeostasis". Advances in Physiology Education. 40 (4): 480–490. doi:10.1152/advan.00121.2016. ISSN 1043-4046.
  2. Veltri KT, Mason C (March 2015). "Medication-induced hypokalemia". P T. 40 (3): 185–90. PMC 4357351. PMID 25798039.
  3. Marti G, Schwarz C, Leichtle AB, Fiedler GM, Arampatzis S, Exadaktylos AK, Lindner G (February 2014). "Etiology and symptoms of severe hypokalemia in emergency department patients". Eur J Emerg Med. 21 (1): 46–51. doi:10.1097/MEJ.0b013e3283643801. PMID 23839104.
  4. Wojtaszek E, Matuszkiewicz-Rowińska J (2013). "[Hypokalemia]". Wiad. Lek. (in Polish). 66 (4): 290–3. PMID 24490479.
  5. Jensen HK, Brabrand M, Vinholt PJ, Hallas J, Lassen AT (January 2015). "Hypokalemia in acute medical patients: risk factors and prognosis". Am. J. Med. 128 (1): 60–7.e1. doi:10.1016/j.amjmed.2014.07.022. PMID 25107385.
  6. Lodin K, Palmér M (December 2015). "[Investigation of hypokalemia]". Lakartidningen (in Swedish). 112. PMID 26671430.
  7. Trefz FM, Lorch A, Zitzl J, Kutschke A, Knubben-Schweizer G, Lorenz I (2015). "Risk factors for the development of hypokalemia in neonatal diarrheic calves". J. Vet. Intern. Med. 29 (2): 688–95. doi:10.1111/jvim.12541. PMC 4895488. PMID 25818223.
  8. Alscher MD (October 2016). "["The silent killer: hyper- and hypokalaemia"]". Dtsch. Med. Wochenschr. (in German). 141 (21): 1531–1536. doi:10.1055/s-0042-109043. PMID 27750339.
  9. Vavruk AM, Martins C, Nascimento MM, Hayashi SY, Riella MC (2012). "[Association between hypokalemia, malnutrition and mortality in peritoneal dialysis patients]". J Bras Nefrol (in Portuguese). 34 (4): 349–54. PMID 23318823.
  10. Gennari FJ (August 1998). "Hypokalemia". N. Engl. J. Med. 339 (7): 451–8. doi:10.1056/NEJM199808133390707. PMID 9700180.

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