Hypokalemia differential diagnosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(10 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Hypokalemia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hypokalemia]]
{{CMG}}; {{AE}}{{EG}}
{{CMG}}; {{AE}}{{EG}}


== Overview ==
== Overview ==
[[Potassium]] is one of the [[intracellular]] [[cation]]. Any derangement of potassium serum levels can disturb the transmembrane [[potential]] and renders excitable cells ([[nerve]] and [[muscle]]) [[Hyperpolarization (biology)|hyperpolariz]]<nowiki/>ed and less excitable. However, [[Cardiac|cardiac cells]] don't obey this rule and become hyperexcitable.
[[Potassium]] is one of the [[intracellular]] [[cation]]. Any derangement of potassium serum levels can disturb the transmembrane [[potential]] and renders excitable cells ([[nerve]] and [[muscle]]) [[Hyperpolarization (biology)|hyperpolariz]]<nowiki/>ed and less excitable. However, [[Cardiac|cardiac cells]] don't obey this rule and become hyperexcitable. [[Potassium]] regulation is essential to maintain a normal activity in cells. Any imparment in potassium serum levels will have severe consequences on several organs especially the [[heart]] and the [[nervous system]].
 
[[Potassium]] regulation is essential to maintain a normal activity in cells. Any imparment in potassium serum levels will have severe consequences on several organs especially the [[heart]] and the [[nervous system]].
== Differentiating Causes of Hypokalemia ==
== Differentiating Causes of Hypokalemia ==


=== Differentiating the diseases that can cause hypokalemia is as following table: ===
=== Differentiating the diseases that can cause hypokalemia is as following table: ===
<small><small>
{| class="wikitable"
{| class="wikitable"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |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="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para−clinical findings
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
Line 21: Line 20:
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
|-
Line 32: Line 31:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |ABG
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |ABG
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transtubular potassium gradient
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urine Potassium:Creatinine
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
Line 42: Line 43:
! rowspan="7" style="background: #DCDCDC; text-align: center;" |[[Renal]] and [[adrenal disorders]]
! rowspan="7" style="background: #DCDCDC; text-align: center;" |[[Renal]] and [[adrenal disorders]]
! style="background: #DCDCDC; text-align: center;" |[[Loop diuretics|Loop 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;" |[[Loop diuretics|Loop 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>
!+/−
! +/−
!−
!−
!+
! +
!−
!−
!+/−
! +/−
!↓
!↓
!−
!−
!+
! +
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]]
!↑[[Potassium|K<sup>+</sup>]]
!↑[[Sodium|Na]]
! rowspan="7" |> 7
! rowspan="7" |>20mEq/g
!↑'''[[Sodium|Na<sup>+</sup>]]'''
!−
!−
!−
!−
Line 59: Line 62:
|-
|-
! 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>
! 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>
!+
! +
!−
!−
!+
! +
!−
!−
!+
! +
!↑
!↑
![[Facial flushing]]
![[Facial flushing]]
!−
!−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K<sup>+</sup>]], ↓'''[[Sodium|Na<sup>+</sup>]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↑'''[[Aldosterone|PAC]], ↓[[Sodium|Na]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↑'''[[Aldosterone|PAC]], ↓[[Sodium|Na<sup>+</sup>]]'''
!Unilateral [[adrenal hyperplasia]]
!Unilateral [[adrenal hyperplasia]]
!Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) 
!Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) 
Line 76: Line 79:
|-
|-
! 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>
! 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]]
![[Plethora|Facial plethora]], [[Striae|purple striae]]
!+
! +
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Glucosuria]]
![[Glucosuria]]
Line 93: Line 96:
|-
|-
! 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>
! 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 103: Line 106:
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!Normal
!Normal
!↓[[Sodium|Na]]
!↓'''[[Sodium|Na<sup>+</sup>]]'''
!−
!−
!−
!−
Line 110: Line 113:
|-
|-
! 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>
! 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 ↓
!Normal or ↓
!−
!−
!−
!−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↑[[Ca]], ↑[[Chloride|Cl]]
!↑[[Potassium|K<sup>+</sup>]], ↑[[Ca|Ca<sup>+2</sup>]], ↑[[Chloride|Cl<sup>-</sup>]]
!−
!−
!−
!−
Line 127: Line 130:
|-
|-
! 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>
! 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>
!+
! +
!−
!−
!+
! +
!−
!−
!+
! +
!Normal  
!Normal  
!−
!−
!−
!−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Ca]], ↑[[Chloride|Cl]]
!↑[[Potassium|K<sup>+</sup>]], ↓[[Ca|Ca<sup>+2</sup>]], ↑[[Chloride|Cl<sup>-</sup>]]
!−
!−
!−
!−
!−
!−
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Growth retardation]], [[tetany]], [[muscle cramp]]
![[Growth retardation]], [[tetany]], [[muscle cramp]]
|-
|-
Line 146: Line 149:
!−
!−
!−
!−
!+/−
! +/−
!−
!−
!−
!−
!↑
!↑
!−
!−
!+/−
! +/−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K<sup>+</sup>]], ↓'''[[Sodium|Na<sup>+</sup>]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!−
!−
!−
!−
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Pseudohyperaldosteronism]]
![[Pseudohyperaldosteronism]]
|-
|-
! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal disorders]]
! rowspan="5" style="background: #DCDCDC; text-align: center;" |[[Gastrointestinal disorders]]
! 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>
! 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 172: Line 175:
!Normal
!Normal
!Normal
!Normal
! rowspan="16" |< 3
! rowspan="16" |< 20 mEq/g
![[Anemia]]
![[Anemia]]
!−
!−
!−
!−
!Clinical findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Orthostatic hypotension]], [[bradycardia]]
![[Orthostatic hypotension]], [[bradycardia]]
|-
|-
! 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>
! 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 188: Line 193:
!−
!−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Chloride|Cl]] <20 mEq/L
![[Chloride|Cl<sup>-</sup>]] <20 mEq/L
!−
!−
!−
!−
!−
!−
!Clinical findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
!Dry [[mucous membranes]], [[lethargy]]
!Dry [[mucous membranes]], [[lethargy]]
|-
|-
! 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>
! 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 205: Line 210:
!−
!−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Potassium|K]]<20 mEq/L
![[Potassium|K<sup>+</sup>]]<20 mEq/L
!−
!−
!−
!−
!−
!−
!Clinical findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
!Dry [[mucous membranes]], [[lethargy]]
!Dry [[mucous membranes]], [[lethargy]]
|-
|-
! 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>
! 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 222: Line 227:
!−
!−
!Normal
!Normal
![[Potassium|K]] and [[Chloride|Cl]] <20 mEq/L
![[Potassium|K<sup>+</sup>]] and [[Chloride|Cl<sup>-</sup>]] <20 mEq/L
![[Anemia]]
![[Anemia]]
!−
!−
Line 230: Line 235:
|-
|-
! 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>
! 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>
!+
! +
!+/−
! +/−
!−
!−
!+
! +
!−
!−
!↓
!↓
![[Facial flushing]], [[skin rash]]
![[Facial flushing]], [[skin rash]]
!+
! +
!Normal
!Normal
![[Potassium|K]]<20 mEq/L
![[Potassium|K<sup>+</sup>]]<20 mEq/L
!'''[[Osmolarity|Stool osmolar gap]] '''<50 mOsm/kg
!'''[[Osmolarity|Stool osmolar gap]] '''<50 mOsm/kg
!'''[[Endoscopic ultrasound]] for''' [[VIPoma|VIPomas]] of 2−3 mm
!'''[[Endoscopic ultrasound]] for''' [[VIPoma|VIPomas]] of 2−3 mm
![[Pancreatic]] [[VIPoma|VIPomas]] >3 cm
![[Pancreatic]] [[VIPoma|VIPomas]] >3 cm
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Weight loss]]
![[Weight loss]]
|-
|-
Line 250: Line 255:
!−
!−
!−
!−
!+
! +
!−
!−
!+
! +
!Normal
!Normal
!−
!−
!+/−
! +/−
!Normal
!Normal
!↓[[Osmolarity|Urine osmolarity]]
!↓[[Osmolarity|Urine osmolarity]]
!↓[[Sodium|Na]]
!↓'''[[Sodium|Na<sup>+</sup>]]'''
!−
!−
!−
!−
Line 265: Line 270:
|-
|-
! 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>
! 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>
!+
! +
!−
!−
!+
! +
!−
!−
!+
! +
!Normal or ↓
!Normal or ↓
!−
!−
Line 275: Line 280:
!Normal
!Normal
!↓[[Osmolarity|Urine osmolarity]]
!↓[[Osmolarity|Urine osmolarity]]
!↑[[Sodium|Na]]
!↑'''[[Sodium|Na<sup>+</sup>]]'''
!−
!−
!−
!−
Line 285: Line 290:
!−
!−
!−
!−
!+/−
! +/−
!−
!−
!Normal or ↓
!Normal or ↓
Line 291: Line 296:
!−
!−
!Normal
!Normal
!↑[[Potassium|K]], ↓[[Chloride|Cl]]
!↑[[Potassium|K<sup>+</sup>]], ↓[[Chloride|Cl<sup>-</sup>]]
!−
!−
!−
!−
Line 299: Line 304:
|-
|-
! 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>
! 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 308: Line 313:
!−
!−
!Normal
!Normal
!↑[[Potassium|K]], ↓[[Chloride|Cl]]
!↑[[Potassium|K<sup>+</sup>]], ↓[[Chloride|Cl<sup>-</sup>]]
!−
!−
!−
!−
Line 316: Line 321:
|-
|-
! 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>
! 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 or ↓
!Normal or ↓
!−
!−
!+/−
! +/−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Potassium|K]]<20 mEq/L
![[Potassium|K<sup>+</sup>]]<20 mEq/L
![[Thyrotoxicosis]], ↓[[Magnesium|Mg]], ↓[[Phosphor|Ph]]
![[Thyrotoxicosis]], ↓[[Magnesium|Mg<sup>+</sup>]], ↓PO<sub>4</sub><sup>-3</sup>
!−
!−
!−
!−
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Paralysis|Paralytic episodes]], [[arrhythmias]]
![[Paralysis|Paralytic episodes]], [[arrhythmias]]
|-
|-
Line 337: Line 342:
!−
!−
!−
!−
!+/−
! +/−
!−
!−
!Normal
!Normal
Line 351: Line 356:
|-
|-
! 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>
! 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>
!+
! +
!+/−
! +/−
!+
! +
!−
!−
!+
! +
!Normal or ↓
!Normal or ↓
![[Icterus]], [[caput medusae]]
![[Icterus]], [[caput medusae]]
!+
! +
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
![[Ketonuria]]
![[Ketonuria]]
Line 368: Line 373:
|-
|-
! 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>
! 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>
!+
! +
!+/−
! +/−
!+
! +
!−
!−
!+
! +
!↓
!↓
![[Xerosis]]
![[Xerosis]]
Line 381: Line 386:
!−
!−
!−
!−
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
!Dry [[mucous membranes]], [[shock]]
!Dry [[mucous membranes]], [[shock]]
|-
|-
! 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>
! 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>
!+
! +
!−
!−
!−
!−
!+/−
! +/−
!−
!−
!Normal
!Normal
!−
!−
!+/−
! +/−
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!−
!−
!↓[[Calcium|Ca]]
!↓[[Calcium|Ca<sup>+2</sup>]]
!−
!−
!−
!−
!Laboratory findings
![[Bartter syndrome laboratory findings|Laboratory findings]]
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]]
![[Trousseau's sign|Trousseau]] and [[Chvostek's Sign|Chvostek signs]]
|-
|-
! 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>
! 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>
!+/−
! +/−
!−
!−
!−
!−
!+
! +
!−
!−
!↓
!↓
![[Vesicle]] and bullae, [[erythema]]
![[Vesicle]] and bullae, [[erythema]]
!+
! +
!Normal
!Normal
!−
!−
Line 419: Line 424:
|-
|-
! 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>
! 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>
!+/−
! +/−
!+/−
! +/−
!−
!−
!+/−
! +/−
!−
!−
!↓
!↓
![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]]
![[Aquagenic wrinkling of the palms|Early aquagenic '''skin''' wrinkling]]
!+/−
! +/−
!Normal
!Normal
!−
!−
!−
!−
![[Pancreatitis]]
! -
![[Pulmonary]] infiltration
![[Pulmonary]] infiltration
!'''[[Sweat chloride test]]'''
!'''[[Sweat chloride test]]'''
![[Pancreatic insufficiency]]
![[Pancreatic insufficiency]]
|}
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 22:47, 14 February 2019

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

Overview

Potassium is one of the intracellular cation. Any derangement of potassium serum levels can disturb the transmembrane potential and renders excitable cells (nerve and muscle) hyperpolarized and less excitable. However, cardiac cells don't obey this rule and become hyperexcitable. Potassium regulation is essential to maintain a normal activity in cells. Any imparment in potassium serum levels will have severe consequences on several organs especially the heart and the nervous system.

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 Transtubular potassium gradient Urine Potassium:Creatinine Other Ultrasonography CT scan
Polyuria Oliguria Nocturia
Renal and adrenal disorders Loop diuretic use[1] +/− + +/− + Metabolic alkalosis K+ > 7 >20mEq/g Na+ History of medication use
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+2, ↑Cl- Laboratory findings Mental retardation, sensorineural hearing loss
Gitelman syndrome[6] + + + Normal Metabolic alkalosis K+, ↓Ca+2, ↑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 < 3 < 20 mEq/g Anemia Laboratory findings Orthostatic hypotension, bradycardia
Vomiting[9] + + Metabolic alkalosis Cl- <20 mEq/L Laboratory findings Dry mucous membranes, lethargy
Severe diarrhea[10] + + Metabolic alkalosis K+<20 mEq/L Laboratory 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+, ↓PO4-3 Laboratory findings Paralytic episodes, arrhythmias
Systemic diseases Hypothermia[18] +/− Normal Frostbite Normal Normal Clinical findings Impaired mental state
Alcoholism[19] + +/− + + Normal or ↓ Icterus, caput medusae + 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+2 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 - 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.


Template:WH Template:WS