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Symptoms and Signs – Differential Diagnosis of hypokalemia
• β-Adrenergic agonists (e.g., terbutaline), decongestants, bronchodilators, theophylline, caffeine
• Vitamin B12 therapy for megaloblastic anemias, acute leukemias
• Renal tubular acidosis (RTA): distal (type 1) or proximal (type 2)
• Postobstruction diuresis, diuretic phase of tyrosinase-negative oculocutaneous albinism (ATN)
• Osmotic diuresis (e.g., mannitol)
• Magnesium deficiency
• Insulin administration
• Increased renal excretion secondary to medications: diuretics, including carbonic anhydrase inhibitors (e.g., acetazolamide); amphotericin B; high-dose sodium penicillin, nafcillin, ampicillin, or carbenicillin; cisplatin; aminoglycosides, corticosteroids, mineralocorticoids, foscarnet sodium
• Increased mineralocorticoid activity (primary or secondary aldosteronism), Cushing’s syndrome
• Inadequate dietary intake (e.g., anorexia nervosa)
• Hypokalemic periodic paralysis: rare familial disorder manifested by recurrent attacks of flaccid paralysis and hypokalemia
• High dietary sodium intake, excessive use of licorice
• GI loss: vomiting, nasogastric suction, diarrhea, laxative abuse, villous adenoma, fistulas
• Diabetic ketoacidosis (DKA), ureteroenterostomy
• Cutaneous loss (excessive sweating)
• Correction of digoxin intoxication with digoxin antibody fragments (Digibind)
• Chronic metabolic alkalosis from loss of gastric fluid (increased renal potassium secretion)
• Cellular shift (redistribution) and undetermined mechanisms
• Bartter’s syndrome: hyperplasia of juxtaglomerular cells leading to increased renin and aldosterone, metabolic alkalosis, hypokalemia, muscle weakness, and tetany (seen in young adults)
• Barium poisoning, toluene intoxication, verapamil intoxication, chloroquine intoxication
• Alkalosis (each 0.1 increase in pH decreases serum potassium by 0.4 to 0.6 mEq/L)
• β-Adrenergic agonists (e.g., terbutaline), decongestants, bronchodilators, theophylline, caffeine
• Vitamin B12 therapy for megaloblastic anemias, acute leukemias
• Renal tubular acidosis (RTA): distal (type 1) or proximal (type 2)
• Postobstruction diuresis, diuretic phase of tyrosinase-negative oculocutaneous albinism (ATN)
• Osmotic diuresis (e.g., mannitol)
• Magnesium deficiency
• Insulin administration
• Increased renal excretion secondary to medications: diuretics, including carbonic anhydrase inhibitors (e.g., acetazolamide); amphotericin B; high-dose sodium penicillin, nafcillin, ampicillin, or carbenicillin; cisplatin; aminoglycosides, corticosteroids, mineralocorticoids, foscarnet sodium
• Increased mineralocorticoid activity (primary or secondary aldosteronism), Cushing’s syndrome
• Inadequate dietary intake (e.g., anorexia nervosa)
• Hypokalemic periodic paralysis: rare familial disorder manifested by recurrent attacks of flaccid paralysis and hypokalemia
• High dietary sodium intake, excessive use of licorice
• GI loss: vomiting, nasogastric suction, diarrhea, laxative abuse, villous adenoma, fistulas
• Diabetic ketoacidosis (DKA), ureteroenterostomy
• Cutaneous loss (excessive sweating)
• Correction of digoxin intoxication with digoxin antibody fragments (Digibind)
• Chronic metabolic alkalosis from loss of gastric fluid (increased renal potassium secretion)
• Cellular shift (redistribution) and undetermined mechanisms
• Bartter’s syndrome: hyperplasia of juxtaglomerular cells leading to increased renin and aldosterone, metabolic alkalosis, hypokalemia, muscle weakness, and tetany (seen in young adults)
• Barium poisoning, toluene intoxication, verapamil intoxication, chloroquine intoxication
• Alkalosis (each 0.1 increase in pH decreases serum potassium by 0.4 to 0.6 mEq/L)
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