Hypokalemia differential diagnosis: Difference between revisions

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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="5" |Diseases
! colspan="2" rowspan="5" |Diseases
! colspan="9" 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="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="6" 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
|-
|-
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="4" 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="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
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! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin lesions
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin lesions
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Edema
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Edema
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! 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;" |Electrolytes
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
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! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Polyuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Polyuria
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!+/-
!+/-
!Normal or ↓
!Normal or ↓
!-
!-
!-
!-
!-
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!Normal  
!Normal  
!
!
!-
!
!
![[Mental retardation]], [[Sensorineural hearing loss]]
![[Mental retardation]], [[Sensorineural hearing loss]]
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!+
!+
!Normal  
!Normal  
!-
!-
!-
!-
!-
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!Normal  
!Normal  
!
!
!-
!
!
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
![[Growth retardation]], [[Tetany]], [[Muscle cramps|Muscle cramp]]
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!-
!-
!+/-
!+/-
!
![[Metabolic alkalosis]]
![[Metabolic alkalosis]]
!↓[[Potassium|K]]
!↓[[Potassium|K]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!↓'''[[Plasma renin activity|Plasma renin activity (PRA)]]''', ↓'''[[Aldosterone|Plasma aldosterone concentration (PAC)]]'''
!↓'''[[Plasma renin activity|PRA]]''', ↓'''[[Aldosterone|PAC]]'''
!
!
!
!
!-
!
!
![[Pseudohyperaldosteronism]]
![[Pseudohyperaldosteronism]]
|-
|-
![[Diuretic use]]
![[Diuretic use]]
!
!+/-
!
!-
!
!+
!
!-
!
!+/-
!
!↓
!
!-
!
!+
!
![[Metabolic alkalosis]]
!
!↓[[Potassium|K]], ↑[[Sodium|Na]]
!
!↑[[Potassium|K]]
!
!-
!
!Normal
!
!Normal
!
!History
!
!-
!
!
|-
|-
![[Hemodialysis]]
![[Hemodialysis]]
!
!+/-
!
!+/-
!
!+/-
!
!-
!
!-
!
!Normal
!
![[Pustular rash|Pustular lesions]]
!
!-
!
![[Metabolic alkalosis]]
!
!↓[[Potassium|K]], ↓[[Sodium|Na]]
!
!Normal
!
!-
!
!Normal
!
!Normal
!
!History
!
![[Carpal tunnel syndrome]]
!
!
|-
|-
![[Primary hyperaldosteronism]]
![[Primary hyperaldosteronism]]
!
!+
!
!-
!
!+
!
!-
!
!+
!
!↑
!
![[Facial flushing]]
!
!-
!
![[Metabolic alkalosis]]
!
!↓[[Potassium|K]], ↑[[Sodium|Na]]
!
!↑[[Potassium|K]], ↓[[Sodium|Na]]
!
!↓'''[[Plasma renin activity|PRA]]''', ↑'''[[Aldosterone|PAC]]'''
!
!Unilateral [[adrenal hyperplasia]]
!
!Hypodense unilateral [[Adrenal Mass|adrenal macroadenoma]] (>1 cm) 
!
!'''[[Aldosterone|PAC]]:[[Plasma renin activity|PRA]] ratio'''
!
![[Mood disturbances|Mood disturbance]], [[Paresthesia]], [[Muscle cramps]]
!
!
|-
|-
![[Cushing syndrome]]
![[Cushing syndrome]]
!
!
!
!
!
!
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! rowspan="5" |[[Gastrointestinal disorders]]
! rowspan="5" |[[Gastrointestinal disorders]]
![[Gastrointestinal bleeding|GI bleeding]]
![[Gastrointestinal bleeding|GI bleeding]]
!
!
!
!
!
!
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|-
|-
![[Vomiting]]
![[Vomiting]]
!
!
!
!
!
!
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|-
|-
!Severe [[diarrhea]]
!Severe [[diarrhea]]
!
!
!
!
!
!
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|-
|-
![[Villous adenoma]]
![[Villous adenoma]]
!
!
!
!
!
!
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|-
|-
![[VIPoma]]
![[VIPoma]]
!
!
!
!
!
!
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! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
! rowspan="5" |[[Neuropsychiatric|Neuropsychiatric disorders]]
![[Hypokalemic periodic paralysis]]
![[Hypokalemic periodic paralysis]]
!
!
!
!
!
!
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|-
|-
![[Central diabetes insipidus]]
![[Central diabetes insipidus]]
!
!
!
!
!
!
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|-
|-
![[Bulimia nervosa]]
![[Bulimia nervosa]]
!
!
!
!
!
!
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|-
|-
![[Anorexia nervosa]]
![[Anorexia nervosa]]
!
!
!
!
!
!
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|-
|-
![[Polydipsia|Primary polydipsia]]
![[Polydipsia|Primary polydipsia]]
!
!
!
!
!
!
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! rowspan="7" |[[Systemic diseases]]
! rowspan="7" |[[Systemic diseases]]
![[Hypothermia]]
![[Hypothermia]]
!
!
!
!
!
!
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|-
|-
![[Alcoholism]]
![[Alcoholism]]
!
!
!
!
!
!
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|-
|-
![[Diabetic ketoacidosis]]
![[Diabetic ketoacidosis]]
!
!
!
!
!
!
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|-
|-
![[Hypothermia]]
![[Hypothermia]]
!
!
!
!
!
!
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|-
|-
![[Hypomagnesemia]]
![[Hypomagnesemia]]
!
!
!
!
!
!
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|-
|-
![[Burns]]
![[Burns]]
!
!
!
!
!
!
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|-
|-
![[Cystic fibrosis]]
![[Cystic fibrosis]]
!
!
!
!
!
!

Revision as of 15:47, 18 May 2018

Hypokalemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Causes of Hypokalemia

Differentiating the diseases that can cause hypokalemia is as following:

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 Electrolytes Urinalysis Other Ultrasonography CT scan
Polyuria Oliguria Nocturia
Renal and adrenal disorders Bartter syndrome + - + - +/- Normal or ↓ - - Metabolic alkalosis ↓K ↑K, ↑Ca, ↑Cl - Normal Mental retardation, Sensorineural hearing loss
Gitelman syndrome + - + - + Normal - - Metabolic alkalosis ↓K ↑K, ↓Ca, ↑Cl - Normal Growth retardation, Tetany, Muscle cramp
Liddle syndrome - - +/- - - ↑ - +/- Metabolic alkalosis ↓K ↑K, ↓Na ↓PRA, ↓PAC Pseudohyperaldosteronism
Diuretic use +/- - + - +/- ↓ - + Metabolic alkalosis ↓K, ↑Na ↑K - Normal Normal History -
Hemodialysis +/- +/- +/- - - Normal Pustular lesions - Metabolic alkalosis ↓K, ↓Na Normal - Normal Normal History Carpal tunnel syndrome
Primary hyperaldosteronism + - + - + ↑ Facial flushing - Metabolic alkalosis ↓K, ↑Na ↑K, ↓Na ↓PRA, ↑PAC Unilateral adrenal hyperplasia Hypodense unilateral adrenal macroadenoma (>1 cm)  PAC:PRA ratio Mood disturbance, Paresthesia, Muscle cramps
Cushing syndrome
Gastrointestinal disorders GI bleeding
Vomiting
Severe diarrhea
Villous adenoma
VIPoma
Neuropsychiatric disorders Hypokalemic periodic paralysis
Central diabetes insipidus
Bulimia nervosa
Anorexia nervosa
Primary polydipsia
Systemic diseases Hypothermia
Alcoholism
Diabetic ketoacidosis
Hypothermia
Hypomagnesemia
Burns
Cystic fibrosis

References


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