Hypokalemia differential diagnosis

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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:

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 + - + - +/- Normal or ↓ - - Metabolic alkalosis K, ↑Ca, ↑Cl - Normal Mental retardation, Sensorineural hearing loss
Gitelman syndrome + - + - + Normal - - Metabolic alkalosis K, ↓Ca, ↑Cl - Normal Growth retardation, Tetany, Muscle cramp
Liddle syndrome - - +/- - - - +/- Metabolic alkalosis K, ↓Na PRA, ↓PAC Pseudohyperaldosteronism
Diuretic use +/- - + - +/- - + Metabolic alkalosis K Na Normal Normal History -
Hemodialysis +/- +/- +/- - - Normal Pustular lesions - Metabolic alkalosis Normal Na Normal Normal History Carpal tunnel syndrome
Primary hyperaldosteronism + - + - + 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 + +/- +/- - - 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 + - - + -
Vomiting + - - + -
Severe diarrhea + - - + -
Villous adenoma + - - + -
VIPoma + +/- - + -
Neuropsychiatric disorders Hypokalemic periodic paralysis + - - - +/- Normal or ↓
Central diabetes insipidus + - + - + Normal or ↓
Bulimia nervosa - - - +/- - Normal or ↓
Anorexia nervosa + - - +/- -
Primary polydipsia - - + - + Normal
Systemic diseases Hypothermia - - - +/- - Normal
Alcoholism + +/- + - + Normal or ↓
Diabetic ketoacidosis + +/- + - +
Hypomagnesemia + - - +/- - Normal
Burns +/- - - + -
Cystic fibrosis +/- +/- - +/- -

References


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