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Hypokalemia

Etiology

Most common causes:

  • Decreased intake: Deficient diet in alcoholics and elderly; anorexia nervosa
  • GI loss: Vomiting, diarrhea, nasogastric tubes, laxative abuse, fistulas, villous adenoma, ureterosigmoidostomy, malabsorption, chemotherapy, radiation enteropathy, bulimia
  • Intracellular shift of potassium: Metabolic alkalosis, insulin excess, β-adrenergic catecholamine excess (acute stress, B2 agonists [2]), hypokalemic periodic paralysis, intoxications (theophylline, caffeine, barium, toluene)
  • Renal potassium loss:
    • Drugs: Diuretics (especially loop and thiazides), amphotericin B, aminoglycosides (3,4,5)
    • Mineralocorticoid-excess states: Primary hyperaldosteronism; secondary hyperaldosteronism (congestive heart failure [CHF], cirrhosis, nephrotic syndrome, malignant hypertension, renin-producing tumors); renovascular hypertension; Bartter syndrome; Gitelman syndrome; congenital adrenogenital syndromes; exogenous mineralocorticoids (glycyrrhizic acid in licorice, carbenoxolone, steroids in nasal sprays); Liddle syndrome; vasculitis
  • Glucocorticoid-excess states: Cushing syndrome, exogenous steroids, ectopic adrenocorticotrophic hormone (ACTH) production, II B hydroxysteroid dehydrogenase deficiency.
  • Renal tubular acidosis (type I and II):
    • Leukemia
    • Magnesium depletion
    • Thyrotoxic hypokalemic paralysis
  • Osmotic diuresis (e.g., poorly controlled diabetes)

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