Algorithm for patients with hypokalemia on the basis of the potassium-to-creatinine ratio in the urine Urine K+ <13 mEq K+/g creatinine (<2.5 mEq K+/mmol creatinine) • Cell shift: Hypokalemic periodic paralysis, Administration of inulin, B2-adrenergic stimulation • Gastrointestinal loss: Diarrhea Urine K+ >13 mEq K+/g creatinine (>2.5 mEq K+/mmol creatinine) High effective arterial blood volume • ↑ Renin, ↑ Aldosterone: Kidney artery stenosis, Renin secreting tumor • ↓ Renin, ↑ Aldosterone: Adrenal adenoma, Bilateral cortical hyperplasia, Glucocorticoid suppressible hyperaldosteronism • ↓ Renin, ↓ Aldosterone: Cushing syndrome, 11beta-hydroxylase deficiency, 17alpha-hydroxylase deficiency, Syndrome of apparent mineralocorticoid excess, Liddle syndrome Low-normal EABV, Low Plasma HCO3-: • Proximal RTA • Distal RTA Low-normal EABV, High Plasma HCO3- • Low Urine Cl - Non-reabsorbable anion effect: Vomiting, Ticarcillin, carbenicillin, piperacillin • High Urine Cl - Loop diuretics, Thiazide diuretics, Mg2+ deficiency, Bartter syndrome, Gitelman syndrome #hypokalemia #urine #potassium #differential #algorithm #diagnosis #nephrology
