Hypokalemia: a Clinical Update

Overview

Journal Endocr Connect

Specialty Endocrinology

Date 2018 Mar 16

PMID 29540487

Citations 99

Authors

Efstratios Kardalas

Stavroula A Paschou

Panagiotis Anagnostis

Giovanna Muscogiuri

Gerasimos Siasos

Andromachi Vryonidou

Affiliations

Soon will be listed here.

Abstract

Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalemia requires urgent medical attention. The aim of this review is to present updated information regarding: (1) the definition and prevalence of hypokalemia, (2) the physiology of potassium homeostasis, (3) the various causes leading to hypokalemia, (4) the diagnostic steps for the assessment of hypokalemia and (5) the appropriate treatment of hypokalemia depending on the cause. Practical algorithms for the optimal diagnostic, treatment and follow-up strategy are presented, while an individualized approach is emphasized.

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References

Kamel K, Schreiber M, Halperin M . Renal potassium physiology: integration of the renal response to dietary potassium depletion. Kidney Int. 2017; 93(1):41-53. DOI: 10.1016/j.kint.2017.08.018. View

Groeneveld J, Sijpkens Y, Lin S, Davids M, Halperin M . An approach to the patient with severe hypokalaemia: the potassium quiz. QJM. 2005; 98(4):305-16. DOI: 10.1093/qjmed/hci046. View

Seyberth H, Weber S, Komhoff M . Bartter's and Gitelman's syndrome. Curr Opin Pediatr. 2016; 29(2):179-186. DOI: 10.1097/MOP.0000000000000447. View

Nguyen M, Yang L, Fletcher N, Lee D, Kocinsky H, Bachmann S . Effects of K+-deficient diets with and without NaCl supplementation on Na+, K+, and H2O transporters' abundance along the nephron. Am J Physiol Renal Physiol. 2012; 303(1):F92-104. PMC: 3431149. DOI: 10.1152/ajprenal.00032.2012. View

Wang W, Giebisch G . Regulation of potassium (K) handling in the renal collecting duct. Pflugers Arch. 2008; 458(1):157-68. PMC: 2730119. DOI: 10.1007/s00424-008-0593-3. View

Gumz M, Lynch I, Greenlee M, Cain B, Wingo C . The renal H+-K+-ATPases: physiology, regulation, and structure. Am J Physiol Renal Physiol. 2009; 298(1):F12-21. PMC: 2806118. DOI: 10.1152/ajprenal.90723.2008. View

Udensi U, Tchounwou P . Potassium Homeostasis, Oxidative Stress, and Human Disease. Int J Clin Exp Physiol. 2017; 4(3):111-122. PMC: 5716641. DOI: 10.4103/ijcep.ijcep_43_17. View

Wu K, Cheng C, Sung C, Tseng M, Hsu Y, Yang S . Identification of the Causes for Chronic Hypokalemia: Importance of Urinary Sodium and Chloride Excretion. Am J Med. 2017; 130(7):846-855. DOI: 10.1016/j.amjmed.2017.01.023. View

Seys E, Andrini O, Keck M, Mansour-Hendili L, Courand P, Simian C . Clinical and Genetic Spectrum of Bartter Syndrome Type 3. J Am Soc Nephrol. 2017; 28(8):2540-2552. PMC: 5533235. DOI: 10.1681/ASN.2016101057. View

10.

Proesmans W . Threading through the mizmaze of Bartter syndrome. Pediatr Nephrol. 2006; 21(7):896-902. DOI: 10.1007/s00467-006-0113-7. View

11.

Molin C, Trevisol D . Persistent severe hypokalemia: Gitelman syndrome and differential diagnosis. J Bras Nefrol. 2017; 39(3):337-340. DOI: 10.5935/0101-2800.20170058. View

12.

Marti G, Schwarz C, Leichtle A, Fiedler G, Arampatzis S, Exadaktylos A . Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med. 2013; 21(1):46-51. DOI: 10.1097/MEJ.0b013e3283643801. View

13.

Filippatos T, Rizos C, Tzavella E, Elisaf M . Gitelman syndrome: an analysis of the underlying pathophysiologic mechanisms of acid-base and electrolyte abnormalities. Int Urol Nephrol. 2017; 50(1):91-96. DOI: 10.1007/s11255-017-1653-4. View

14.

Wang L, Yang K, Jiang X, Wu H, Zhang H, Zou Y . Prevalence of Liddle Syndrome Among Young Hypertension Patients of Undetermined Cause in a Chinese Population. J Clin Hypertens (Greenwich). 2015; 17(11):902-7. PMC: 8031848. DOI: 10.1111/jch.12598. View

15.

Hassan-Smith Z, Stewart P . Inherited forms of mineralocorticoid hypertension. Curr Opin Endocrinol Diabetes Obes. 2011; 18(3):177-85. DOI: 10.1097/MED.0b013e3283469444. View

16.

Elsayes K, Emad-Eldin S, Morani A, Jensen C . Practical Approach to Adrenal Imaging. Radiol Clin North Am. 2017; 55(2):279-301. DOI: 10.1016/j.rcl.2016.10.005. View

17.

Kovesdy C, Appel L, Grams M, Gutekunst L, McCullough P, Palmer B . Potassium homeostasis in health and disease: A scientific workshop cosponsored by the National Kidney Foundation and the American Society of Hypertension. J Am Soc Hypertens. 2017; 11(12):783-800. DOI: 10.1016/j.jash.2017.09.011. View

18.

Seifter J, Chang H . Disorders of Acid-Base Balance: New Perspectives. Kidney Dis (Basel). 2017; 2(4):170-186. PMC: 5260542. DOI: 10.1159/000453028. View

19.

Alfonzo A, Isles C, Geddes C, Deighan C . Potassium disorders--clinical spectrum and emergency management. Resuscitation. 2006; 70(1):10-25. DOI: 10.1016/j.resuscitation.2005.11.002. View

20.

El-Maouche D, Arlt W, Merke D . Congenital adrenal hyperplasia. Lancet. 2017; 390(10108):2194-2210. DOI: 10.1016/S0140-6736(17)31431-9. View