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