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Hypokalemia due to Renal Potassium Loss

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1. Hypokalemia due to Renal Potassium Loss

Hypokalemia due to Renal Potassium Loss Hypokalemia due to Renal Potassium Loss Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Hypokalemia due to Renal Potassium Loss Hypokalemia due to Renal Potassium Loss Aka: Hypokalemia due to Renal Potassium Loss , Renal Potassium Loss , Hyperkaluria From Related Chapters II. Definition with > 20 meq/day III. Causes: Blood Pressure Elevated and Hypokalemia Elevated Renovascular disease secreting tumor Normal Liddle's Syndrome Low Aldosterone High Primary Bilateral adrenal hyperplasia suppression Aldosterone Low Mineralocorticoid ingestion Ectopic ACTH chewing Licorice IV. Causes: Blood

2018 FP Notebook

2. Hypokalemia due to Extrarenal Potassium Loss

Administration 4 Hypokalemia due to Extrarenal Potassium Loss Hypokalemia due to Extrarenal Potassium Loss Aka: Hypokalemia due to Extrarenal Potassium Loss , Extrarenal Potassium Loss , Hypokalemia with Excessive Renal Losses From Related Chapters II. Definition with < 20 meq/day III. Causes: Normal Acid-Base Status and Hypokalemia s High dose Intracellular is not reflected by level Consider empiric in refractory Constant GI loss and inadequate intake (<10-20 meq/day) Skin losses from sweating IV. Causes (...) Hypokalemia due to Extrarenal Potassium Loss Hypokalemia due to Extrarenal Potassium Loss Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2018 FP Notebook

3. Hypokalemia due to Renal Potassium Loss

Hypokalemia due to Renal Potassium Loss Hypokalemia due to Renal Potassium Loss Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Hypokalemia due to Renal Potassium Loss Hypokalemia due to Renal Potassium Loss Aka: Hypokalemia due to Renal Potassium Loss , Renal Potassium Loss , Hyperkaluria From Related Chapters II. Definition with > 20 meq/day III. Causes: Blood Pressure Elevated and Hypokalemia Elevated Renovascular disease secreting tumor Normal Liddle's Syndrome Low Aldosterone High Primary Bilateral adrenal hyperplasia suppression Aldosterone Low Mineralocorticoid ingestion Ectopic ACTH chewing Licorice IV. Causes: Blood

2015 FP Notebook

4. Hypokalemia due to Extrarenal Potassium Loss

Administration 4 Hypokalemia due to Extrarenal Potassium Loss Hypokalemia due to Extrarenal Potassium Loss Aka: Hypokalemia due to Extrarenal Potassium Loss , Extrarenal Potassium Loss , Hypokalemia with Excessive Renal Losses From Related Chapters II. Definition with < 20 meq/day III. Causes: Normal Acid-Base Status and Hypokalemia s High dose Intracellular is not reflected by level Consider empiric in refractory Constant GI loss and inadequate intake (<10-20 meq/day) Skin losses from sweating IV. Causes (...) Hypokalemia due to Extrarenal Potassium Loss Hypokalemia due to Extrarenal Potassium Loss Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2015 FP Notebook

5. STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

of hypokalemia consists of minimizing further potassium loss and providing potassium replacement. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 mEq/L). Gradual correction of hypokalemia is preferable to rapid correction unless the patient is clinically unstable. "Administration of potassium may be empirical in emergent conditions. When indicated, the maximum amount of IV potassium replacement should be 10 to 20 mEq/h (...) and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694) The Journal of Clinical Pharmacology. pages 1077–1082 , November 1994 Although concentrated infusions of potassium chloride commonly are used to treat hypokalemia in intensive care unit patients, few studies have examined their effects on plasma potassium levels. Forty patients with hypokalemia were given infusions of 20 mmol

2016 Dr Smith's ECG Blog

6. Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Risks

No. 18-EHC009-EF June 2018ii Key Messages Purpose of Review To synthesize the evidence regarding the effects of dietary sodium reduction and increased potassium intake on blood pressure and risk for cardiovascular diseases (CVD) and renal disease outcomes and related risk factors. Key Messages • Decreasing dietary sodium intake most likely reduces blood pressure in normotensive adults and more so in those with hypertension. • Higher sodium intake may be associated with greater risk for developing (...) on cardiovascular and renal disease outcomes and related risk factors, as well as evidence from prospective cohort studies on the associations between sodium, potassium, or sodium to potassium ratio and these outcomes. The purpose of the review is to provide a future Dietary Reference Intakes (DRI) Committee with the evidence on chronic disease endpoints for consideration in reviewing the DRIs for sodium and potassium. Data sources. PubMed ® , Embase ® , the Cochrane Database of Systematic Reviews, Cochrane

2018 Effective Health Care Program (AHRQ)

7. Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks

-EHC009-EF June 2018ii Key Messages Purpose of Review To synthesize the evidence regarding the effects of dietary sodium reduction and increased potassium intake on blood pressure and risk for cardiovascular diseases (CVD) and renal disease outcomes and related risk factors. Key Messages • Decreasing dietary sodium intake most likely reduces blood pressure in normotensive adults and more so in those with hypertension. • Higher sodium intake may be associated with greater risk for developing (...) on cardiovascular and renal disease outcomes and related risk factors, as well as evidence from prospective cohort studies on the associations between sodium, potassium, or sodium to potassium ratio and these outcomes. The purpose of the review is to provide a future Dietary Reference Intakes (DRI) Committee with the evidence on chronic disease endpoints for consideration in reviewing the DRIs for sodium and potassium. Data sources. PubMed ® , Embase ® , the Cochrane Database of Systematic Reviews, Cochrane

2018 Effective Health Care Program (AHRQ)

8. Is Potassium Supplementation Beneficial in Hospitalized Patients?

also be caused by intracellular redistribution of potassium due to insulin or beta-adrenergic agonists. Gastrointestinal and non-diuretic renal losses are additional mechanisms of hypokalemia. Hypokalemia is usually asymptomatic above levels of 3.0 mEq/L, and may be tolerated at or below this level in individuals with chronic hypokalemia. However, there is an increased risk of generalized weakness and constipation at levels between 2.5 and 3.0 mEq/L, particularly if this is an acute change (...) with a 22% reduction in risk of mortality (HR 0.78, p=0.003). These authors therefore recommend potassium-sparing diuretics and/or potassium supplementation to maintain levels greater than 4.0 mEq/L in those patients who require diuretics, and to avoid diuretics altogether in euvolemic patients with asymptomatic CHF due to the risk of hypokalemia. [8] In addition, a recent study of patients over 65 years old with CHF found that all-cause mortality was increased in patients with potassium of 3.5-4.0 mEq

2017 Clinical Correlations

9. Hypokalemia (Treatment)

chloride is administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss (eg, those on thiazide diuretics), when it must be maintained. Potassium-sparing diuretics are generally used only in patients with normal renal function who are prone to significant hypokalemia. Angiotensin-converting enzyme (ACE) inhibitors, which inhibit renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. However, ACE (...) inhibitors can lead to lethal hyperkalemia in patients with renal insufficiency who are taking potassium supplements or potassium-sparing diuretics. Surgical care Generally, hypokalemia is a medical, not a surgical, condition. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma Intestinal obstruction producing massive vomiting Villous adenoma Next: Decreasing Potassium Losses Measures to identify and stop ongoing losses of potassium

2014 eMedicine.com

10. Hypokalemia (Overview)

are present simultaneously. Increased excretion The most common mechanisms leading to increased renal potassium losses include the following: Enhanced sodium delivery to the collecting duct, as with diuretics Mineralocorticoid excess, as with primary or secondary hyperaldosteronism Increased urine flow, as with an osmotic diuresis Gastrointestinal losses, from diarrhea, vomiting, or nasogastric suctioning, also are common causes of hypokalemia. Vomiting leads to hypokalemia via a complex pathogenesis (...) excretion Increased excretion of potassium, especially coupled with poor intake, is the most common cause of hypokalemia. Increased potassium excretion may result from any of the following: Mineralocorticoid excess (endogenous or exogenous) Hyperreninism from renal artery stenosis Osmotic diuresis: Mannitol and hyperglycemia can cause osmotic diuresis Increased gastrointestinal losses Drugs Genetic disorders Endogenous sources of excess mineralocorticoid include the following: Primary hyperaldosteronism

2014 eMedicine.com

11. Hypokalemia (Follow-up)

chloride is administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss (eg, those on thiazide diuretics), when it must be maintained. Potassium-sparing diuretics are generally used only in patients with normal renal function who are prone to significant hypokalemia. Angiotensin-converting enzyme (ACE) inhibitors, which inhibit renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. However, ACE (...) inhibitors can lead to lethal hyperkalemia in patients with renal insufficiency who are taking potassium supplements or potassium-sparing diuretics. Surgical care Generally, hypokalemia is a medical, not a surgical, condition. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma Intestinal obstruction producing massive vomiting Villous adenoma Next: Decreasing Potassium Losses Measures to identify and stop ongoing losses of potassium

2014 eMedicine.com

12. Hypokalemia (Diagnosis)

conditions that promote the shift of extracellular potassium into the intracellular space. Next: Pathophysiology Hypokalemia may be due to a total body deficiency of potassium, which may result from prolonged inadequate intake or excessive losses (including but not limited to, long-term diuretic or laxative use, and chronic , , or hyperhidrosis). Acute causes of potassium depletion include , [ ] severe GI losses due to vomiting and diarrhea, dialysis, and diuretic therapy. Hypokalemia may also (...) be the manifestation of large potassium shifts from the extracellular to intracellular space, as seen with alkalosis, insulin, catecholamines (including albuterol and other commonly-used beta2-adrenergic agonists), sympathomimetics, and hypothermia. Other recognizable causes include renal tubular disorders, such as distal renal tubular acidosis, , [ ] and Gitelman syndrome, periodic hypokalemic paralysis, , and . Other mineralocorticoid excess states that may cause hypokalemia include (with hyperaldosteronism from

2014 eMedicine Pediatrics

13. Hypokalemia (Overview)

conditions that promote the shift of extracellular potassium into the intracellular space. Next: Pathophysiology Hypokalemia may be due to a total body deficiency of potassium, which may result from prolonged inadequate intake or excessive losses (including but not limited to, long-term diuretic or laxative use, and chronic , , or hyperhidrosis). Acute causes of potassium depletion include , [ ] severe GI losses due to vomiting and diarrhea, dialysis, and diuretic therapy. Hypokalemia may also (...) be the manifestation of large potassium shifts from the extracellular to intracellular space, as seen with alkalosis, insulin, catecholamines (including albuterol and other commonly-used beta2-adrenergic agonists), sympathomimetics, and hypothermia. Other recognizable causes include renal tubular disorders, such as distal renal tubular acidosis, , [ ] and Gitelman syndrome, periodic hypokalemic paralysis, , and . Other mineralocorticoid excess states that may cause hypokalemia include (with hyperaldosteronism from

2014 eMedicine Pediatrics

14. Hypokalemia (Diagnosis)

are present simultaneously. Increased excretion The most common mechanisms leading to increased renal potassium losses include the following: Enhanced sodium delivery to the collecting duct, as with diuretics Mineralocorticoid excess, as with primary or secondary hyperaldosteronism Increased urine flow, as with an osmotic diuresis Gastrointestinal losses, from diarrhea, vomiting, or nasogastric suctioning, also are common causes of hypokalemia. Vomiting leads to hypokalemia via a complex pathogenesis (...) excretion Increased excretion of potassium, especially coupled with poor intake, is the most common cause of hypokalemia. Increased potassium excretion may result from any of the following: Mineralocorticoid excess (endogenous or exogenous) Hyperreninism from renal artery stenosis Osmotic diuresis: Mannitol and hyperglycemia can cause osmotic diuresis Increased gastrointestinal losses Drugs Genetic disorders Endogenous sources of excess mineralocorticoid include the following: Primary hyperaldosteronism

2014 eMedicine.com

15. Renal Grand Rounds - What Lurks in the Gap

tubule results in poor reabsorption of D-lactate relative to L-lactate. The negatively charged D-lactate essentially drags positively charged sodium and potassium into the urine causing hypokalemia as well as a positive urine anion gap (Na + K - Cl) due to the increased urine sodium and potassium. This patient did well after his Gatorade was cut off and he was treated with antibiotics to address gram positive anaerobic overgrowth. Posted by Patrick Reeves (Image taken from - an educational blog (...) Renal Grand Rounds - What Lurks in the Gap Renal Fellow Network: Renal Grand Rounds - What Lurks in the Gap | | | | | Tuesday, January 10, 2017 Renal Grand Rounds - What Lurks in the Gap I recently presented the case of a middle-aged man with a history of a remote Roux-en-Y gastric bypass, chronic diarrhea, and colon cancer on chemotherapy who initially presented with progressive fatigue and weakness in the setting of increased diarrhea. Shortly after admission he developed agitation

2017 Renal Fellow Network

16. Incidence of Renal Tubular Acidosis in Nephrology Unit in Assiut University Childern Hospital

a hyperkalemic non-anion gap metabolic acidosis. Urine may be alkaline or acidic. Elevated urinary sodium levels with inappropriately low urinary potassium levels reflect the absence of aldosterone effect . The first step in the evaluation of a patient with suspected RTA is to confirm the presence of a normal anion gap metabolic acidosis, identify electrolyte abnormalities, assess renal function, and rule out other causes of bicarbonate loss such as diarrhea . The mainstay of therapy in all forms of RTA (...) anhydrase II deficiency. Electrolyte and acid-base disturbances are key components of each disorder . Patients with pRTA present with growth failure in the 1st yr of life. Additional symptoms can include polyuria, dehydration (from sodium loss), anorexia, vomiting, constipation, and hypotonia. Patients with primary Fanconi syndrome have additional symptoms, secondary to phosphate wasting, such as rickets. Hypokalemia and related symptoms are also restricted to cases with the Fanconi syndrome. Distal RTA

2017 Clinical Trials

17. PK of Pacritinib in Patients With Mild, Moderate, Severe Renal Impairment and ESRD Compared to Healthy Subjects

permission) coronary artery bypass surgery or percutaneous coronary intervention unstable angina or stroke Past medical history of clinically significant ECG abnormalities, presence of an abnormal ECG (which in the Investigator's opinion is clinically significant), QTcF>450 msec, or has concomitant conditions that increase risk for QTc interval prolongation (e.g., heart failure, hypokalemia [defined as serum potassium <3.0mEq/L that is persistent and refractory to correction], or family history of long (...) ), elevated serum creatinine, hyperglycemia, and/or glycosuria Alanine aminotransferase (ALT)>1.5xULN Aspartate aminotransferase (AST)>1.5xULN Total bilirubin >1.3x ULN (unless due to Gilbert's Syndrome) Hemoglobin < 8 g/dL Laboratory testing may be repeated once prior to dosing (to rule out any possible laboratory error) Planned surgery during the study period Subjects who are deemed vulnerable by way of imprisonment, remand or detention Patients with Renal Impairment Only In addition to the exclusion

2016 Clinical Trials

18. Hypertension and Symptomatic Hypokalemia in a Patient With Simultaneous Unilateral Stenoses of Intrarenal Arteries and Mesangioproliferative Glomerulonephritis. (PubMed)

hypersecretion due to intrarenal arterial stenoses and mesangioproliferative glomerulonephritis, presumed to be secondary to hepatitis B infection. Targeted pharmacotherapy reversed all clinical manifestations, normalizing blood pressure and serum potassium level and achieving full remission of proteinuria and loss of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), and a dramatic decrease in viral load.Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All (...) Hypertension and Symptomatic Hypokalemia in a Patient With Simultaneous Unilateral Stenoses of Intrarenal Arteries and Mesangioproliferative Glomerulonephritis. We present the case of a young patient with hypertension and unprovoked symptomatic hypokalemia. His workup uncovered secondary aldosteronism, moderate proteinuria, and, quite unusually, concurrent chronic hepatitis B. Detailed investigations, including renal angiography, renal vein sampling, and kidney biopsy, showed unilateral renin

2011 American Journal of Kidney Diseases

19. Hypokalemia

or gastric suction (which removes volume and hydrochloric acid) causes renal potassium losses due to and stimulation of aldosterone due to volume depletion; aldosterone and metabolic alkalosis both cause the kidneys to excrete potassium. Intracellular shift The transcellular shift of potassium into cells may also cause hypokalemia. This shift can occur in any of the following: Glycogenesis during TPN or enteral hyperalimentation (stimulating insulin release) After administration of insulin Stimulation (...) . They are typically precipitated by a large carbohydrate meal or strenuous exercise. Renal potassium losses Various disorders can increase renal potassium excretion. Excess mineralocorticoid (ie, aldosterone) effect can directly increase potassium secretion by the distal nephrons and occurs in any of the following: Adrenal steroid excess that is due to , , rare renin-secreting tumors, glucocorticoid-remediable aldosteronism (a rare inherited disorder involving abnormal aldosterone metabolism), and . Ingestion

2013 Merck Manual (19th Edition)

20. Chronic Renal Failure (Diagnosis)

rate (GFR) of less than 60 mL/min/1.73 m 2 for at least 3 months. Whatever the underlying etiology, once the loss of nephrons and reduction of functional renal mass reaches a certain point, the remaining nephrons begin a process of irreversible sclerosis that leads to a progressive decline in the GFR. [ ] Hyperparathyroidism is one of the pathologic manifestations of CKD. See the image below. Calciphylaxis due to secondary hyperparathyroidism. Staging The different stages of CKD form a continuum (...) -quality evidence). Laboratory studies Laboratory studies used in the diagnosis of CKD can include the following: Complete blood count (CBC) Basic metabolic panel Urinalysis Serum albumin levels: Patients may have hypoalbuminemia due to malnutrition, urinary protein loss, or chronic inflammation Lipid profile: Patients with CKD have an increased risk of cardiovascular disease Evidence of renal bone disease can be derived from the following tests: Serum calcium and phosphate 25-hydroxyvitamin D Alkaline

2014 eMedicine.com

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