0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:54
Hypokalemia 787
loop or thiazide diuretics, not K sparing diuretics
Mg++deficiency
Bartter’s syndrome
Gitelman’s syndrome
increased serum HCO3, decreased Cl (<20 mEq/L)
active vomiting/nasogastric suction
penicillins (ticarcillin, carbenicillin)
decreased serum HCO3, increased urine Cl (>20 mEq/L)
metabolic acidosis
type I and II RTA
decreased serum HCO3, decreased urine Cl (<20 mEq/L)
ketoacid excretion
■primary increase in mineralocorticoid or mineralocorticoid effect
(high EABV, high BP)
➣increased renin, increased aldosterone
renal artery stenosis
malignant hypertension
renin secreting tumor
➣decreased renin, increased aldosterone
adrenal adenoma
bilateral adrenal hyperplasia
glucocorticoid remediable hyperaldosteronism
➣decreased renin, decreased aldosterone
Cushing syndrome
carbenoxolone
licorice or chewing tobacco containing glycyrrhetinic acid
11 beta-hydroxysteroid dehydrogenase deficiency
Liddle’s syndromemanagement
■history and physical and routine laboratory evaluation will establish
etiology in most cases
■initial management depends on etiology and severity of hypo-
kalemia
■redistribution hypokalemia does not require K administration
■poor correlation between serum K and total deficit
➣in general 200–400 mEq K deficit will lower the serum K by 1
mEq/L
specific therapy
■oral K supplements are indicated for serum K concentrations
between 2.5–3.5 mEq/L