Hypokalemia due to Renal Potassium Loss

Aka: Hypokalemia due to Renal Potassium Loss, Renal Potassium Loss, Hyperkaluria

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II. Labs

  1. Hypokalemia with increased Urine Potassium
    1. 24 hour Urine Potassium > 15 to 30 meq/L/day
    2. Urine Potassium to Creatinine ratio > 13
      1. Poor Specificity and high variability

III. Causes: Blood Pressure Elevated and Hypokalemia

  1. Renin Elevated
    1. Malignant Hypertension
    2. Renovascular disease
    3. Renin Secreting tumor
  2. Renin Normal
    1. Liddle's Syndrome
  3. Renin Low
    1. Aldosterone High
      1. Primary Hyperaldosteronism
      2. Bilateral adrenal hyperplasia
      3. Dexamethasone suppression
    2. Aldosterone Low
      1. Mineralocorticoid ingestion
      2. Congenital Adrenal Hyperplasia
      3. Cushing's Syndrome
      4. Ectopic ACTH
      5. Tobacco chewing
      6. Licorice
      7. Exogenous Corticosteroids (e.g. Prednisone)

IV. Causes: Blood Pressure Normal and Hypokalemia

  1. Hypomagnesemia
    1. See Hypomagnesemia Causes
  2. Serum Bicarbonate Low
    1. Renal Tubular Acidosis (Types 1 and 2)
  3. Serum Bicarbonate High
    1. Urine Chloride Low (<10 meq/L)
      1. Vomiting
    2. Urine Chloride High (>10 meq/L)
      1. Intrinsic renal transport defect (Bartter Syndrome, Gitelman Syndrome)
      2. Normotensive Primary Hyperaldosteronism
      3. Diuretic use (Loop Diuretics, Thiazide Diuretics)
      4. Severe Potassium depletion

V. References

  1. Kim (2023) Am Fam Physician 107(1): 59-70 [PubMed]

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