Content continues after advertisement

Differential Diagnosis: Hypokalemia

Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP (Clinical), Durham, North Carolina

Internal Medicine

|October 2019|Peer Reviewed

Sign in to Print/View PDF

Editor's note: A previous version of this article incorrectly listed hyperkalemic periodic paralysis in Burmese cats as a differential diagnosis. This has been corrected as of February 2020.

Following are differential diagnoses, listed in order of likelihood, for patients presented with hypokalemia.

  • Increased loss
    • Through the kidney (most common)
      • Chronic kidney disease
      • Loop and thiazide diuretics
      • Postobstructive diuresis (cats affected more than dogs)
      • Renal tubular disease
      • Osmotic diuresis
      • Acute metabolic acidosis secondary to lactic acid or ketone excretion
      • Primary metabolic alkalosis
      • Diuresis secondary to hyperadrenocorticism; some patients with adrenocortical tumors also produce excess aldosterone
      • High dietary sodium intake
      • Primary hyperaldosteronism, usually due to an adrenal tumor or hyperplasia
      • Excessive mineralocorticoid administration (eg, overdose of desoxycorticosterone pivalate or fludrocortisone)
      • Administration of certain drugs (eg, penicillins, carbonic anhydrase inhibitors, amphotericin B)
    • Through the GI tract
      • Vomiting
      • Chronic diarrhea
      • Ileus
    • Third-spacing (eg, loss in peritoneal fluid)
  • Transcellular shifts
    • Insulin release or administration
    • Increased endogenous catecholamines (eg, pheochromocytoma) or epinephrine administration
    • Primary respiratory or metabolic alkalosis
    • Hyperthyroidism, likely due to transcellular shifts
    • Endotoxemia
    • Refeeding syndrome
    • Hypomagnesemia
    • Treatment with or toxicosis from β2 agonists (eg, albuterol, terbutaline)
    • Hyperinsulinemia secondary to xylitol toxicosis, which stimulates the activity of the Na+/K+-ATPase pump, which catalyzes transfer of potassium in the cells
    • Hypothermia
    • Periodic hypokalemic polymyopathy (Burmese cats)
  • Decreased intake
    • Administration of low-/no-potassium intravenous fluids
    • Low-potassium diets, often acidifying diets
    • Severe anorexia (usually a confounding factor and not a primary cause)
    • Ingestion of clay cat litter containing bentonite, which binds potassium in the GI tract
  • Pseudohypokalemia; occurs secondary to lipemia and marked hyperglobulinemia*
*Only when measured by indirect potentiometry, the method used by most chemistry analyzers; blood gas analyzers using direct potentiometry are unaffected.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Podcasts

Clinician's Brief:
The Podcast
Listen as host Alyssa Watson, DVM, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2023 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy