Hypokalemia Questions & Answers

1. Castro D, Sharma S. Hypokalemia. StatPearls. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].

2. Lin SH, Huang CL. Mechanism of thyrotoxic periodic paralysis. J Am Soc Nephrol. 2012 Jun. 23 (6):985-8. [QxMD MEDLINE Link]. [Full Text].

3. Zacchia M, Abategiovanni ML, Stratigis S, Capasso G. Potassium: From Physiology to Clinical Implications. Kidney Dis (Basel). 2016 Jun. 2 (2):72-9. [QxMD MEDLINE Link].

4. Harvey TC. Addison's disease and the regulation of potassium: the role of insulin and aldosterone. Med Hypotheses. 2007. 69(5):1120-6. [QxMD MEDLINE Link].

5. Spat A. Glomerulosa cell--a unique sensor of extracellular K+ concentration. Mol Cell Endocrinol. 2004 Mar 31. 217(1-2):23-6. [QxMD MEDLINE Link].

6. Greenlee M, Wingo CS, McDonough AA, Youn JH, Kone BC. Narrative review: evolving concepts in potassium homeostasis and hypokalemia. Ann Intern Med. May 2009. 150:619-625. [QxMD MEDLINE Link].

7. McDonough AA, Thompson CB, Youn JH. Skeletal muscle regulates extracellular potassium. Am J Physiol Renal Physiol. 2002 Jun. 282(6):F967-74. [QxMD MEDLINE Link]. [Full Text].

8. McDonough AA, Youn JH. Role of muscle in regulating extracellular [K+]. Seminars in Nephrology. 2005. 25:335-342. [QxMD MEDLINE Link].

9. Chen D, Li X, Song Q, Hu C, Su F, Dai J, et al. Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Netw Open. 2020 Jun 1. 3 (6):e2011122. [QxMD MEDLINE Link]. [Full Text].

10. Moreno-P O, Leon-Ramirez JM, Fuertes-Kenneally L, Perdiguero M, Andres M, Garcia-Navarro M, et al. Hypokalemia as a sensitive biomarker of disease severity and the requirement for invasive mechanical ventilation requirement in COVID-19 pneumonia: A case series of 306 Mediterranean patients. Int J Infect Dis. 2020 Nov. 100:449-454. [QxMD MEDLINE Link]. [Full Text].

11. Barkas F, Filippas-Ntekouan S, Liontos A, Kosmidou M, Kalambokis G, Milionis H. Multifaceted persistent hypokalaemia in a patient with coronavirus disease 2019. Intern Med J. 2020 Oct. 50 (10):1289-1291. [QxMD MEDLINE Link]. [Full Text].

12. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 May. 17 (5):259-260. [QxMD MEDLINE Link]. [Full Text].

13. Pezhouman A, Singh N, Song Z, Nivala M, Eskandari A, Cao H, et al. Molecular Basis of Hypokalemia-Induced Ventricular Fibrillation. Circulation. 2015 Aug 12. [QxMD MEDLINE Link].

14. Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med. March 2009. 150:387-395. [QxMD MEDLINE Link].

15. Born-Frontsberg E, Reincke M, Rump LC, et al. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn's Registry. J Clin Endocrinol Metab. 2009 Apr. 94(4):1125-30. [QxMD MEDLINE Link].

16. Toto A, Takahashi Y, Kishimoto M, Minowada S, Aibe H, Hasuo K, et al. Primary aldosteronism associated with severe rhabdomyolysis due to profound hypokalemia. Intern Med. 2009. 48:219-223. [QxMD MEDLINE Link].

17. Shafi, T, Appel LJ, Miller III, ER, Klag MJ, et al. Changes in Serum Potassium Mediate Thiazide-Induced Diabetes. Hypertension. 2008. 52:1022-1029.

18. Greenfeld D, Mickley D, Quinlan DM, Roloff P. Hypokalemia in outpatients with eating disorders. Am J Psychiatry. 1995 Jan. 152(1):60-3. [QxMD MEDLINE Link].

19. Sitprija V. Altered fluid, electrolyte and mineral status in tropical disease, with an emphasis on malaria and leptospirosis. Nat Clin Pract Nephrol. 2008 Feb. 4(2):91-101. [QxMD MEDLINE Link].

20. Kapoor R, Moseley RH, Kapoor JR, et al. Clinical problem-solving. Needle in a haystack. N Engl J Med. 2009 Feb 5. 360(6):616-21. [QxMD MEDLINE Link].

21. Lionakis MS, Samonis G, Kontoyiannis DP. Endocrine and Metabolic Manifestations of Invasive Fungal Infections and Systemic Antifungal Treatment. Mayo Clin Proc. 2008. 83:1046-1060.

22. Emiroglu M. Micafungin use in children. Expert Rev Anti Infect Ther. 2011 Sep. 9(9):821-34. [QxMD MEDLINE Link].

23. de Wijkerslooth LR, Koch BC, Malingre MM, et al. Life-threatening hypokalaemia and lactate accumulation after autointoxication with Stacker 2, a 'powerful slimming agent'. Br J Clin Pharmacol. 2008 Nov. 66(5):728-31. [QxMD MEDLINE Link]. [Full Text].

24. Matteucci MJ, Danen DA. A Levalbuterol Therapeutic Misadventure. Journal of Emergency Medicine. 2008. 35:209-211.

25. Amirlak I, Dawson KP. Bartter syndrome: an overview. QJM. 2000 Apr. 93(4):207-15. [QxMD MEDLINE Link].

26. Bichet DG, Fujiwara TM. Reabsorption of sodium chloride--lessons from the chloride channels. N Engl J Med. 2004 Mar 25. 350(13):1281-3. [QxMD MEDLINE Link].

27. Naesens M, Steels P, Verberckmoes R, et al. Bartter's and Gitelman's syndromes: from gene to clinic. Nephron Physiol. 2004. 96(3):p65-78. [QxMD MEDLINE Link].

28. Konrad M, Vollmer M, Lemmink HH, et al. Mutations in the chloride channel gene CLCNKB as a cause of classic Bartter syndrome. J Am Soc Nephrol. 11(8):1449-59. [QxMD MEDLINE Link].

29. Kamiyoshi N, Nozu K, Urahama Y, Matsunoshita N, Yamamura T, Minamikawa S, et al. Pathogenesis of hypokalemia in autosomal dominant hypocalcemia type 1. Clin Exp Nephrol. 2015 Sep 1. 19 (4):525-8. [QxMD MEDLINE Link].

30. Letz S, Haag C, Schulze E, Frank-Raue K, Raue F, Hofner B, et al. Amino alcohol- (NPS-2143) and quinazolinone-derived calcilytics (ATF936 and AXT914) differentially mitigate excessive signalling of calcium-sensing receptor mutants causing Bartter syndrome Type 5 and autosomal dominant hypocalcemia. PLoS One. 2014. 9 (12):e115178. [QxMD MEDLINE Link]. [Full Text].

31. Nakada T, Koike H, Akiya T, Katayama T, Kawamata S, Takaya K, et al. Liddle's syndrome, an uncommon form of hyporeninemic hypoaldosteronism: functional and histopathological studies. J Urol. 1987 Apr. 137(4):636-40. [QxMD MEDLINE Link].

32. Potter WZ, Trygstad CW, Helmer OM, Nance WE, Judson WE. Familial hypokalemia associated with renal interstitial fibrosis. Am J Med. 1974 Dec. 57(6):971-7. [QxMD MEDLINE Link].

33. Gullner H-G, Tiwari JL, Terasaki PI, Gill JR Jr, Bartter FC. Genetic linkage between histocompatibility antigens (HLA) and a new syndrome of familial hypokalemia. IRCS Med. Sci. 1980. 8:369-370.

34. Güllner HG, Bartter FC, Gill JR Jr, Dickman PS, Wilson CB, Tiwari JL. A sibship with hypokalemic alkalosis and renal proximal tubulopathy. Arch Intern Med. 1983 Aug. 143(8):1534-40. [QxMD MEDLINE Link].

35. Lamberts SW, Poldermans D, Zweens M, de Jong FH. Familial cortisol resistance: differential diagnostic and therapeutic aspects. J Clin Endocrinol Metab. 1986 Dec. 63(6):1328-33. [QxMD MEDLINE Link].

36. Nawata H, Sekiya K, Higuchi K, Kato K, Ibayashi H. Decreased deoxyribonucleic acid binding of glucocorticoid-receptor complex in cultured skin fibroblasts from a patient with the glucocorticoid resistance syndrome. J Clin Endocrinol Metab. 1987 Aug. 65(2):219-26. [QxMD MEDLINE Link].

37. Kung AW, Lau KS, Fong GC, Chan V. Association of novel single nucleotide polymorphisms in the calcium channel alpha 1 subunit gene (Ca(v)1.1) and thyrotoxic periodic paralysis. J Clin Endocrinol Metab. 2004 Mar. 89(3):1340-5. [QxMD MEDLINE Link].

38. Scholl UI, Choi M, Liu T, Ramaekers VT, Häusler MG, Grimmer J, et al. Seizures, sensorineural deafness, ataxia, mental retardation, and electrolyte imbalance (SeSAME syndrome) caused by mutations in KCNJ10. Proc Natl Acad Sci U S A. 2009 Apr 7. 106(14):5842-7. [QxMD MEDLINE Link]. [Full Text].

39. Nilsson E, Gasparini A, Ärnlöv J, Xu H, Henriksson KM, Coresh J, et al. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J Cardiol. 2017 Oct 15. 245:277-284. [QxMD MEDLINE Link].

40. Greenfeld D, Mickley D, Quinlan DM, Roloff P. Hypokalemia in outpatients with eating disorders. Am J Psychiatry. 152(1):60-3. [QxMD MEDLINE Link].

41. Miller KK, Grinspoon SK, Ciampa J, et al. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005 Mar 14. 165(5):561-6. [QxMD MEDLINE Link].

42. Perazella MA, Brown E. Electrolyte and acid-base disorders associated with AIDS: an etiologic review. J Gen Intern Med. 1994 Apr. 9(4):232-6. [QxMD MEDLINE Link].

43. Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K. Hypokalaemia in alcoholic patients. Drug Alcohol Rev. 21(1):73-6. [QxMD MEDLINE Link].

44. Al-Momen A, El-Mogy I. Intragastric balloon for obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2005 Jan. 15(1):101-5. [QxMD MEDLINE Link].

45. Coregliano-Ring L, Goia-Nishide K, Rangel ÉB. Hypokalemia in Diabetes Mellitus Setting. Medicina (Kaunas). 2022 Mar 16. 58 (3):[QxMD MEDLINE Link]. [Full Text].

46. Marti G, Schwarz C, Leichtle AB, Fiedler GM, Arampatzis S, Exadaktylos AK, et al. Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med. 2014 Feb. 21 (1):46-51. [QxMD MEDLINE Link].

47. Cunningham JW, Mehra MR. Hypokalemia in heart failure: A low or a high point?. Eur J Prev Cardiol. 2020 Mar 22. [QxMD MEDLINE Link]. [Full Text].

48. Makinouchi R, Machida S, Matsui K, Shibagaki Y, Imai N. Severe hypokalemia in the emergency department: A retrospective, single-center study. Health Sci Rep. 2022 May. 5 (3):e594. [QxMD MEDLINE Link]. [Full Text].

49. Coentre R, Saraiva R, Levy P. First-Episode Psychosis and Hypokalemia: A Case Report and Review of the Literature. Clin Schizophr Relat Psychoses. 2018 Jun 26. [QxMD MEDLINE Link].

50. Packer M. Pathophysiological mechanisms underlying the effects of beta-adrenergic agonists and antagonists on functional capacity and survival in chronic heart failure. Circulation. 1990 Aug. 82(2 Suppl):I77-88. [QxMD MEDLINE Link].

51. Wu KL, Cheng CJ, Sung CC, Tseng MH, Hsu YJ, Yang SS, et al. Identification of the Causes for Chronic Hypokalemia: Importance of Urinary Sodium and Chloride Excretion. Am J Med. 2017 Jul. 130 (7):846-855. [QxMD MEDLINE Link].

52. Weinstein AM. A mathematical model of rat cortical collecting duct: determinants of the transtubular potassium gradient. Am J Physiol Renal Physiol. 2001 Jun. 280(6):F1072-92. [QxMD MEDLINE Link].

53. West ML, Marsden PA, Richardson RM, et al. New clinical approach to evaluate disorders of potassium excretion. Miner Electrolyte Metab. 1986. 12(4):234-8. [QxMD MEDLINE Link].

54. Kamel KS, Halperin ML. Intrarenal urea recycling leads to a higher rate of renal excretion of potassium: an hypothesis with clinical implications. Curr Opin Nephrol Hypertens. 2011 Sep. 20(5):547-54. [QxMD MEDLINE Link].

55. Carlisle EJ, Donnelly SM, Vasuvattakul S, et al. Glue-sniffing and distal renal tubular acidosis: sticking to the facts. J Am Soc Nephrol. 1(8):1019-27. [QxMD MEDLINE Link].

56. [Guideline] Sandau KE, Funk M, Auerbach A, et al. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation. 2017 Nov 7. 136 (19):e273-e344. [QxMD MEDLINE Link]. [Full Text].

57. Marill KA, Miller ES. Hypokalemia in women and methadone therapy are the strongest non-cardiologic factors associated with QT prolongation in an emergency department setting. J Electrocardiol. 2017 Jul - Aug. 50 (4):416-423. [QxMD MEDLINE Link].

58. Moser M. Diuretics and cardiovascular risk factors. Eur Heart J. 1992 Dec. 13 Suppl G:72-80. [QxMD MEDLINE Link].

59. Herrmann SM, Textor SC. Diagnostic criteria for renovascular disease: where are we now?. Nephrol Dial Transplant. 2012 Jul. 27(7):2657-63. [QxMD MEDLINE Link]. [Full Text].

60. Karagiannis A, Tziomalos K, Papageorgiou A, Kakafika AI, Pagourelias ED, Anagnostis P, et al. Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism. Expert Opin Pharmacother. March 2008. 9:509-515. [QxMD MEDLINE Link].

61. Pitt B, Bakris G, Ruilope LM, et al. Serum potassium and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008 Oct 14. 118(16):1643-50. [QxMD MEDLINE Link].

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc.

Zygimantas C Alsauskas, MD Assistant Professor of Medicine, Division of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

Zygimantas C Alsauskas, MD is a member of the following medical societies: American Society of Nephrology

Disclosure: Nothing to disclose.

Lina Mackelaite, MD Assistant Professor of Medicine, University of Louisville School of Medicine

Lina Mackelaite, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Transplantation, National Kidney Foundation

Disclosure: Nothing to disclose.

Vibha Nayak, MD Assistant Professor of Nephrology, Director of Home Dialysis, Kidney Disease Program, University of Louisville School of Medicine

Vibha Nayak, MD is a member of the following medical societies: American Society of Nephrology

Disclosure: Nothing to disclose.

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Leslie Ford, MD Assistant Professor of Medicine, Kidney Disease Program, University of Louisville School of Medicine

Leslie Ford, MD is a member of the following medical societies: American Medical Association, American Society of Nephrology, and Kentucky Medical Association

Disclosure: Nothing to disclose.

James W Lohr, MD Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Nothing to disclose.

Rosemary Ouseph, MD Professor of Medicine, Director of Kidney Transplant, University of Louisville School of Medicine

Rosemary Ouseph, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society of Nephrology, and American Society of Transplant Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Christie P Thomas, MBBS, FRCP, FASN, FAHA Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics

Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians

Disclosure: Genzyme Grant/research funds Other

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