Pathophysiology and management of hypokalemia: A clinical perspective

Nature Reviews Nephrology

Volumn 7, Issue 2, 2011, Pages 75-84

  Unwin, Robert J ^a   Luft, Friedrich C ^b   Shirley, David G ^a  

^a UNIVERSITY COLLEGE LONDON   (United Kingdom)

^b MAX DELBRÜCK CENTER FOR MOLECULAR MEDICINE   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

AMINOGLYCOSIDE; BICARBONATE; MINERALOCORTICOID; POTASSIUM; POTASSIUM CHLORIDE; PROTON PUMP INHIBITOR; SODIUM; SPIRONOLACTONE; TRIAMTERENE;

ACID BASE BALANCE; CELL MEMBRANE; CHRONIC DIARRHEA; GITELMAN SYNDROME; HORMONE ACTION; HUMAN; HYPERKALEMIA; HYPOKALEMIA; HYPOMAGNESEMIA; KIDNEY FUNCTION; NEPHRON; NONHUMAN; POTASSIUM BLOOD LEVEL; POTASSIUM CELL LEVEL; POTASSIUM DEPLETION; POTASSIUM TRANSPORT; PRIORITY JOURNAL; REVIEW; SWEATING; TUBE FLOW; URINARY EXCRETION;

HUMANS; HYPOKALEMIA; KIDNEY; WATER-ELECTROLYTE BALANCE;

EID: 79551532149     PISSN: 17595061     EISSN: 1759507X     Source Type: Journal    
DOI: 10.1038/nrneph.2010.175     Document Type: Review

References (81)

1. Paltiel, O., Salakhov, E., Ronen, I., Berg, D. & Israeli, A. Management of severe hypokalemia in hospitalized patients: a study of quality of care based on computerized databases. Arch. Intern. Med. 161, 1089-1095 (2001).
2. Crop, M. J., Hoorn, E. J., Lindemans, J. & Zietse, R. Hypokalaemia and subsequent hyperkalaemia in hospitalized patients. Nephrol. Dial. Transplant 22, 3471-3477 (2007).
3. Widodo, D., Setiawan, B., Chen, K., Nainggolan, L. & Santoso, W. D. The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto Mangunkusumo Hospital, Jakarta. Acta Med. Indones. 38, 202-205 (2006).
4. Paice, B. J. et al. Record linkage study of hypokalaemia in hospitalized patients. Postgrad. Med. J. 62, 187-191 (1986).
5. Lam, M. H., Chau. S. W. & Wing, Y. K. High prevalence of hypokalemia in acute psychiatric inpatients. Gen. Hosp. Psychiatry 31, 262-265 (2009).
6. Tziviskou, E. et al. Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis: one center's experience and review of the literature. Int. Urol. Nephrol. 35, 429-34 (2003).
7. Hawkins, R. C. Gender and age as risk factors for hypokalemia and hyperkalemia in a multiethnic Asian population. Clin. Chim. Acta 331, 171-172 (2003).
8. Toner, J. M. & Ramsay, L. E. Thiazide-induced hypokalaemia; prevalence higher in women. Br. J. Clin. Pharmacol. 18, 449-452 (1984).
9. Sodi, R., Davison, A. S., Holmes, E., Hine. T. J. & Roberts, N. B. The phenomenon of seasonal pseudohypokalemia: effects of ambient temperature, plasma glucose and role for sodium-potassium-exchanging-ATPase. Clin. Biochem. 42, 813-818 (2009).
10. Greenlee, M., Wingo, C. S., McDonough, A. A., Youn, J. H. & Kone, B. C. Narrative review: evolving concepts in potassium homeostasis and hypokalemia. Ann. Intern. Med. 150, 619-625 (2009).
11. Hibino, H. et al. Inwardly rectifying potassium channels: their structure, function, and physiological roles. Physiol. Rev. 90, 291-366 (2010).
12. rd edn Vol. 1 Ch. 2.2 (eds Davison, A. M. et al.) 241-267 (Oxford University Press, Oxford, 2005).
13. Therien, A. G. & Blostein, R. Mechanisms of sodium pump regulation. Am. J. Physiol. Cell Physiol. 279, C541-C566 (2000).
14. +-ATPase: mechanisms underlying rapid and sustained changes in pump activity. Am. J. Physiol. 269, C295-C311 (1995).
15. Vick, R. L., Todd, E. P & Luedke, D. W. Epinephrineinduced hypokalemia: relation to liver and skeletal muscle. J. Pharmacol. Exp. Ther. 181, 139-146 (1972).
16. Alton, M. & Shanklin, N. Adrenergic modulation of extrarenal potassium disposal in men with endstage renal disease. Kidney Int. 40, 1103-1109 (1991).
17. Halperin, M. L. & Kamel, K. S. Potassium. Lancet 352, 135-140 (1998).
18. Wehling, M. Nongenomic aldosterone effects: the cell membrane as a specific target of mineralocorticoid action. Steroids 60, 153-156 (1995).
19. + pump activation during short-term exposure of cardiac myocytes to aldosterone. Am. J. Physiol. 274, C175-C181 (1998).
20. Edwards, R., Winnie, A. P. & Ramamurthy, S. Acute hypocapneic hypokalemia: an iatrogenic anesthetic complication. Anesth. Analg. 56, 786-792 (1977).
21. Krapf, R., Caduff, P., Wagdi, P., Staubli, M. & Hulter, H. N. Plasma potassium response to acute respiratory alkalosis. Kidney Int. 47, 217-224 (1995).
22. Clemessy, J. L. et al. Hypokalaemia related to acute chloroquine ingestion. Lancet 346, 877-880 (1995).
23. Malik, A. R., Wolf, P K. & Ravasia, S. Hypokalemia from risperidone and quetiapine overdose. Can. J. Psychiatry 50, 76(2005).
24. Lyon, A. W. & Mayhew, W. J. Cesium toxicity: a case of self-treatment by alternate therapy gone awry. Ther. Drug Monit. 25, 114-116 (2003).
25. Diengott, D., Rozsa, O., Levy, N. & Muammar, S. Hypokalaemia in barium poisoning. Lancet 2, 343-344 (1964).
26. Pinter, A., Dorian, P. & Newman, D. Cesiuminduced torsades de pointes. N. Engl. J. Med. 346, 383-384 (2002).
27. Wells, J. A. & Wood, K. E. Acute barium poisoning treated with hemodialysis. Am. J. Emerg. Med. 19, 175-177 (2001).
28. Liu. Y C., Tsai. W. S. Chau, T. & Lin, S.-H. Acute hypercapnic respiratory failure due to thyrotoxic periodic paralysis. Am. J. Med. Sci. 327, 264-267 (2004).
29. Lin, S.-H., Lin, Y-F. & Halperin, M. L. Hypokalaemia and paralysis. QJM 94, 133-139 (2001).
30. Stedwell, R. E., Allen, K. M. & Binder, L. S. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am. J. Emerg. Med. 10, 143-148 (1992).
31. Christensen, K. S. Hypokalemic paralysis in Sjogren's syndrome secondary to renal tubular acidosis. Scand. J. Rheumatol. 14, 58-60 (1985).
32. Barta, Z., Miltenyi, Z., Toth, L. & Illes, A. Hypokalemic myopathy in a patient with glutensensitive enteropathy and dermatitis herpetiformis Duhring: a case report. World J. Gastroenterol. 11, 2039-2040 (2005).
33. Verner, J. V. & Morrison, A. B. Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia. Am. J. Med. 25, 374-380 (1958)
34. Sato, K., Feibleman, C. & Dobson, R. L. The electrolyte composition of pharmacologically and thermally stimulated sweat: a comparative study. J. Invest. Dermatol. 55, 433-38 (1970).
35. Godek, S. F., Bartolozzi, A. R. & Godek, J. J. Sweat rate and fluid turnover in American football players compared with runners in a hot and humid environment. Br. J. Sports Med. 39, 205-211 (2005).
36. Bates, C. M., Baum, M. & Quigley, R. Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent. J. Am. Soc. Nephrol. 8, 352-355 (1997).
37. Wang. W. H. & Giebisch, G. Regulation of potassium (K) handling in the renal collecting duct. Pflügers Arch. 458, 157-168 (2009).
38. + homeostasis. Proc. Natl Acad. Sci. USA 104, 4025-4029 (2007).
39. Rabinowitz, L. Aldosterone and potassium homeostasis. Kidney Int. 49, 1738-1742 (1996).
40. Pan, Y.-J. & Young, D. B. Experimental aldosterone hypertension in the dog. Hypertension 4, 279-287 (1982).
41. Young, D. B. Quantitative analysis of aldosterone's role in potassium regulation. Am J. Physiol. 255, F811-F822 (1988).
42. Welling, P.A. & Ho, K. A comprehensive guide to the ROMK potassium channel: form and functior in health and disease. Am. J. Physiol. Renal Physiol. 297, F849-F863 (2009).
43. Liapis, H., Nag, M. & Kaji, D. M. K-CI cotransporter expression in the human kidney. Am. J. Physiol. 275, C1432-C1437 (1998).
44. Hropot, M., Fowler, N., Karlmark, B. & Giebisch, G. Tubular action of diuretics: distal effects on electrolyte transport and acidification. Kidney Int. 28, 477-489 (1985).
45. Unwin, R. J., Walter, S. J., Giebisch, G., Capasso, G. & Shirley, D. G. Localization of diuretic effects along the loop of Henle: an in vivo microperfusion study in rats. Clin. Sci. (Lond.) 98, 481-88 (2000).
46. Kamel, K. S., Ethier, J., Levin, A. & Halperin, M. L. Hypokalemia in the "beautiful people". Am. J. Med. 88, 534-536 (1990).
47. Velazquez, H., Ellison, D. H. & Wright, F. S. Luminal influences on potassium secretion: chloride, sodium, and thiazide diuretics. Am. J. Physiol. 262, F1076-F1082 (1992).
48. Amorim, J. B., Bailey, M. A., Musa-Aziz, R., Giebisch, G. & Malnic, G. Role of luminal anion and pH in distal tubule potassium secretion. Am. J. Physiol. Renal Physiol. 284, F381-F388 (2003).
49. Wang, W.-H., Yue, P, Sun, P. & Lin, D.-H. Regulation and function of potassium channels in aldosterone-sensitive distal nephron. Curr. Opin. Nephrol. Hypertens. 19, 463-470 (2010).
50. Stanton, B. A. & Giebisch, G. H. In Handbook of Physiology, Section 8 Vols I and II Ch. 15 (ed. Windhager, E. E.) 813-874 (American Physiological Society, Bethseda, 1992).
51. Batlle, D., Moorthi, K. M., Schlueter, W. & Kurtzman, N. Distal renal tubular acidosis and the potassium enigma. Semin. Nephrol. 26, 471-478 (2006).
52. Jaeger, P., Karlmark, B. & Giebisch, G. Ammonium transport in rat cortical tubule: relationship to potassium metabolism. Am. J. Physiol. 245, F593-F600 (1983).
53. Field, M. J., Stanton, B. A. & Giebisch, G. H. Influence of ADH on renal potassium handling: a micropuncture and microperfusion study. Kidney Int. 25, 502-511 (1984).
54. Cundy, T. & Dissanayake, A. Severe hypomagnesaemia in long-term users of protonpump inhibitors. Clin. Endocrinol. (Oxf.) 69, 338-341 (2008).
55. Huang, C. L. & Kuo, E. Mechanism of hypokalemia in magnesium deficiency. J. Am. Soc. Nephrol. 18, 2649-2652 (2007).
56. Rossetti, L., Klein-Robbenhaar, G., Giebisch, G., Smith, D. & DeFronzo, R. Effect of insulin on renal potassium metabolism. Am. J. Physiol. 252, F60-F64 (1987).
57. Ahloulay, M., Dechaux, M., Laborde, K. & Bankir, L. Influence of glucagon on GFR and on urea and electrolyte excretion: direct and indirect effects. Am. J. Physiol. 269, F225-F235 (1995).
58. Rabelink, T. J., Koomans, H. A., Hene, R. J. & Dorhout Mees, E. J. Early and late adjustment to potassium loading in humans. Kidney Int. 38, 942-947 (1990).
59. Campen, T. J., Vaughn, D. A. & Fanestil, D. D. Mineralo-and glucocorticoid effects on renal excretion of electrolytes. Pflügers Arch. 399, 93-101 (1983).
60. Stanton, B., Pan, L., Deetjen, H., Guckian, V & Giebisch, G. Independent effects of aldosterone and potassium on induction of potassium adaptation in rat kidney. J. Clin. Invest. 79, 198-206 (1987).
61. Calo, L., Borsatti, A., Favaro, S. & Rabinowitz, L. Kaliuresis in normal subjects following oral potassium citrate intake without increased plasma potassium concentration. Nephron 69, 253-258 (1995).
62. + homeostasis. Am. J. Physiol. Renal Physiol. 293, F541-F547 (2007).
63. Michell, A. R., Debnam, E. S. & Unwin, R. J. Regulation of renal function by the gastrointestinal tract: potential role of gutderived peptides and hormones. Annu. Rev. Physiol. 70, 379-403 (2008).
64. + excretion. Am. J. Physiol. Regul. Integr. Comp. Physiol. 278, R1134-R1139 (2000).
65. Youn, J. H. & McDonough, A. A. Recent advances in understanding integrative control of potassium homeostasis. Annu. Rev. Physiol. 71, 381-401 (2009).
66. Unwin, R., Capasso, G. & Giebisch, G. Potassium and sodium transport along the loop of Henle: effects of altered dietary potassium intake. Kidney Int. 46, 1092-1099 (1994).
67. Trojak, B. et al. Hypokalemia is associated with lengthening of QT interval in psychiatric patients on admission. Psychiatry Res. 169, 257-260 (2009).
68. Coca, S. G., Perazella, M. A. & Buller, G. K. The cardiovascular implications of hypokalemia. Am. J. Kidney Dis. 45, 233-247 (2005).
69. He, F J. & MacGregor, G. A. Fortnightly review: beneficial effects of potassium. BMJ 323, 497-501 (2001).
70. Reddy, V G. Potassium and anesthesia. Singapore Med. J. 39, 511-516 (1998).
71. Vitez, T. S., Soper, L. E., Wong, K. C. & Soper, P Chronic hypokalemia and intraoperative dysrhythmias. Anesthesiology 63, 130-133 (1985).
72. Conn, J. W. & Johnson, R. D. Kaliopenic nephropathy. Am. J. Clin. Nutr. 4, 523-528 (1956).
73. Arimura, Y. et al. Anorexia nervosa: an important cause of chronic tubulointerstitial nephropathy. Nephrol. Dial. Transplant. 14, 957-959 (1999).
74. Bock, K. D., Cremer, W. & Werner, U. Chronic hypokalemic nephropathy: a clinical study. Klin. Wochenschr. 56 (Suppl. 1), 91-96 (1978).
75. Reimann, D. & Gross, P. Chronic, diagnosisresistant hypokalaemia. Nephrol. Dial. Transplant. 14, 2957-2961 (1999).
76. West, M. L. et al. Development of a test to evaluate the transtubular potassium concentration gradient in the cortical collecting duct in vivo. Miner. Electrolyte Metab. 12, 226-233 (1986).
77. Chacko, M., Fordtran, J. S. & Emmett, M. Effect of mineralocorticoid activity on transtubular potassium gradient, urinary [K]/[Na] ratio, and fractional excretion of potassium. Am. J. Kidney Dis. 32, 47-51 (1998).
78. Colussi, G. et al. A thiazide test for the diagnosis of renal tubular hypokalemic disorders. Clin. J. Am. Soc. Nephrol. 2, 454-460 (2007).
79. Unwin, R. J. & Capasso, G. Bartter's and Gitelman's syndromes: their relationship to the actions of loop and thiazide diuretics. Curr. Opin. Pharmacol. 6, 208-213 (2006).
80. Lin, S.-H. et al. Laboratory tests to determine the cause of hypokalemia and paralysis. Arch. Intern. Med. 164, 1561-1566 (2004).
81. Lin, S.-H. Thyrotoxic periodic paralysis. Mayo Clin. Proc. 80, 99-105 (2005).