Table 4.

Identifying the Cause of Secondary Hypokalemia

If blood
pressure
is:		& urinary
potassium
is:		& blood
bicarbonate
is:		Diagnostic explanations
High
  • Primary or secondary inappropriate (pseudo) hyperaldosteronism
  • Secondary hyperaldosteronism (↑ renin blood concentration): renin secreting tumor, renal artery stenosis, malignant hypertension
  • Hyperglucocorticism (normal renin blood concentration)
  • Licorice (normal renin blood concentration)
>25 mmol/LHighLiddle syndrome (tubulopathy)
Normal<25 mmol/LHighPast treatment w/diuretics
Low or normal
  • Gastrointestinal losses
  • Insufficient potassium intake
>25 mmol/LHigh
  • Vomiting
  • Present treatment w/diuretics
  • Bartter syndrome (tubulopathy w/normo- or hypercalcuria, normomagnesemia)
  • Gitelman syndrome (tubulopathy w/hypocalciuria, hypomagnesemia)
Low
  • Distal tubular acidosis type 1, 2 (but not 4, in which there is hyperkalemia)
  • Diabetic acidosis

From: Hypokalemic Periodic Paralysis

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