Potassium Deficiency (Hypokalemia): Causes

Pathogenesis (development of disease)

More than 98% of the potassium in the body is in the intracellular space (IZR = fluid located inside the body cells). The distribution of potassium between extracellular volume (EZR = intravascular space (located inside the vessels) + extravascular space (located outside the vessels) and IZR is influenced by the following factors:

The balance of body potassium occurs primarily through the kidney. There, potassium is filtered glomerularly. About 90% of the filtered potassium ions are reabsorbed in the proximal tubule (main piece of the renal tubules) and in Henle’s loop (straight sections of the renal tubules and transition piece). In the distal tubule (middle section of the renal tubules) and in the collecting tubule of the kidney, the decisive regulation of potassium excretion finally occurs. For details, see Potassium/Definition, Synthesis, Absorption, Transport, and Distribution. Differential pathogenetic classification of hypokalemia:

  • Renal (kidney-related) hypokalemia, e.g., wg :
    • Renal tubular acidosis (RTA) (see “Genetic disorders” below).
    • Hypokalemic nephropathy (kidney disease) with impaired ability to concentrate, polyuria (increased urination), and polydipsia (excessive fluid intake through drinking)
    • Medications: Diuretics (dehydrating drugs) such as thiazides and/or loop diuretics; see also under “Hypokalemia due to medication”
    • Licorice abuse
  • Enteral (gut-related) hypokalemia, e.g., wg :
  • Metabolic (metabolic) hypokalemia, e.g., wg :

Notice:

Etiology (causes)

Biographical causes

  • Genetic burden/disease
    • Bartter syndrome – very rare genetic metabolic disorder with autosomal dominant or autosomal recessive or X-linked recessive inheritance; defect of tubular transport proteins; hyperaldosteronism (disease states associated with increased secretion of aldosterone), hypokalemia (potassium deficiency), and hypotension (low blood pressure).
    • EAST syndrome (synonym: SeSAME syndrome) – genetic disorder with autosomal recessive inheritance characterized by cerebral spasms, sensorineural hearing loss, ataxia (disorder of movement coordination and postural innervation), retardation (delayed development), intellectual deficit, and electrolyte disturbances (hypokalemia, metabolic alkalosis (metabolic alkalosis), hypomagnesemia/magnesium deficiency); age of manifestation: Infancy, neonatal period
    • Gitelman syndrome (GS; synonym: familial hypokalemia-hypomagnesemia) – genetic condition with autosomal recessive inheritance characterized by hypokalemic metabolic alkalosis (metabolic alkalosis with potassium deficiency) with marked hypomagnesemia (magnesium deficiency) and low urinary calcium excretion.
    • Liddle syndrome – very rare genetic disorder with autosomal dominant inheritance associated with severe, early-onset hypertension with decreased plasma levels of potassium, renin, and aldosterone
    • Renal tubular acidosis (RTA) – genetic disorder with autosomal recessive inheritance leading to a defect in H+ ion secretion in the renal tubular system and, as a result, bone demineralization (hypercalciuria and hyperphosphaturia/increased urinary excretion of calcium and phosphate) and hypokalemia (potassium deficiency)

Behavioral causes

  • Nutrition
    • Licorice abuse (aldosterone-like effect).
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients: Hypokalemia
  • Consumption of stimulants

Disease-related causes

Congenital malformations, deformities and chromosomal abnormalities (Q00-Q99).

  • EAST syndrome (synonym: SeSAME syndrome) – genetic disorder with autosomal recessive inheritance characterized by cerebral spasms, sensorineural hearing loss, ataxia (disturbance of movement coordination and postural innervation), retardation (delayed development), intellectual deficit, and electrolyte disturbances (hypokalemia, metabolic alkalosis (metabolic alkalosis), hypomagnesemia/magnesium deficiency); age of manifestation: Infancy, neonatal period

Endocrine, nutritional and metabolic disorders (E00-E90).

  • Alkalosis
  • Condition after compensation of metabolic acidosis/hyperacidity (e.g., in diabetic coma).
  • Conn syndrome (primary hyperaldosteronism) or secondary hyperaldosteronism (increased formation of aldosterone).
  • Bartter syndrome – very rare genetic metabolic disorder with autosomal dominant or autosomal recessive or X-linked recessive inheritance; defect tubular transport proteins; hyperaldosteronism (disease states associated with increased secretion of aldosterone), hypokalemia (potassium deficiency) and hypotension (low blood pressure).
  • Gitelman syndrome (GS; synonym: familial hypokalemia-hypomagnesemia) – genetic condition with autosomal recessive inheritance characterized by hypokalemic metabolic alkalosis (metabolic alkalosis with potassium deficiency) with marked hypomagnesemia (magnesium deficiency) and low urinary calcium excretion.
  • Hyperinsulinism – presence of elevated insulin levels in the blood (fasting insulin > 17 mU/l).
  • Hypomagnesemia (magnesium deficiency)
  • Cushing’s disease – group of diseases leading to hypercortisolism (hypercortisolism; excess of cortisol).

Infectious and parasitic diseases (A00-B99).

Circulatory system (I00-I99)

  • Liddle syndrome – very rare genetic disorder with autosomal dominant inheritance associated with severe, early-onset hypertension with decreased plasma levels of potassium, renin, and aldosterone.

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Musculoskeletal system and connective tissue (M00-M99).

  • Sjögren’s syndrome – autoimmune disease from the group of collagenoses leading to chronic inflammatory disease or destruction of the exocrine glands, with the salivary and lacrimal glands most commonly affected; including hypokalemia (potassium deficiency) with metabolic acidosis (metabolic acidosis), interstitial nephritis (kidney inflammation).

Psyche – nervous system (F00-F99; G00-G99).

  • Anorexia nervosa (anorexia nervosa)
  • Bulimia nervosa (BN) – also called binge eating disorder; belongs to the psychogenic eating disorders.
  • Paroxysmal muscle paralysis
  • Tremor (shaking)

Pregnancy, childbirth and puerperium (O00-O99)

  • Hyperemesis gravidarum (extreme morning sickness) – extreme vomiting during pregnancy.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Diarrhea (diarrhea)
  • Constipation (constipation)
  • Polydipsia (excessive fluid intake by drinking).
  • Polyuria (increased urination).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Acute renal failure (ANV)
  • Hypokalemic nephropathy (kidney disease) with impaired ability to concentrate, polyuria (increased urination), and polydipsia (excessive fluid intake through drinking)
  • Renal tubular acidosis (RTA) – genetic disease with autosomal recessive inheritance leading to a defect in H+ ion secretion in the tubular system of the kidney and, as a result, demineralization of bone (hypercalciuria and hyperphosphaturia/increased excretion of calcium and phosphate in the urine) and hypokalemia (potassium deficiency)

Other causes

Medication