The causes of hypokalemia include the following except-
I. Decreased intake A. Starvation B. Clay ingestion II. Redistribution into cells A. Acid-base 1. Metabolic alkalosis B. Hormonal 1. Insulin 2. Increased b2-adrenergic sympathetic activity: post-myocardial infarction, head injury 3. b2-Adrenergic agonists - bronchodilators, tocolytics 4. a-Adrenergic antagonists 5. Thyrotoxic periodic paralysis 6. Downstream stimulation of Na+/K+-ATPase: theophylline, caffeine C. Anabolic state 1. Vitamin B12 or folic acid administration (red blood cell production) 2. Granulocyte-macrophage colony-stimulating factor (white blood cell production) 3. Total parenteral nutrition D. Other 1. Pseudohypokalemia 2. Hypothermia 3. Familial hypokalemic periodic paralysis 4. Barium toxicity: systemic inhibition of "leak" K+ channels III. Increased loss A. Nonrenal 1. Gastrointestinal loss (diarrhea) 2. Integumentary loss (sweat) B. Renal 1. Increased distal flow and distal Na+ delivery: diuretics, osmotic diuresis, salt-wasting nephropathies 2. Increased secretion of potassium a. Mineralocoicoid excess: primary hyperaldosteronism (aldosterone- producing adenomas, primary or unilateral adrenalhyperplasia, idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia, and adrenal carcinoma), genetic hyperaldosteronism (familial hyperaldosteronism types I/II/III, congenital adrenal hyperplasias), secondary hyperaldosteronism (malignant hypeension, renin-secreting tumors, renal aery stenosis, hypovolemia), Cushing's syndrome, Bater's syndrome, Gitelman's syndrome b. Apparent mineralocoicoid excess: genetic deficiency of 11b-dehydrogenase-2 (syndrome of apparent mineralocoicoid excess), inhibition of 11b-dehydrogenase-2 (glycyrrhetinic/ glycyrrhizinic acid and/or carbenoxolone; licorice, food products, drugs), Liddle's syndrome (genetic activation of epithelial Na+ channels) c. Distal delivery of nonreabsorbed anions: vomiting, nasogastric suction, proximal renal tubular acidosis, diabetic ketoacidosis, glue-sniffing (toluene abuse), penicillin derivatives (penicillin, nafcillin, dicloxacillin, ticarcillin, oxacillin, and carbenicillin) 3. Magnesium deficiency (ref: harrisons ,19 E , PG -305)
Tamoxifen therapy
ACTH producing tumors
Non-bilious vomiting
Diabetic ketoacidosis
Fluid and electrolytes