Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (10): 41-48.doi: 10.6040/j.issn.1671-7554.0.2021.0333

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Retrospective analysis of causes and clinical characteristics of 554 cases with hypokalemia in endocrinology department: a single-center study

FU Yilin, GUO Tian, GONG Ying, YAO Zhenyu, GUAN Qingbo, XU Chao, ZHOU Xinli, ZHANG Haiqing, ZHENG Dongmei, LIU Luna, ZHAO Jiajun   

  1. Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2021-10-15

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Abstract: Objective To explore the causes, clinical features and influencing factors of moderate to severe hypokalemia. Methods The clinical data of 554 hospitalized patients with hypokalemia treated in the Endocrinology Department of Shandong Provincial Hospital during Jan. 2006 and Dec. 2018 were retrospectively analyzed. The patients were divided into mild, moderate and severe groups according to the serum potassium levels. The influencing factors of hypokalemia were determined with Logistic regression analysis. Results The causes of hypokalemia were diabetes(n=109, 19.68%), hyperthyroidism(n=95,17.15%)and primary aldosteronism(n=64, 11.55%). With the severity of hypokalemia, the ratio of male, free triiodothyronine(FT3)and carbon dioxide combining power(CO2CP)increased, while age, total cholesterol(TC)level and low density lipoprotein-cholesterol(LDL-C)decreased. In Logistic regression analysis, except for hypokalemia caused by unknown causes, male(OR=2.071, P=0.001)was an influencing factor for moderate to severe hypokalemia, and patients with hyperthyroidism(OR=2.953, P<0.001), primary aldosteronism(OR=2.660, P=0.004), renal tubular acidosis(OR=4.967, P<0.001)and Gitelmans syndrome(OR=7.326, P=0.015)had a higher risk for the patients with moderate to severe hypokalemia than those with abnormal glucose metabolism. Conclusion Diabetes, hyperthyroidism and primary aldosteronism are influencing factors for hypokalemia. Gender and etiology are independent influencing factors for moderate to severe hypokalemia.

Key words: Hypokalemia, Endocrine metabolic disease, Etiology, Clinical characteristics, Related factor

CLC Number: 

  • R591.1
[1] Paice BJ, Paterson KR, Onyanga-Omara F, et al. Record linkage study of hypokalaemia in hospitalized patients[J]. Postgrad Med J, 1986, 62(725): 187-191.
[2] Gennari FJ. Hypokalemia[J]. N Engl J Med, 1998, 339(7): 451-458.
[3] Collins AJ, Pitt B, Reaven N, et al. Association of serum potassium with all-cause mortality in patients with and without heart Failure, chronic kidney disease, and/or diabetes[J]. Am J Nephrol, 2017, 46(3): 213-221.
[4] Paltiel O, Salakhov E, Ronen I, et al. Management of severe hypokalemia in hospitalized patients: a study of quality of care based on computerized databases[J]. Arch Intern Med, 2001,161(8):1089-1095.
[5] Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J]. J Am Soc Nephrol, 2006, 17(10): 2937-2944.
[6] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67.
[7] 中华医学会内分泌学分会肾上腺学组. 原发性醛固酮增多症诊断治疗的专家共识[J]. 中华内分泌代谢杂志, 2016, 32(3): 188-195.
[8] 中华医学会内分泌学分会. 库欣综合征专家共识(2011年)[J]. 中华内分泌代谢杂志, 2012, 28(2): 96-102.
[9] Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal Replacement in hypopituitarism in adults: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(11): 3888-3921.
[10] Knoers NV, Levtchenko EN. Gitelman syndrome[J]. Orphanet J Rare Dis, 2008, 3: 22. doi: 10.1186/1750-1172-3-22.
[11] 中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组. 中国甲状腺疾病诊治指南——甲状腺功能亢进症[J]. 中华内科杂志, 2007, 46(10): 876-882.
[12] Rodríguez Soriano J. Renal tubular acidosis: the clinical entity[J]. J Am Soc Nephrol, 2002, 13(8): 2160-2170.
[13] Fontenele R, Costa-Santos MKater CE. 17α-Hydroxylase deficiency is an underdiagnosed disease: high frequency of misdiagnoses in a large cohort of Brazilian patients[J]. Endocr Pract, 2018, 24(2): 170-178.
[14] Statland JM, Fontaine B, Hanna MG, et al. Review of the diagnosis and treatment of periodic paralysis[J]. Muscle Nerve, 2018, 57(4): 522-530.
[15] Schwartz WB, Bennett W, Curelop S, et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone[J]. Am J Med, 1957, 23(4): 529-542.
[16] Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes(KDIGO)[J]. Kidney Int, 2005, 67(6): 2089-2100.
[17] Kovesdy CP, Matsushita K, Sang Y, et al. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis[J]. Eur Heart J, 2018, 39(17): 1535-1542.
[18] Aldahl M, Jensen AC, Davidsen L, et al. Associations of serum potassium levels with mortality in chronic heart failure patients[J]. Eur Heart J, 2017, 38(38): 2890-2896.
[19] 万璐, 袁振芳, 郭晓蕙. 内分泌住院患者353例低钾血症病因分析[J]. 临床合理用药杂志, 2012, 21(5): 84-85. WAN Lu, YUAN Zhenfang, GUO Xiaohui, et al. Cause analysis of 353 cases of endocrine inpatients with hypokalemia[J]. Chinese Journal of Clinical Rational, 2012, 21(5): 84-85.
[20] 邢万佳, 顾欣, 曲卫, 等. 78例住院低钾血症患者病因及临床特点分析[J]. 山东医药, 2015, 55(6): 71-73.
[21] Kayal AK, Goswami M, Das M, et al. Clinical and biochemical spectrum of hypokalemic paralysis in North: East India[J]. Ann Indian Acad Neurol, 2013, 16(2): 211-217.
[22] Sotirakopoulos N, Kalogiannidou I, Tersi M, et al. Acid-base and electrolyte disorders in patients with diabetes mellitus[J]. Saudi J Kidney Dis Transplant, 2012, 23(1): 58-62.
[23] Chatterjee R, Yeh HC, Shafi T, et al. Serum and dietary potassium and risk of incident type 2 diabetes mellitus: the atherosclerosis risk in communities(ARIC)study[J]. Arch Intern Med, 2010, 170(19): 1745-1751.
[24] Meisinger C, Stöckl D, Rückert IM, et al. Serum potassium is associated with prediabetes and newly diagnosed diabetes in hypertensive adults from the general population: the KORA F4-Study[J]. Diabetologia, 2013, 56(3): 484-491.
[25] Sagild U, Andersen V, Andreasen PB. Glucose tolerance and insulin responsiveness in experimental potassium depletion[J]. Acta Med Scand, 1961, 169: 243-251. doi: 10.1111/j.0954-6820.1961.tb07829.x.
[26] Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review[J]. Hypertension, 2006, 48(2): 219-224.
[27] Ji W, Foo JN, ORoak BJ, et al. Rare independent mutations in renal salt handling genes contribute to blood pressure variation[J]. Nat Genet, 2008, 40(5): 592-599.
[28] Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, et al. Hypopituitarism[J]. Lancet, 2007, 369(9571): 1461-1470.
[29] Lim CH, Han JH, Jin J, et al. Electrolyte Imbalance in Patients with Sheehans Syndrome[J]. Endocrinol Metab(Seoul), 2015, 30(4): 502-508.
[30] Shinde SD, Sabnis GR, Lanjewar CP, et al. A rare endocrine cause of electrical storm-a case report[J]. Eur Heart J Case Rep, 2017, 1(2): ytx008. doi: 10.1093/ehjcr/ytx008.
[31] Cao LJ, Lu ZH, Zheng Y. Sheehans syndrome with cardiac arrest: a case report and review of the literature[J]. Neuro Endocrinology Letters, 2014, 35(5): 352-354.
[32] Lanzi R, Previtali SC, Sansone V, et al. Hypokalemic periodic paralysis in a patient with acquired growth hormone deficiency[J]. J Endocrinol Invest, 2007, 30(4): 341-345.
[33] Hawkins RC. Gender and age as risk factors for hypokalemia and hyperkalemia in a multiethnic Asian population[J]. Clinica Chimica Acta, 2003, 331(1-2): 171-172.
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