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Urinary sodium/chloride excretion vital in diagnosis, treatment of chronic hypokalemia

29 Jun 2017
Mobile phone battery running low? Charge it with your pee!

To make an accurate diagnosis and treatment plan for patients with chronic normotensive hypokalemia, it is important to include an integrated interpretation of the urine sodium (Na+) and chloride (Cl) excretion and their ratio apart from body mass index (BMI), sex and blood acid-base status, suggests a recent study.

Researchers identified clinical and laboratory parameters helpful for differentiating the causes of chronic hypokalemia by prospectively enrolling normotensive patients (n=99; serum potassium [K+], 2.8 mmol/L; duration 4.1 years) referred to a tertiary academic medical centre over 5 years. They determined clinical features and laboratory examinations, including blood and spot urine electrolytes, acid-base status, biochemistries and hormones.

The most common complaints were neuromuscular symptoms. The predominant renal tubular disorders were Gitelman syndrome (n=33), Bartter syndrome (n=10) and distal renal tubular acidosis (n=12), but 44 patients were diagnosed with anorexia/bulimia nervosa (n=21), surreptitious use of laxatives (n=11) or diuretics (n=12). Patients with gastrointestinal causes and surreptitious diuretics use were predominantly female, had lower BMI and less K+ supplementation.

All patients with renal tubular disorders had high urine K+ excretion (transtubular potassium gradient >3; urine K+/Cr >2 mmol/mmol), which was also found in >50 percent of patients with gastrointestinal causes.

Urine Na+ and Cl excretions were high and coupled (urine Na+/Cl ratio 1) in renal tubular disorders and “on” diuretics use, whereas skewed or uncoupled urine Na+ and Cl excretions were observed in anorexia/bulimia nervosa and laxatives abuse (urine Na+/Cl ratio, 5.0 and 0.4, respectively) and low urine Na+ and Cl excretions with fixed Na+/Cl ratios (0.9) when “off” diuretics.

The findings suggest that integrated interpretation of Na+/Cl excretion and ratio is critical in correctly diagnosing chronic hypokalemia with K+ wasting from the kidneys or gut.

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Most Read Articles
Roshini Claire Anthony, 6 days ago

Treatment failure in osteoporosis remains a problem, even among patients who are treatment-adherent, according to a presentation at the recent meeting of the Asian Federation of Osteoporosis Societies (AFOS 2017), held in Kuala Lumpur, Malaysia. 

Elvira Manzano, 5 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
2 days ago
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.