Cause Analysis And Control Measures For155Cases Of Patients With Hypokalemia

ObjectiveTo sumrhary the etiology, clinical manifestations and conventional diagnostic methods of hypokalemia retrospectively;To analyze the features and diagnosis of endocrine related hypokalemia;To discuss Diagnostic errors of Hypokalemia;To propose the control measures of hypokalemia in clinical and nursing.MethodsCollected155patients of hypokalemia from January2009to December2010(Male87,female68, aged14to84years,mean age42.43±13.73,duration from16hours to20years);Statistic the patient's general information, clinical presentation and examination results;Focus on analysis of the results of patient's activity of rennin-angiotensin Ⅱ-aldosterone system (RAS),stimulated furosemide experiment, vertical and horizontal tests,spironolactone experiments,calcium chloride load test,overnight dexamethasone (lmg,8mg) inhibition test,Thin-enhanced CT scan of adrenal,pituitary magnetic resonance imaging (MRI),CTA of renal artery,renal biopsy and surgical pathology report. ResultsPrimary aldosteronism is a major cause of hypokalemia (55,35.48%); Followed by Hypokalemic periodic paralysis (41,26.45%), Bartter syndrome (16,10.32%), renal tubular acidosis (11,7.10%), drug-induced hypokalemia (10,6.45%), panic disorder induced(6,3.87%), Gitelman syndrome (3,1.94%), gastrointestinal loss of potassium (2,1.29%); intake, ectopic ACTH syndrome, Cushing syndrome, pheochromocytoma, diabetic ketoacidosis (1,0.65%, respectively); unknown person (6,3.87%). In patients with primary aldosteronism, ARR average of48.83±40.12ng.ml-1h-1, which ARR>20were63.89%, ARR>50were47.22%; potassium range of2.46±0.52mmol/L; blood pressure range:systolic blood pressure181.11±23.97mmHg, diastolic blood pressure106.86±11.87mmHg. There were40cases of adrenal masses in patients, of which32patients were resected (19females,13males). In the surgical patients,29patients with hypertension, of which left adrenal adenoma in15cases, the right adrenal gland adenoma in9cases, adenomatous hyperplasia in2cases, bilateral adenoma in2cases, pheochromocytoma in1case.ConclusionMany causes led to hypokalemia, mainly of primary aldosteronism and periodic paralysis. Through the systematic Inspection, special stimulation test, imaging analysis, and clinical manifestations, to make an accurate diagnosis and treatment of typical cases is not too difficult. However, in clinical practice, also need to pay special attention to the cause of atypical cases, such as Bartter syndrome, drug-induced hypokalemia, Sjogren's syndrome, panic disorder, Gitelman syndrome and unexplained diagnosis and treatment of patients.