A hidden cause of hypokalemia
Open accessAbstract
A hidden cause of hypokalemiaA 21-year-old-man presented to the emergency department with increasing fatigue and psychosis symptoms.He had experienced no nausea, vomiting, diarrhea, chest pain, dyspnea, or urinary symptoms.He was not on any prescribed or over-the-counter medications or herbal supplements, and he denied smoking and alcohol consumption.Recently, he observed a 20-lb weight gain over 6 weeks.On examination, the patient was alert and oriented, with clear lungs on auscultation.His temperature was 37.0°C (98.6°F), heart rate 60 beats per minute, respiratory rate 11 breaths per minute, oxygen saturation 98% on room air, blood pressure 153/92 mm Hg, and body mass index 34 kg/m2.Cardiovascular and gastrointestinal fi ndings were unremarkable, and there were no focal neurologic abnormalities.Striae were noted over his abdomen and back.Initial laboratory test results are listed in Table 1. ■ EVALUATION OF THE METABOLIC DISORDER1 What is the most appropriate next step in investi- gating this patient's acid-base disorder?□ Random urine potassium □ Random urine chloride □ Random urine sodium □ Random urine urea
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Written from the paper’s full text.
TL;DR
A 21-year-old man presenting with fatigue, psychosis symptoms, hypertension, and hypokalemia was found to have chloride-resistant metabolic alkalosis with suppressed renin and aldosterone, ultimately diagnosed with ectopic ACTH syndrome from a pulmonary carcinoid tumor. The case illustrates a stepwise workup of metabolic alkalosis and hypokalemia, ending with tumor resection that resolved the hypokalemia and hypertension.
Key findings
- Initial labs showed potassium 2.5 mmol/L, bicarbonate 34 mEq/L, pH 7.55, sodium 143 mmol/L, glucose 127 mg/dL, and blood pressure 153/92 mm Hg with BMI 34 kg/m² and abdominal/back striae.
- Urine chloride was 34 mmol/L (chloride-/volume-resistant alkalosis); spot urine potassium-to-creatinine ratio was 43.5 mmol/g (values > 15 mmol/g indicate renal potassium loss) and fractional excretion of potassium was > 9.3%, consistent with inappropriate renal potassium wasting.
- Renin was < 0.1 ng/mL per hour (0.5–4) and aldosterone 3.1 ng/dL (4–31), indicating suppressed renin-aldosterone; morning cortisol was 49.5 μg/dL, 24-hour urinary cortisol 5,904.8 μg/24 hours, and ACTH 258 pg/mL.
- High-dose dexamethasone suppression produced < 50% suppression (66.7 → 45.2 μg/dL), suggesting ectopic ACTH; IPSS indicated a nonfunctional pituitary adenoma, and gallium-68 dotatate PET identified a left lung perihilar nodule. Resection revealed a 1.2-cm typical carcinoid tumor immunohistochemically labeled with ACTH, after which ACTH levels decreased and hypokalemia and hypertension resolved.
Methods
- Single-patient case report structured as a five-question diagnostic quiz (Cleveland Clinic Journal of Medicine case format), with each question followed by discussion of the differential diagnosis.
- Diagnostic workup included arterial blood gas analysis, spot and 24-hour urine electrolytes, serum renin/aldosterone/magnesium, cortisol hormone studies, high-dose dexamethasone suppression testing, CT of chest/abdomen/pelvis, brain MRI, bilateral inferior petrosal sinus sampling, and gallium-68 dotatate PET.
- Management described: eplerenone plus metyrapone with potassium supplements while awaiting resection, followed by surgical removal of the lung nodule.
Limitations
- Not stated in the paper: the article does not include a formal limitations section.
- Evident from the text: this is a single case report, so the diagnostic sequence and treatment response described are not generalizable; the authors also note that a 5-mm pituitary adenoma could theoretically have produced the observed cortisol excess despite normal CT of the chest, abdomen, and pelvis, and that nonfunctioning pituitary adenomas occur at an estimated prevalence of approximately 7 to 41.3 per 100,000, which complicates interpretation of the imaging finding.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
0 of 13 cited sources checked · 0 supported · 0 flagged
- Findingown data§ ■ EVALUATION OF THE METABOLIC DISORDER · p. 1
The patient had primary metabolic alkalosis with respiratory compensation, based on blood gas analysis showing pH 7.55, bicarbonate 34 mEq/L, and PaCO2 42 mm Hg.
“Our patient's blood gas analysis revealed a pH of 7.55 (indicating alkalemia), an elevated serum bicarbonate level of 34 mEq/L (suggesting a metabolic process), and an elevated partial pressure of carbon dioxide at 42 mm Hg (suggesting respiratory compensation).”
- Also stated in: § ■ EVALUATION OF THE METABOLIC DISORDER · p. 1 · plain
“he was diagnosed with primary metabolic alkalosis with respiratory compensation.”
Quote in the paperSubstantial claim - Also stated in: § ■ EVALUATION OF THE METABOLIC DISORDER · p. 1 · plain
- Findingown data§ ■ CASE CONTINUED: HORMONE TESTING · p. 4
Computed tomography with intravenous contrast of the chest, abdomen, and pelvis did not identify an ectopic source of ACTH production.
“Computed tomography with intravenous contrast of the chest, abdomen, and pelvis did not identify an ectopic source of ACTH production.”
Quote in the paperSubstantial claim - Findingcitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2
The patient's fractional excretion of potassium was greater than 9.3%, indicative of inappropriate renal potassium wasting in the context of hypokalemia.
“The fractional excretion of potassium was greater than 9.3%, indicative of inappropriate renal potassium wasting in the context of hypokalemia. 2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. Li J, Ma H, Lei Y, Wan Q. Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia. Clin Chim Acta 2020; 511:221-226. doi:10.1016/j.cca.2020.10.024 <!-- image -->
Not checked in the free run.
- Findingown data§ ■ CASE CONTINUED · p. 5
Gallium-68 dotatate positron emission tomography revealed an anomalous tracer-avid left lung perihilar nodule with somatostatin receptor positivity.
“Our patient then underwent gallium-68 dotatate positron emission tomography, revealing an anomalous tracer-avid left lung perihilar nodule with somatostatin receptor positivity ( Figure 3 ).”
Quote in the paperSubstantial claim - Findingown data§ ■ CASE CONTINUED: HORMONE TESTING · p. 4
Magnetic resonance imaging of the brain revealed a 5-mm pituitary adenoma.
“Magnetic resonance imaging of the brain revealed a 5-mm pituitary adenoma ( Figure 2 ).”
Quote in the paperSubstantial claim
- Findingcitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2
The patient's spot urine potassium-to-creatinine ratio was 43.5 mmol/g, indicating renal potassium loss (values >15 mmol/g indicate renal potassium loss).
“The patient's spot urine potassium-to-creatinine ratio was 43.5 mmol/g (values > 15 mmol/g indicate renal potassium loss). 2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. Li J, Ma H, Lei Y, Wan Q. Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia. Clin Chim Acta 2020; 511:221-226. doi:10.1016/j.cca.2020.10.024 <!-- image -->
Not checked in the free run.
- Findingcitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2
The patient's 24-hour urine collection was consistent with renal potassium loss.
“A 24-hour urine collection, the most accurate measurement of urinary potassium excretion, also was consistent with renal potassium loss. 2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] 2. Li J, Ma H, Lei Y, Wan Q. Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia. Clin Chim Acta 2020; 511:221-226. doi:10.1016/j.cca.2020.10.024 <!-- image -->
Not checked in the free run.
- Findingown data§ CASE CONCLUSION · p. 6
Surgical pathology revealed a 1.2-cm typical carcinoid tumor immunohistochemically labeled with ACTH.
“Surgical pathology revealed a 1.2-cm typical carcinoid tumor immunohistochemically labeled with ACTH.”
Quote in the paperSubstantial claim - Premisereasoning§ ■ EVALUATION OF THE METABOLIC DISORDER · p. 1
In cases of alkalemia, urine chloride is a more reliable indicator of intravascular volume depletion than urine sodium.
“In cases of alkalemia, urine chloride is a more reliable indicator of intravascular volume depletion than urine sodium.”
Quote in the paperSubstantial claim - Premisecitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 3
Hypomagnesemia can induce hypokalemia by its effects on the renal outer medullary potassium channel, leading to increased potassium excretion through the apical tubular membrane.
“Hypomagnesemia can induce hypokalemia by its effects on the renal outer medullary potassium channel, leading to increased potassium excretion through the apical tubular membrane. 5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5]
Not checked in the free run.
- Premisecitation§ ■ EVALUATION OF THE METABOLIC DISORDER · p. 1
Urine chloride level is crucial to differentiate volume-responsive (urine chloride <20 mmol/L) from volume-resistant (urine chloride ≥20 mmol/L) metabolic alkalosis.
“The urine chloride level is crucial to differentiate volume-responsive (urine chloride < 20 mmol/L) from volume-resistant (urine chloride ≥ 20 mmol/L) metabolic alkalosis. 1”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] 1. Emmett M. Metabolic alkalosis: a brief pathophysiologic review. Clin J Am Soc Nephrol 2020; 15(12):1848-1856. doi:10.2215/CJN.16041219
Not checked in the free run.
- Premisecitation§ ■ NEXT STEPS IN MANAGEMENT OF HYPERCORTISOLISM · p. 5
Bilateral IPSS is the definitive test to distinguish between pituitary and ectopic ACTH-dependent Cushing syndrome.
“Bilateral IPSS is the defi nitive test to distinguish between pituitary and ectopic ACTH-dependent Cushing syndrome. 18”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18]
Not checked in the free run.
- Interpretationreasoning§ ■ EVALUATION OF THE METABOLIC DISORDER · p. 1
The patient's hypokalemia, metabolic alkalosis, and serum sodium concentration in the upper normal range suggest a volume-expanded form of metabolic alkalosis.
“Our patient's hypokalemia, metabolic alkalosis, and serum sodium concentration in the upper normal range suggest a volume-expanded form of metabolic alkalosis.”
Quote in the paperSubstantial claim - Interpretationown data§ ■ CASE CONTINUED · p. 5
The PET finding of a tracer-avid left lung perihilar nodule with somatostatin receptor positivity conclusively established the diagnosis of a pulmonary carcinoid tumor.
“This fi nding conclusively established the diagnosis of a pulmonary carcinoid tumor.”
Quote in the paperSubstantial claim
- May combine two claims. 10
- Classified as probably not a substantial claim. 5
May combine two claims.
Findingown data§ ■ CASE CONTINUED: FURTHER TESTING · p. 3Further testing revealed a serum renin level less than 0.1 ng/mL per hour, serum aldosterone level 3.1 ng/dL, and serum magnesium level 2.0 mg/dL.
“Further testing revealed a serum renin level less than 0.1 ng/mL per hour (0.5-4), serum aldosterone level 3.1 ng/dL (4-31), and serum magnesium level 2.0 mg/dL (1.7-2.2).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2The patient had chloride-resistant (volume-resistant) metabolic alkalosis along with hypokalemia, with a urine chloride level of 34 mmol/L.
“With a urine chloride level of 34 mmol/L, this patient had chloride-resistant (or volume-resistant) metabolic alkalosis along with hypokalemia.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ CASE CONCLUSION · p. 6After the tumor was removed, ACTH levels decreased, leading to resolution of both hypokalemia and hypertension.
“After the tumor was removed, ACTH levels decreased, leading to resolution of both hypokalemia and hypertension.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2Given the presence of chloride-resistant metabolic alkalosis, renal potassium wasting, and hypertension, the most prudent next step was to assess the patient's renin and aldosterone levels.
“Given the presence of chloride-resistant metabolic alkalosis, renal potassium wasting, and hypertension, the most prudent next step would be to assess the patient's renin and aldosterone levels.”
Quote in the paperSubstantial claim- Rests on an assumption: Diuretic abuse commonly induces hypokalemia through renal wasting and may lead to chloride-resistant metabolic alkalosis, but patients typically exhibit hypotension or are not hypertensive.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2Gitelman syndrome is characterized by mutations in the SLC12A3 gene, leading to defects in the thiazide-sensitive sodium-chloride co-transporter in the distal convoluted tubule, resulting in excessive salt and water loss, leading to hypokalemia, metabolic alkalosis, and hypomagnesemia.
“Gitelman syndrome is characterized by mutations in the SLC12A3 gene, leading to defects in the thiazide-sensitive sodium-chloride co-transporter in the distal convoluted tubule. This results in excessive salt and water loss, leading to hypokalemia, metabolic alkalosis, and hypomagnesemia. 3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3]
Not checked in the free run.
May combine two claims.
Premisereasoning§ ■ METABOLIC ALKALOSIS WITH INHIBITED SERUM ALDOSTERONE AND RENIN ACTIVITY · p. 4Cushing disease and Cushing syndrome are associated with chloride-resistant metabolic alkalosis, hypokalemia, hypertension, and low serum renin and aldosterone levels.
“Consequently, both Cushing disease and Cushing syndrome are associated with chloride-resistant metabolic alkalosis, hypokalemia, hypertension, and low serum renin and aldosterone levels. 13”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ ■ NEXT STEPS IN MANAGEMENT OF HYPERCORTISOLISM · p. 5The prevalence of nonfunctioning pituitary adenomas in the population is estimated to be approximately 7 to 41.3 per 100,000.
“The prevalence of nonfunctioning pituitary adenomas in the population is estimated to be approximately 7 to 41.3 per 100,000. 19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ ■ EVALUATION OF HYPOKALEMIA IN VOLUMERESISTANT METABOLIC ALKALOSIS · p. 2Bartter syndrome involves mutations in genes affecting the thick ascending limb of the loop of Henle, causing impaired sodium reabsorption, leading to an electrolyte imbalance similar to that seen in Gitelman syndrome, but with hypercalciuria.
“Bartter syndrome involves mutations in genes affecting the thick ascending limb of the loop of Henle, causing impaired sodium reabsorption. This leads to an electrolyte imbalance similar to that seen in Gitelman syndrome, but with hypercalciuria. 4”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ ■ METABOLIC ALKALOSIS WITH INHIBITED SERUM ALDOSTERONE AND RENIN ACTIVITY · p. 4Liddle syndrome is characterized by an overactive epithelial sodium channel, resulting in excessive sodium reabsorption and potassium excretion, leading to chloride-resistant metabolic alkalosis, hypokalemia, hypertension, and low serum renin and aldosterone levels.
“This condition is characterized by an overactive epithelial sodium channel, resulting in excessive sodium reabsorption and potassium excretion, leading to chloride-resistant metabolic alkalosis, hypokalemia, hypertension, and low serum renin and aldosterone levels. 10”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10]
Not checked in the free run.
May combine two claims.
Premisecitation§ ■ METABOLIC ALKALOSIS WITH INHIBITED SERUM ALDOSTERONE AND RENIN ACTIVITY · p. 4Glucocorticoid-remediable aldosteronism is a cause of volume-resistant metabolic alkalosis, but aldosterone levels are elevated, distinguishing it from the other causes being considered.
“While glucocorticoidremedial aldosteronism is a cause of volume-resistant metabolic alkalosis, aldosterone levels are elevated in this condition, distinguishing it from the other causes being considered. 14”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14]
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ ■ CASE CONTINUED · p. 5The findings from IPSS indicated a nonfunctional adenoma, supporting the diagnosis of an ectopic ACTH source as the root cause of hypercortisolism.
“The fi ndings from IPSS indicated a nonfunctional adenoma, supporting the diagnosis of an ectopic ACTH source as the root cause of hypercortisolism.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ ■ TREATING HYPERTENSION IN ECTOPIC ADRENOCORTICOTROPIC SYNDROME · p. 6Eplerenone is effective in managing hypertension in Cushing syndrome and can ameliorate aldosterone-mediated metabolic alkalosis and hypokalemia.
“Eplerenone is effective in managing hypertension in Cushing syndrome and can ameliorate aldosterone-mediated metabolic alkalosis and hypokalemia. 22”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22]
Not checked in the free run.
The paper relies on this without support.
Diuretic abuse commonly induces hypokalemia through renal wasting and may lead to chloride-resistant metabolic alkalosis, but patients typically exhibit hypotension or are not hypertensive.
“While diuretic abuse commonly induces hypokalemia through renal wasting and may lead to chlorideresistant metabolic alkalosis, patients typically exhibit hypotension or, at minimum, are not hypertensive.”
The paper relies on this without support.
Most patients with Gitelman and Bartter syndromes have normal to low blood pressure, but hypertension can be observed in certain instances.
“Most patients with these syndromes have normal to low blood pressure, but hypertension can be observed in certain instances.”
The paper relies on this without support.
In Gitelman and Bartter syndromes, reduction of extracellular fluid volume increases renin and aldosterone production, leading to hyperreninemia and secondary hyperaldosteronism.
“In Gitelman and Bartter syndromes, reduction of the extracellular fl uid volume increases renin and aldosterone production, leading to hyperreninemia and secondary hyperaldosteronism.”
The paper relies on this without support.
Ectopic ACTH syndrome, though rare, accounts for a minority of Cushing syndrome cases; neuroendocrine tumors are the most common cause of ectopic ACTH syndrome.
“Ectopic ACTH syndrome, though rare, accounts for a minority of Cushing syndrome cases. While ectopic ACTH syndrome is associated with various malignancies, neuroendocrine tumors are the most common cause.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Urine chloride is reported as both 34 and 35 mmol/L
MinorThe narrative gives a urine chloride level of 34 mmol/L, while Table 2 reports 35 mmol/L for the same patient's random urine chloride.
“With a urine chloride level of 34 mmol/L, this patient had chloride-resistant (or volume-resistant) metabolic alkalosis along with hypokalemia.”
“| Urine chloride, random (30-260 mmol/L) | 35 |”
Expected carbon dioxide calculation does not match the stated formula
MinorSubstituting the patient's bicarbonate level into the stated formula gives 0.7 × (34 + 20) = 37.8 mm Hg, not 44 mm Hg. The measured value of 42 mm Hg remains within the corrected ±5 range.
“The patient's partial pressure of carbon dioxide was within the expected range, which in metabolic alkalosis can be calculated using the following formula: 0.7 × (bicarbonate level + 20) ± 5.”
“Our patient's values were 0.7 × (34 + 20) = 44 ± 5”
Cites
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“20 Metyrapone should not be started until all diagnostic evaluations are completed because it may infl uence the results of IPSS.”
Mechanism of Hypokalemia in Magnesium Deficiency
Huang, C.-L., & Kuo, E. (2007) · Journal of the American Society of Nephrology · doi:10.1681/asn.2007070792 · Cited by 432 · see citing works
Hypercortisolemia and depression
Gillespie, C. F., & Nemeroff, C. B. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000163456.22154.d2 · Cited by 361 · cited 1× · see citing works
“17 Consequently, depression appeared less probable in our patient.”
Licorice-Induced Hypermineralocorticoidism
Farese, R. V., Biglieri, E. G., Shackleton, C. H. L., Irony, I., & Gomez-Fontes, R. (1991) · New England Journal of Medicine · doi:10.1056/nejm199110243251706 · Cited by 293 · see citing works
Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas
Ntali, G., & Wass, J. A. H. (2018) · Pituitary · doi:10.1007/s11102-018-0869-3 · Cited by 283 · cited 1× · see citing works
“19 Given the presence of a pituitary adenoma and the inability to identify an ectopic source of ACTH production, we proceeded with IPSS to differentiate between pituitary and ectopic ACTH–dependent Cushing syndrome.”
Stewart, P. M., Walker, B., Holder, G., O’Halloran, D., & Shackleton, C. H. L. (1995) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.80.12.8530609 · Cited by 174 · cited 1× · see citing works
“13 Glucocorticoid-remediable aldosteronism , also referred to as familial hyperaldosteronism type I, is an autosomal dominant condition marked by adrenocorticotropic hormone (ACTH)–sensitive aldosterone production in the zona fasciculata.”
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Bilateral inferior petrosal sinus sampling
Zampetti, B., Grossrubatscher, E., Dalino Ciaramella, P., Boccardi, E., & Loli, P. (2016) · Endocrine Connections · doi:10.1530/ec-16-0029 · Cited by 130 · cited 4× · see citing works
“18 If the presence of a functional pituitary adenoma is confi rmed on IPSS, the patient should be referred to neurosurgery for adenoma resection.”
InfluentialPsychiatric Phenomenology in Cushing's Disease
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“16 Although elevated cortisol levels can also be associated with depression, the concurrent presence of metabolic alkalosis, hypertension, and hypokalemia is highly unusual in cases of depression.”
Approach to the Patient: Diagnosis of Cushing Syndrome
Savas, M., Mehta, S., Agrawal, N., van Rossum, E. F. C., & Feelders, R. A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac492 · Cited by 91 · cited 1× · see citing works
“11 Elevated levels of circulating cortisol overpower the activity of 11 β -HSD2, enabling cortisol to exert its mineralocorticoid effect on the collecting ducts.”
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“15 The high-dose dexamethasone suppression test resulted in less than 50% suppression of serum cortisol, with a baseline of 66.7 μg/dL dropping to 45.2 μg/dL after an 8-mg dose of dexamethasone was administered.”
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“12 This results in sodium resorption and potassium excretion.”
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“6 Additionally, inhibition of 11 β -HSD2 by substances such as licorice products 6–9 and certain antifungal agents such as posaconazole and itraconazole 8,9 can mimic the effects of SAME.”
Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia
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“6 Additionally, inhibition of 11 β -HSD2 by substances such as licorice products 6–9 and certain antifungal agents such as posaconazole and itraconazole 8,9 can mimic the effects of SAME.”
Flagged first, then by citations
Cited by
Sorted by citations
Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms
Qing, G., Zakaria, W. N. A., Rom, F. Z. M., Nik, W. N. F. H. W., Zulkeflee, H. A., & Rahim, S. N. A. (2025) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2554 · Cited by 5 · see citing works
“This increases sodium reabsorption and potassium excretion, contributing to hypokalemia [47,48].”
- Authors
- Haq, K., Hannouneh, Z. A., Cervantes, C. E., & Hanouneh, M.
- Affiliations
- Johns Hopkins University (US)
- Al Andalus University (SY)
- Venue
- Cleveland Clinic Journal of Medicine
- Publisher
- Cleveland Clinic Journal of Medicine
- Published
- 2024-06
- Volume
- 91
- Issue
- 6
- Pages
- 345-351
- ISSN
- 0891-1150 (ISSN-L)
- 1939-2869
- OpenAlex
- W4399288142
- Cited by
- 1
- References
- 22
- Citations by year
- 2025: 1
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Cleveland Clinic Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Surgery › Medical Case Reports and Studies
- Keywords
- hypokalemia, metabolic acidosis, urinary electrolytes, urinary potassium, urine chloride, urinary sodium, urine urea, psychosis, weight gain, obesity, abdominal striae, differential diagnosis
- MeSH terms
- Female, Humans, Hypokalemia, Male, Middle Aged, Young Adult
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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