Renal Case: 22-year-old Woman Complaining of Weakness

by Amy Sussman, MD

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    00:01 Let's go to our next case.

    00:03 We have a 22 year old woman who presented to her primary care provider complaining of weakness.

    00:07 Her exam is significant for a blood pressure of 105 over 70.

    00:11 Her laboratory evaluation demonstrated a potassium of 2.9 milli equivalents per liter.

    00:16 Her serum bicarbonate was 14 and we can see the normal is between 22 and 25.

    00:23 A potassium to creatinine ratio was 12 milliequivalents per gram.

    00:28 So the question is what is the most likely etiology of this woman's hypokalemia? Let's again go through our diagnostic algorithm to see if we can figure this out.

    00:38 So our first step we want to check the acid-based status.

    00:42 Is she alkalimic or is she acidemic? She has a serum bicarbonate of 14, so she has an acidosis.

    00:48 So I'm already thinking potential causes could either be a renal tubular acidosis.

    00:52 I cannot on reabsorbable anion or GI losses from the stool.

    00:58 So my second step I want to check that potassium to creatinine ratio.

    01:02 Here she's actually less than 15 Milli equivalents per gram of creatinine.

    01:06 Our kidneys are trying to conserve potassium.

    01:09 So this has to be a extrarenal loss.

    01:12 So if I think about extrarenal losses in association with a metabolic acidosis, then I really think about stool losses.

    01:19 So in this particular setting this patient likely has two losses and she could have potential laxative abuse.

    About the Lecture

    The lecture Renal Case: 22-year-old Woman Complaining of Weakness by Amy Sussman, MD is from the course Potassium Disorders: Hypo- and Hyperkalemia.

    Included Quiz Questions

    1. Blood pH < 7.35
    2. Potassium-to-creatinine ratio > 15 mEq/g
    3. Elevated blood pressure
    4. Serum bicarbonate > 25 mEq/L
    5. Serum potassium > 5.2 mEq/L

    Author of lecture Renal Case: 22-year-old Woman Complaining of Weakness

     Amy Sussman, MD

    Amy Sussman, MD

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