Identification of the Causes for Chronic Hypokalemia: Importance of Urinary Sodium and Chloride Excretion Kun-Lin Wu, MD, Chih-Jen Cheng, MD, PhD, Chih-Chen.

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Identification of the Causes for Chronic Hypokalemia: Importance of Urinary Sodium and Chloride Excretion Kun-Lin Wu, MD, Chih-Jen Cheng, MD, PhD, Chih-Chen Sung, MD, Ming-Hua Tseng, MD, Yu-Juei Hsu, MD, PhD, Sung-Sen Yang, MD, PhD, Tom Chau, MD, Shih-Hua Lin, MD The American Journal of Medicine Volume 130, Issue 7, Pages 846-855 (July 2017) DOI: 10.1016/j.amjmed.2017.01.023 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 Breakdown of patients referred for normotensive hypokalemia. The American Journal of Medicine 2017 130, 846-855DOI: (10.1016/j.amjmed.2017.01.023) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Transtubular potassium gradient (TTKG) (A), urine K+/Cr ratio (B), and urine Ca2+/Cr ratio (C) in different groups with hypokalemia. On and off action of diuretics is also shown. *Denotes P <.05 compared with other 5 subgroups. The American Journal of Medicine 2017 130, 846-855DOI: (10.1016/j.amjmed.2017.01.023) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 Urine Na+ and Cl− concentrations (A) with FeNa+ and FeCl− (B) in different groups with hypokalemia. There was high urine Na+ and low Cl− in anorexia/bulimia nervosa, low Na+ and high Cl− in surreptitious laxative use, and roughly equivalent urine Na+ and Cl− excretion in the other 4 subgroups. However, high to low urine Na+ and Cl− excretion reflected the diuretic effect with on and off action. The American Journal of Medicine 2017 130, 846-855DOI: (10.1016/j.amjmed.2017.01.023) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 4 Urine Na+/Cl− ratio (A) and FeNa+/FeCl− ratio (B) in different groups with hypokalemia. Urine Na+/Cl− and FeNa+/FeCl− ratio were elevated in anorexia/bulimia nervosa, depressed in surreptitious laxative use, fixed in on and off action of surreptitious diuretic use and close to 1 in renal tubular disorders. *Denotes P <.05 compared with other 5 subgroups. #Denotes P <.05 compared with renal tubular disorders. The American Journal of Medicine 2017 130, 846-855DOI: (10.1016/j.amjmed.2017.01.023) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 5 Receiver operating characteristic curves for the diagnosis of anorexia/bulimia nervosa (A) and laxative use (B). The American Journal of Medicine 2017 130, 846-855DOI: (10.1016/j.amjmed.2017.01.023) Copyright © 2017 Elsevier Inc. Terms and Conditions