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Potassium, Urine


Definition


  • Urinary potassium levels are helpful in the evaluation of patients with unexplained hypokalemia, electrolyte, and acid " “base balance. In the presence of such hypokalemia, urine excretion is helpful to separate renal from nonrenal losses. Excretion <20 mmol/24 hours is evidence that hypokalemia is not from renal loss. Renal loss >50 mmol/L in a hypokalemic, and hypertensive patient not on a diuretic may indicate primary or secondary aldosteronism.
  • Normal range:
    • Twenty-four " “hour urine:
      • Male:
        • Less than 10 years: 17 " “54 mmol/day
        • 10 " “14 years: 22 " “57 mmol/day
        • Greater than 14 years: 25 " “125 mmol/day
      • Female:
        • 6 " “10 years: 8 " “37 mmol/day
        • 10 " “14 years: 18 " “58 mmol/day
        • Greater than 14 years: 25 " “125 mmol/day
  • Random urine:
    • Male: 13 " “116 mmol/g creatinine
    • Female: 8 " “129 mmol/g creatinine

Use


  • Evaluation of patients with unexplained hypokalemia, electrolyte, and acid " “base balance.

Interpretation


Increased In


  • Dehydration
  • Primary and secondary aldosteronism
  • Diabetic acidosis
  • Mercurial and thiazide diuretic administration
  • Ammonium chloride administration
  • Renal tubular acidosis
  • Chronic renal failure
  • Starvation
  • Cushing syndrome

Decreased In


  • Acute renal failure
  • Malabsorption
  • Chronic potassium deficiency states
  • Addison disease
  • Severe GN
  • Pyelonephritis
  • Nephrosclerosis

Limitations


  • Urinary potassium may be elevated with dietary (food and/or medicinal) increase, hyperaldosteronism, renal tubular acidosis, onset of alkalosis, and with other disorders.
  • Urine chloride is often ordered with sodium and potassium as timed urine. The urinary anion gap [Na+ ข ˆ ’ (Cl ข ˆ ’ + HCO3 ข ˆ ’]) or [(Na+ + K+) ข ˆ ’ (Cl ข ˆ ’)] is useful in the initial evaluation of hyperchloremic metabolic acidosis.
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