Aldosterone Response in Severe Hypokalemia and Volume Depletion: A Case Report and Review of the Recent Research

Abstract

We report a case of severe hypokalemia and volume depletion complicated by chronic watery diarrhea resulting from chronic alcoholism in a 57-year-old man. Prompt replacement of normal saline with potassium chloride and cessation of alcohol intake resulted in a favorable outcome. We discuss the pathophysiology of the case, emphasizing the response of aldosterone in both hypokalemia and volume depletion, and provide a review of recent research.

Hypokalemia, how to clarify and treat: a review article

“…Aldosterone also increases the amiloride sensitive sodium channels (ENaCs) in the apical membrane of the CCD and stimulates the secretion of H+ ions by the intercalated CCD cells, thereby affecting the acid-base balance. 5,6 Extrarenal potassium regulation mechanism…”

“…Aldosterone activates ENaC channels in principal cells through various mechanisms, thereby stimulating the Na+-K+-ATPase pump to excrete K+ with the consequent increase in Na+ retention and K+ secretion. 2,3,6 Glucocorticoids such as hydrocortisone, prednisone, and prednisolone do not directly interfere with renal K+ excretion. Glucocorticoids usually have the potential to cause hypokalemia when administered at doses that produce minimal mineralocorticoid stimulation.…”

“…If it is higher than 20, further confirmatory tests such as oral Na+ test, saline infusion test, fludrocortisone suppression test are no longer needed. 2,5,6 Putri LAMPD et al Int J Adv Med. 2023 Nov;10(11) For confirmation, in the case of patients with hypertension, who are at high risk for primary hyperaldosteronism, hypertension with incidental adrenaloma, and a family history of early onset hypertension or cerebrovascular accident), should be examined for the ratio of plasma aldosterone concentration to plasma renin activity.…”

“…2023 Nov;10(11) For confirmation, in the case of patients with hypertension, who are at high risk for primary hyperaldosteronism, hypertension with incidental adrenaloma, and a family history of early onset hypertension or cerebrovascular accident), should be examined for the ratio of plasma aldosterone concentration to plasma renin activity. Adrenal computerized tomography scan is recommended in all patients with PA. Genetic testing for glucocorticoidremediable aldosterone (GRA) is recommended in patients with confirmed PA starting before age 20 years old or with a family history of PA. 2,6 Arterial blood gas (ABG) analysis should be performed to detect metabolic acidosis or alkalosis. It also useful to choose appropriate strategy of potassium supplementation in case of acidosis or alkalosis.…”

Conn’s Syndrome Akibat Adenoma Adrenal

“…Hipokalemia dapat disebabkan oleh asupan kalium yang tidak adekuat, pergeseran kalium dari ekstra ke intrasel, atau kehilangan kalium dari saluran cerna maupun ginjal. 10,11 Setelah menyingkirkan penyebab hipokalemia seperti asupan yang rendah, kehilangan dari traktus gastrointestinal, dan penggunaan obat-obatan pada pasien ini, kemudian dilakukan pengukuran kadar kalium urin. Hasil pengukuran kalium urin tersebut didapatkan kadar 27 mmol/24 jam (>15 mmol/24 jam) sehingga dipikirkan hipokalemia pada pasien ini disebabkan oleh kehilangan kalium dari ginjal.…”