Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Potassium (K+) is the major intracellular cation. Functions of potassium include regulation of neuromuscular excitability, heart contractility, intracellular fluid volume, and hydrogen ion concentration. The physiologic function of K+ requires that the body maintain a low extracellular fluid (ECF) concentration of the cation; the intracellular is 20 times greater than the extracellular K+concentration. Only 2% of total body K+ circulates in the plasma.
The kidneys provide the most important regulation of K+. The proximal tubules reabsorb almost all the filtered K+. Under the influence of aldosterone, the remaining K+ can then be secreted into the urine in exchange for sodium in both the collecting ducts and the distal tubules. Thus, the distal nephron is the principal determinant of urinary K+ excretion.
Decreased excretion of K+ in acute renal disease and end-stage renal failure are common causes of prolonged hyperkalemia.
Renal losses of K+ may occur during the diuretic (recovery) phase of acute tubular necrosis, during administration of non-potassium sparing diuretic therapy, and during states of excess mineralocorticoid or glucocorticoid.
Urine K+ is useful in determining the cause for hyper- or hypokalemia.
Hypokalemia reflecting true total body deficits of K+ can be classified into renal and nonrenal losses based on the daily excretion of K+ in the urine. During hypokalemia, if urine excretion of K+ is <30 mEq/d, it can be concluded that renal reabsorption of K+ is appropriate. In this situation, the causes for the hypokalemic state are either decreased K+ intake or extra renal loss of K+ rich fluid. Urine excretion of >30 mEq/d in a hypokalemia setting is inappropriate and indicates that the kidneys are the primary source of the lost K+.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Ion-selective electrodes are selective for the ion in question but are not absolutely specific. Other monovalent cations may interfere but not in the physiologic range.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
17-77 mmol/24 hours
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Tietz Textbook of Clinical Chemistry. Third edition. Edited by CA Burtis, ER Ashwood. Philadelphia, WB Saunders Co, 2001
2. Toffaletti J: Electrolytes. In Professional Practice in Clinical Chemistry: A Review. Edited by DR Dufour, N Rifai. Washington, AACC Press, 1993