Why does hyperaldosterone never cause acidosis

Pathogenesis

More than 98% of the potassium in the body is in the intracellular space (IZR = fluid that is located within the body's cells).

The distribution of potassium between extracellular volume (ECR = intravascular space (located inside the vessels) + extravascular space (located outside the vessels) and ICR is influenced by the following factors:

  • Hormones like insulin, aldosterone and catecholamines
  • Acid-base balance (pH value in the blood)
  • magnesium

The balance of body potassium is primarily carried out via the kidneys. There potassium is filtered glomerularly. About 90% of the filtered potassium ions are reabsorbed in the proximal tubule (main part of the renal tubules) as well as in Henle's loop (straight sections of the renal tubules and connecting piece). In the distal tubule (middle section of the kidney tubules) and in the collecting tube of the kidney, the decisive regulation of potassium excretion finally takes place.

For details see under Potassium / Definition, Synthesis, Absorption, Transport and Distribution.

Differential pathogenetic classification of hypokalaemia:

  • Renal-related (kidney-related) hypokalaemia, e.g. B. due to:
    • Renal tubular acidosis (RTA) (see below "Genetic Diseases")
    • Hypokalemic nephropathy (kidney disease) with impaired concentration, polyuria (increased urination) and polydipsia (excessive fluid intake through drinking)
    • Medication: Diuretics (diuretic drugs) such as thiazides and / or loop diuretics; see also under "Hypokalaemia due to medication"
    • Licorice abuse
  • Enteral-related (bowel-related) hypokalaemia, e.g. B. due to:
    • Diarrhea
    • Enteral fistulas
    • Probe leads (bile, pancreas / pancreas, small intestine)
  • Metabolic (metabolic) hypokalaemia, e.g. B. due to:
    • Alkalosis
    • Condition after compensating for metabolic acidosis / hyperacidity (e.g. in a diabetic coma)
    • Conn syndrome (primary hyperaldosteronism) or secondary hyperaldosteronism (increased formation of aldosterone)
    • Paroxysmal muscle paralysis

Note:

  • A pH change of 0.1 leads to a change in the serum potassium level of 0.4-1.2 mmol / l.
  • Acidosis can mask a potassium deficiency. This is noticeable in the case of acidosis compensation.

Etiology (causes)

Biographical causes

  • Genetic stress / diseases
    • Bartter syndrome - a very rare genetic metabolic disorder with autosomal dominant or autosomal recessive or X-linked recessive inheritance; Defect of tubular transport proteins; Hyperaldosteronism (conditions associated with an increased release of aldosterone), hypokalaemia (potassium deficiency) and hypotension (low blood pressure)
    • EAST syndrome (synonym: SeSAME syndrome) - a genetic disease with an autosomal recessive inheritance caused by cerebral cramps, sensorineural hearing loss, ataxia (disorder of movement coordination and postural innervation), retardation (delayed development), intellectual deficit and electrolyte disorders (hypokalemia , metabolic alkalosis (metabolism-related alkalosis), hypomagnesaemia / magnesium deficiency) is characterized; Age of manifestation: toddler age, neonatal period
    • Gitelman syndrome (GS; synonym: familial hypokalemia-hypomagnesemia) - a genetic disease with an autosomal recessive inheritance, which is characterized by a hypokalemic metabolic alkalosis (metabolism-related alkalosis with potassium deficiency) with pronounced hypomagnesaemia (magnesium deficiency) and low calcium excretion in the urine
    • Liddle syndrome - a very rare genetic disorder with an autosomal dominant inheritance pattern associated with severe, early onset high blood pressure with decreased plasma levels of potassium, renin and aldosterone
    • Renal tubular acidosis (RTA) - genetic disorder with an autosomal recessive inheritance leading to a defect in the H.+-Ion secretion in the tubular system of the kidneys leads to demineralization of the bone (hypercalciuria and hyperphosphaturia / increased excretion of calcium and phosphate in the urine) and hypokalaemia (potassium deficiency)

Behavioral causes

  • nutrition
    • Low-potassium diet (including less consumption of grain products and legumes such as beans; nuts; fish (mackerel, halibut))
    • Low-magnesium diet (including less consumption of grain products and pulses such as beans)
    • High salt intake (increased sodium concentration)
      Note: A good supply of magnesium is therefore a prerequisite for a good supply of potassium. Magnesium regulates special K + channels and prevents too much potassium from leaving the cell in exchange for sodium.
    • Licorice abuse (aldosterone-like effect)
    • Frequent diets (low intake of magnesium through food)
    • Micronutrient deficiency (vital substances) - see prevention with micronutrients: hypomagnesaemia
  • Consumption of luxury foods
    • Coffee, black or green tea, cola (drinks containing caffeine)
    • Alcohol (women:> 20 g / day; men:> 30 g / day)
  • Psycho-social situation
    • Stress at work or in everyday life
  • Physical activity
    • Intense physical activity (increased consumption of magnesium by the muscles)
    • Sport and competitive sport (loss of minerals through sweat: potassium 300 mg / l sweat)
  • Sauna (increased sweat loss)

Disease-related causes

Congenital malformations, deformities and chromosomal abnormalities (Q00-Q99)

  • EAST syndrome (synonym: SeSAME syndrome) - a genetic disease with an autosomal recessive inheritance caused by cerebral cramps, sensorineural hearing loss, ataxia (disorder of movement coordination and postural innervation), retardation (delayed development), intellectual deficit and electrolyte disorders (hypokalemia , metabolic alkalosis (metabolism-related alkalosis), hypomagnesaemia / magnesium deficiency) is characterized; Age of manifestation: toddler age, neonatal period

Endocrine, nutritional and metabolic diseases (E00-E90)

  • Alkalosis
  • Condition after compensating for metabolic acidosis / hyperacidity (e.g. in a diabetic coma)
  • Conn syndrome (primary hyperaldosteronism) or secondary hyperaldosteronism (increased formation of aldosterone)
  • Bartter syndrome - a very rare genetic metabolic disorder with autosomal dominant or autosomal recessive or X-linked recessive inheritance; Defect of tubular transport proteins; Hyperaldosteronism (conditions associated with an increased release of aldosterone), hypokalaemia (potassium deficiency) and hypotension (low blood pressure)
  • Gitelman syndrome (GS; synonym: familial hypokalemia-hypomagnesaemia) - a genetic disease with an autosomal recessive inheritance, which is characterized by a hypokalemic metabolic alkalosis (metabolism-related alkalosis with potassium deficiency) with pronounced hypomagnesaemia (magnesium deficiency) and low calcium excretion in the urine
  • Hyperinsulinism - the presence of increased insulin levels in the blood (fasting insulin> 17 mU / l)
  • Hypomagnesaemia (magnesium deficiency)
  • Cushing's disease - group of diseases that lead to hypercortisolism (hypercortisolism; excess supply of cortisol)

Infectious and parasitic diseases (A00-B99)

  • Infectious gastroenteritis (gastrointestinal flu), unspecified

Circulatory system (I00-I99)

  • Liddle syndrome - a very rare genetic disorder with an autosomal dominant inheritance pattern associated with severe, early onset high blood pressure with decreased plasma levels of potassium, renin and aldosterone

Mouth, esophagus (gullet), stomach, and intestines (K00-K67; K90-K93)

  • Non-infectious gastroenteritis, unspecified

Musculoskeletal system and connective tissue (M00-M99)

  • Sjogren's syndrome - autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease or destruction of the exocrine glands, the salivary and lacrimal glands being most frequently affected; i.a. Hypokalaemia (potassium deficiency) with metabolic acidosis (excess acidity caused by the metabolism), interstitial nephritis (inflammation of the kidneys)

Psyche - nervous system(F00-F99; G00-G99)

  • Anorexia nervosa (anorexia)
  • Bulimia nervosa (BN) - also known as eating-vomiting addiction; belongs to the psychogenic eating disorders
  • Paroxysmal muscle paralysis
  • Tremor

Pregnancy, childbirth and the puerperium(O00-O99)

  • Hyperemesis gravidarum (extreme pregnancy sickness) - extreme vomiting during pregnancy

Symptoms and abnormal clinical and laboratory findings not elsewhere classified(R00-R99)

  • Diarrhea
  • Constipation (constipation)
  • Polydipsia (excessive fluid intake through drinking)
  • Polyuria (increased urination)

Urogenital system (kidneys, urinary tract - genital organs)(N00-N99)

  • Acute kidney failure (ANV)
  • Hypokalemic nephropathy (kidney disease) with impaired concentration, polyuria (increased urination) and polydipsia (excessive fluid intake through drinking)
  • Renal tubular acidosis (RTA) - genetic disorder with an autosomal recessive inheritance leading to a defect in the H.+-Ion secretion in the tubular system of the kidneys leads to demineralization of the bone (hypercalciuria and hyperphosphaturia / increased excretion of calcium and phosphate in the urine) and hypokalaemia (potassium deficiency)

Other causes

  • Enteral fistulas
  • Enterostomy (artificial anus)
  • Parenteral nutrition ("bypassing the intestine") without added potassium
  • Probe leads (stomach, duodenum (duodenum), bile, pancreas / pancreas, small intestine)

Medication

  • Antibiotics
    • Aminoglycosides (Amikacin, Apramycin, Geneticin (G418), Gentamicine, Kanamycin, Netilmicin, Neomycin, Paromomycin, Spectinomycin, Streptomycin, Tobramycin), Penicillins
  • Antifungal agent (amphotericin B)
  • Arsenic trioxide
  • Betamimetics (synonyms: β2 sympathomimetics, also β2 adrenoceptor agonists) - fenoterol, formoterol, hexoprenaline, indaceterol, olodaterol, ritodrine, salbutamol, salmeterol, terbutaline
  • Carbonic anhydrase inhibitors (acetazolamide)
  • Calcium Sensitizer (Levosimendan)
  • Diuretics
    • Loop diuretics (Etacrynic acid, furosemide, piretanide, torasemide)
    • Thiazide diuretics (Hydrochlorothiazide (HCT), benzthiazide, clopamide, chlortalidone (CTDN), chlorothiazide, hydroflumethiazide, indapamide, methyclothiazide, metolazon, polythiazide and trichloromethiazide, xipamide)
  • Filling / swelling agents (flea seeds, flax seeds) [with prolonged use]
  • HCV inhibitors - telaprevir
  • Hormones
    • Glucocorticoids (betamethasone, budenoside, cortisone, fluticasone, dexmeathasone, prednisolone, triamcinolone)
    • insulin
  • Hydragogenic laxatives (bisacodyl, sodium picosulfate)
  • mTOR inhibitors (everolimus, temsirolimus)
  • Osmotic laxatives (lactulose, polyethylene glycols / PEG, macrogol)
     
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