Hypokalemia and Renal Ammonia Production

[blondemed]

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My attending asked about the role of hypokalemia in hepatic encephalopathy today during rounds. I know that it favors cellular uptake of ammonia and increases renal production of ammonia - does anyone know of the specific mechanism in which hypokalemia upregulates renal ammoniagenesis? I can't seem to find any relevant literature on it. Thanks!

 

[SOUNDMAN]

I don't know, the only thing I can think of is think how the body is going to get rid of acid via HCO3 then titratable PO4, then through formation of ammonia. I think that's right but I hate renal physiology none the less.

but it might give you a starting point to look at though and with hypokalemia aren't K+ and H+ exchanged with each other in the alpha intercalated cells don't know if that has anything to do with it, but I'm just running with some thoughts I guess. Good luck

 

[BrakngLyv]

Along those same lines, some thoughts as well...in a hypokalemic setting in renal tubular cells, K ions will move out of the cells to the extracellular space to replenish potassium. H ions move into the cell to balance the charge. This leaves the cell acidotic, which promotes ammonia formation. Often, there is a concurrent metabolic alkalosis, which promotes the conversion of ammonium to ammonia which can cross the blood-brain barrier.