In a patient with alcohol use disorder, what condition might lead to refractory hypokalemia?

Refractory hypokalemia, or persistent low potassium levels that do not respond to treatment, can indeed be associated with hypomagnesemia. In cases of hypomagnesemia, the body is unable to properly retain potassium, which can lead to continued potassium loss despite supplementation. This is particularly relevant in patients with alcohol use disorder, as chronic alcohol consumption often leads to nutritional deficiencies, including magnesium deficiency.

When someone is hypomagnesemic, the kidneys may excrete more potassium, exacerbating the hypokalemia. Additionally, magnesium plays a vital role in many cellular processes, including those linked to potassium channels. Therefore, restoring normal magnesium levels can be an essential step in addressing refractory hypokalemia in these patients.

Other conditions mentioned, such as hyperkalemia, cirrhosis, and gastritis, do not have the same direct relationship with refractory hypokalemia as hypomagnesemia does. For example, hyperkalemia would not lead to hypokalemia, cirrhosis could contribute to electrolyte imbalances but is more commonly associated with hyperkalemia due to renal failure or altered physiology, and gastritis does not directly correlate with these electrolyte disturbances.