I do have a patient with persistent asymptomatic low potassium level, about 2.5-3mmol/l. She's not on diuretics, oral antiviral. No alcoholic history. Mild to moderate ascites clinically. Renal profile and urine K are normal.
Any other explanations?
I think could ba a case of secondary hyperaldosteronism. The hypovolemia occurs because the loss of volume in the third space and consequent hypoperfusion of kidney induces activation of renin-angiotensin-aldosteron axis. This process should physiologically augment volemia, but in this case also ascites. Patients may need an antialdosteronic drug.
In a compensated cirrhosis this is a very exceptional event. The subreptitious use of diuretics is one possibility and other is a low consumption of foods rich in potassium. Please explore both possibilities before giving anti-aldosteronic diuretics