Adrenal Insufficiency: This condition, including Addison's disease, can lead to hypotension due to the lack of cortisol and aldosterone. Hypokalemia can occur, especially in primary adrenal insufficiency, due to the mineralocorticoid deficiency. Muscle weakness and confusion can result from the electrolyte imbalances and the direct effects of cortisol deficiency on the body.

Diuretic Abuse or Overuse: Excessive use of diuretics can lead to hypokalemia and hypotension. Muscle weakness can be a symptom of severe potassium depletion, and confusion may arise from electrolyte imbalances affecting neurological function.
Gastrointestinal Losses: Severe vomiting or diarrhea can lead to hypokalemia and hypotension due to fluid and electrolyte loss. Muscle weakness and confusion can result from dehydration and electrolyte disturbances.
Renal Tubular Acidosis (RTA): Certain types of RTA can cause hypokalemia, and when severe, can lead to muscle weakness. Hypotension might not be a direct effect but can occur due to associated volume depletion. Confusion can result from severe electrolyte imbalances.

Toxic Ingestions (e.g., Barium, Toluene): Certain toxic ingestions can cause severe hypokalemia, leading to muscle weakness and cardiac arrhythmias. Hypotension and confusion can also occur due to the systemic effects of the toxin.
Acute Myocardial Infarction or Cardiac Tamponade: While not directly causing hypokalemia, these conditions can lead to hypotension. Muscle weakness might not be a primary symptom, but confusion can occur due to decreased perfusion of the brain. Hypokalemia could be a contributing factor or result from treatment (e.g., diuretics in heart failure).

Hypokalemic Periodic Paralysis: A rare genetic disorder that causes episodes of severe hypokalemia, leading to muscle weakness or paralysis. Hypotension and confusion might occur during episodes due to the severity of the electrolyte imbalance.
Liddle's Syndrome: A rare genetic disorder characterized by excessive sodium absorption and potassium wasting in the kidneys, leading to hypokalemia and hypertension, though hypotension can occur in certain contexts. Muscle weakness and confusion can result from the electrolyte disturbances.
Gitelman Syndrome and Bartter Syndrome: Rare genetic disorders affecting the kidneys' ability to reabsorb potassium, leading to hypokalemia. While primarily associated with normal or low blood pressure, hypotension can occur, especially with volume depletion. Muscle weakness and confusion can result from severe electrolyte imbalances.