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Farah R, Carpenter JE, Morgan BW. Oral potassium poisoning: a retrospective review of the National Poison Data System 2010-2021. Clin Toxicol (Phila) 2024; 62:46-52. [PMID: 38421360 DOI: 10.1080/15563650.2024.2308730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Oral potassium poisoning can be life-threatening. The study aimed to describe patterns of oral potassium poisoning in adult and pediatric populations and characterize its clinical presentation and management as reported by United States poison centers. METHODS This is a retrospective review of the National Poison Data System from 1 January 2010 through 30 June 2021. We descriptively analyzed cases involving single substance, oral potassium salts. In a second step, we requested a subset of case-specific narratives for cases that resulted in major outcome or death, as well as cases where patients received any of the following therapies: whole bowel irrigation, sodium bicarbonate, calcium, insulin or hemodialysis. We classified hyperkalemia by expected toxicity: mild (peak potassium concentration <6.5 mEq/L), moderate (peak potassium concentration 6.5 to <8 mEq/L) or severe (peak potassium concentration ≥ 8mEq/L). RESULTS The National Poison Data System included 1,820 cases, 52.3 percent being adults. Among adult cases, 20% (n = 189) resulted in a moderate effect, major effect or death. Among pediatric cases aged <10 years, all exposures were unintentional. Analysis of 49 case narratives showed a median peak potassium concentration of 7.1 mEq/L (interquartile range 5.4-8.6) and a moderate correlation with the dose ingested (r = 0.66). Severe hyperkalemia was associated with QRS complex widening (P < 0.001), peaked T-waves (P = 0.001), and neurological symptoms (P = 0.04). Whole bowel irrigation was associated with mild hyperkalemia (P = 0.011), and hemodialysis was associated with severe hyperkalemia (P < 0.001). DISCUSSION Analysis of data showed that therapy to promote intracellular shift of potassium is the mainstay of management of oral potassium poisoning, followed by hemodialysis. LIMITATIONS Poison center data are susceptible to reporting bias. National Poison Data System data are affected by completeness and accuracy of reporting from health care providers and the lay public. CONCLUSIONS Single substance, oral potassium poisoning, reported to United States poison centers, is mostly unintentional and rarely results in hyperkalemia.
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Affiliation(s)
- Rita Farah
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Health's Blue Ridge Poison Center, University of Virginia, Charlottesville, VA, USA
| | - Joseph E Carpenter
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
- GA Poison Center, Atlanta, GA, USA
| | - Brent W Morgan
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
- GA Poison Center, Atlanta, GA, USA
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Simon G. Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13071339. [PMID: 37046560 PMCID: PMC10093193 DOI: 10.3390/diagnostics13071339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Potassium overdose usually occurs accidentally, but potassium is also used for judicial executions, assisted death, and, rarely, suicides. In addition to exogenous overdose, various drugs, and renal failure, diabetic ketoacidosis can cause hyperkalemia. Potassium tablets are used in most cases of suicidal potassium overdose. Suicide by intravenous administration of potassium is rare but usually fatal. The author reports a rare case of suicide with potassium infusion. Autopsy and histology findings, along with post-mortem biochemical analysis of different body fluids and fluid from the infusion set, are reported. Previously published reports of potassium overdose were reviewed, and the detection possibilities of potassium overdose are discussed. The detection possibilities of lethal hyperkalemia are very limited since hyperkalemia produces only nonspecific autopsy and histology findings. Post-mortem potassium concentrations are not indicative of ante-mortem potassium concentrations; therefore, post-mortem biochemical analysis has limited value in determining potassium overdose. The best way to prove potassium overdose is via the collection and analysis of circumstantial evidence.
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Affiliation(s)
- Gábor Simon
- Department of Forensic Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
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Abstract
OBJECTIVE Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach. METHODS This is a retrospective case series of patients presenting following oral potassium overdose of ≥6000mg between January 2009 and December 2020 in Queensland, Australia as recorded in the state's Poisons Information Centre database and a tertiary Clinical Toxicology Unit database. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. RESULTS Thirteen presentations in eleven patients occurred in the twelve-year period. The median age was 35 years (range 14-55 years). The median dose ingested was 6.4 mmol/kg (range 0.9-30.8 mmol/kg). Severe hyperkalaemia >7mmol/L occurred in five patients, four with ingestions ≥60,000mg. All patients with hyperkalaemia received multiple modes of intracellular potassium shifting therapy. Four patients had endoscopic removal of pharmacobezoars. One also underwent whole bowel irrigation. Three presentations were managed with haemodialysis. All patients were discharged home with a median length of stay of 20 h. CONCLUSION Aggressive medical therapy to shift potassium into cells appears to be the mainstay of treatment in patients with normal renal function. Early decontamination may limit peak potassium concentrations. It is unclear if haemodialysis provides significant additional benefit in patients with normal renal function.
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Affiliation(s)
- Arushi Madan
- Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Australia.,Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher Morris
- Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anna Goggin
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia
| | - Katherine Z Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia
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Morris TG, Lamba S, Fitzgerald T, Roulston G, Johnstone H, Mirzazadeh M. The potential role of the eGFR in differentiating between true and pseudohyperkalaemia. Ann Clin Biochem 2020; 57:444-455. [PMID: 33016076 DOI: 10.1177/0004563220966858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differentiating between true and pseudohyperkalaemia is essential for patient management. The common causes of pseudohyperkalaemia include haemolysis, blood cell dyscrasias and EDTA contamination. One approach to differentiate between them is by checking the renal function, as it is believed that true hyperkalaemia is rare with normal function. This is logical, but there is limited published evidence to support it. The aim of this study was to investigate the potential role of the estimated glomerular filtration rate in differentiating true from pseudohyperkalaemia. METHODS GP serum potassium results >6.0 mmol/L from 1 January 2017 to 31 December 2017, with a repeat within seven days, were included. Entries were retrospectively classified as true or pseudohyperkalaemia based on the potassium reference change value and reference interval. If the initial sample had a full blood count, it was classified as normal/abnormal to remove blood cell dyscrasias. Different estimated glomerular filtration rate cut-points were used to determine the potential in differentiating true from pseudohyperkalaemia. RESULTS A total of 272 patients were included with potassium results >6.0 mmol/L, with 145 classified as pseudohyperkalaemia. At an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 81% (95% CI: 67-90%); this increased to 86% (95% CI: 66-95%) by removing patients with abnormal full blood counts. When only patients with an initial potassium ≥6.5 mmol/L were included (regardless of full blood count), at an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 100%. Lower negative predictive values were seen with decreasing estimated glomerular filtration rate cut-points. CONCLUSION Normal renal function was not associated with true hyperkalaemia, making the estimated glomerular filtration rate a useful tool in predicting true from pseudohyperkalaemia, especially for potassium results ≥6.5 mmol/L.
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Affiliation(s)
- Thomas G Morris
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Sushmita Lamba
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Thomas Fitzgerald
- Nephrology, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Gary Roulston
- Nephrology, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Helen Johnstone
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Mehdi Mirzazadeh
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
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Iijima S. Suicide attempt using potassium tablets for congenital chloride diarrhea: A case report. World J Clin Cases 2020; 8:1463-1470. [PMID: 32368538 PMCID: PMC7190950 DOI: 10.12998/wjcc.v8.i8.1463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/02/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital chloride diarrhea (CCD) is a rare inherited disorder of intestinal electrolyte transport that results in a large wastage of electrolytes and water. Advances in substitution therapy using sodium chloride (NaCl) and potassium chloride (KCl) have dramatically improved survival for patients with CCD. Slow-release KCl is widely prescribed as a potassium supplement; however, it has also occasionally been used in suicide attempts, as potassium poisoning can generate life-threatening hyperkalemia.
CASE SUMMARY A 26-year-old female presented to the emergency department (ED) with self-poisoning, having taken 30 tablets of slow-release KCl (total: 240 mmol potassium) following an auditory hallucination. The patient had been undergoing substitution therapy with NaCl and KCl for CCD and been followed up in the pediatric department. One month prior, she developed insomnia and anxiety and had consulted a psychiatrist. At the ED, although her general condition was good, she appeared agitated. Her serum potassium level was 7.0 mmol/L, indicating hyperkalemia, and electrocardiographic changes showed tenting of the T-waves. She responded to the administration of calcium gluconate, sodium bicarbonate, and insulin with glucose, and the serum potassium level improved. Finally, she was diagnosed with schizophrenia.
CONCLUSION In CCD management, physicians should pay careful attention to patients’ extraintestinal issues, including psychological disorders that may emerge in adulthood.
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Affiliation(s)
- Shigeo Iijima
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan
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Abstract
An 86-year-old gentleman was brought to the emergency department after a massive overdose of slow-release potassium chloride and indapamide. The initial serum potassium was 6.8 mmol/L. His abdominal X-ray did not reveal any radio-opaque drugs. Whole bowel irrigation was commenced shortly after presentation. There was no rebound of hyperkalaemia and his stay in the acute hospital was short. Slow-release potassium overdose is uncommonly reported in the medical literature; such poisoning in the elderly has not been reported. Previous case reports are summarised and the management of this uncommon poisoning is discussed.
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Palmiere C, Scarpelli MP, Varlet V, Baumann P, Michaud K, Augsburger M. Fatal intravenous injection of potassium: Is postmortem biochemistry useful for the diagnosis? Forensic Sci Int 2016; 274:27-32. [PMID: 27932048 DOI: 10.1016/j.forsciint.2016.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023]
Abstract
Fatal cases of potassium overdoses have traditionally been considered indemonstrable due postmortem biochemical investigation limits (mainly potassium determination in postmortem serum and vitreous humor). Nevertheless, some authors have expressed a divergent opinion over the years based on the results of their own investigations. In this study, we investigated left vitreous, right vitreous, postmortem serum from peripheral blood, postmortem serum from cardiac blood, urine, pericardial and cerebrospinal fluid potassium concentrations in 21 forensic autopsy cases. One of these was a case of accidental, fatal intravenous potassium injection in a hospitalized patient. The other twenty cases were subjects with various causes of death unrelated to potassium administration and comparable postmortem intervals. Our aim was to assess whether postmortem biochemical investigations performed in several biological samples may be useful in diagnosing exogenous potassium administration. No statistically significant differences were observed between the measured concentrations in the fatal case of potassium intravenous administration and the control cases in any of the tested samples. Potassium concentrations in the investigated case of exogenous potassium injection were within the range of those measured in the control cases, irrespective of the tested biological sample. Our findings corroborate the conclusions of former authors who highlighted that circumstantial evidence provides the greatest diagnostic contribution in situations of suspected potassium poisoning. This is due to the objective limitations demonstrated by postmortem biochemical investigations in such cases, even when potassium measurements are carried out in several biological samples of satisfying quality and within a relatively short postmortem interval.
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Affiliation(s)
- Cristian Palmiere
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland.
| | - Maria Pia Scarpelli
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Vincent Varlet
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Pia Baumann
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Katarzyna Michaud
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
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Thanacoody R, Caravati EM, Troutman B, Höjer J, Benson B, Hoppu K, Erdman A, Bedry R, Mégarbane B. Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2014; 53:5-12. [DOI: 10.3109/15563650.2014.989326] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guillermo PTJ, Carlos PHJ, Ivonne BAM, Herminio TF, Rubén RP. Extended release potassium salts overdose and endoscopic removal of a pharmacobezoar: A case report. Toxicol Rep 2014; 1:209-213. [PMID: 28962240 PMCID: PMC5598358 DOI: 10.1016/j.toxrep.2014.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reported cases of potassium overdoses have shown that this condition could generate several morbidities, mainly related to cardiac dysrhythmias even with fatal outcomes in some cases. Potassium salts in extended release tablets could form pharmacobezoars if a large amount is ingested. In relation to the above, when the patient has a pharmacobezoar, clinical findings may be delayed and may persist. The techniques available for removal of a pharmacobezoar are whole bowel irrigation (WBI), endoscopy or in some surgery [1]. Endoscopy as a decontamination method has shown promising results. CASE REPORT A 42 year old woman, who intentionally ingested 100 tablets of extended release potassium chloride, 50 mg of clonazepam and an undisclosed amount of ethanol, presented with metabolic acidosis, hyperlactatemia and sinus tachycardia 2 h after ingestion. Gastric lavage and activated charcoal were applied initially, specific measures were not necessary. However, a transcutaneous pacemaker was placed. Because of her background, we considered a pharmacobezoar and an endoscopy were performed to remove 99 tablets of potassium that were isolated or forming concretions. DISCUSSION The readily available techniques to remove a pharmacobezoar are whole bowel irrigation (WBI) and endoscopy; nevertheless there is not a consensus about their relative merits. Our patient was treated by endoscopy because we found on the X-ray a conglomerate of radiopaque images suggesting a pharmacobezoar. In this case we did not have any adverse effect. CONCLUSIONS We consider that endoscopy could be an effective and safe method to remove a drug bezoar from the stomach in uncomplicated patients.
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Affiliation(s)
- Pérez Tuñón Jorge Guillermo
- Jefe del Centro Toxicológico Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico
| | - Pérez Hernández Juan Carlos
- Adscrito al Centro Toxicológico Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico
| | - Bautista Albiter Mayré Ivonne
- Adscrito al Centro Toxicológico Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico
| | - Terán Flores Herminio
- Adscrito al Centro Toxicológico Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico
| | - Ramírez Pérez Rubén
- Residente de Toxicología Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico
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Salfranc E, Candille C, Dumanoir P, Carpentier F. Une intoxication grave au chlorure de potassium. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Briggs AL, Deal LL. Endoscopic removal of pharmacobezoar in case of intentional potassium overdose. J Emerg Med 2013; 46:351-4. [PMID: 24113476 DOI: 10.1016/j.jemermed.2013.08.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 05/01/2013] [Accepted: 08/14/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hyperkalemia is a potentially life-threatening electrolyte abnormality commonly seen in the emergency department (ED). Intentional overdose of potassium supplements is an uncommon occurrence. OBJECTIVE This case illustrates a novel approach to treatment of pharmacobezoar with esophagogastroduodenoscopy (EGD) and demonstrates its effectiveness in the setting of extended-release potassium chloride overdose. CASE REPORT A 44-year-old female presented to the ED with intentional ingestion of an unknown amount of extended-release potassium chloride (K-Dur®) tablets and alprazolam (Xanax®). The patient's serum potassium was initially 7.3 mmol/L and she was treated with standard treatments, including albuterol, calcium gluconate, insulin, dextrose, and sodium bicarbonate. Radiographic investigation showed a pharmacobezoar in the gastric fundus. Treatment was then augmented with whole bowel irrigation (WBI) using polyethylene glycol solution via nasogastric tube. Patient did not tolerate the nasogastric tube, became combative with increasing alteration in her level of consciousness, and WBI therapy was stopped. After discussion with the gastroenterologist, the patient was treated with EGD to remove the pharmacobezoar. The EGD was successful in the removal of the pharmacobezoar and the patient's potassium normalized without complications. CONCLUSIONS We recommend that in cases of suspected or confirmed potassium drug bezoar in the stomach, physicians consider EGD for removal. This allows for normalization of potassium level while preventing adverse sequelae.
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Affiliation(s)
- Albert L Briggs
- Department of Emergency Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Lisa L Deal
- Department of Emergency Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia; Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
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Marina AS, Kutina AV, Natochin YV. Exenatide enhances kaliuresis under conditions of hyperkalemia. Bull Exp Biol Med 2012; 152:177-9. [PMID: 22808453 DOI: 10.1007/s10517-011-1481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Experiments on Wistar rats showed that exenatide (0.015-0.5 nmol per 100 g body weight) somewhat increased renal excretion of potassium from 7±1 to 16±1 μmol/h/100 g body weight (p<0.05) in animals with normal serum concentration of glucose (4.6±0.4 mM) and potassium (4.3±0.1 mM). Exenatide dramatically enhanced excretion of potassium under conditions of hyperkalemia (11.4±0.4 mM) produced by intraperitoneal injection of 1.25% KCl solution (5 ml per 100 g body weight). During the first postinjection hour, potassium excretion increased 2-fold and attained 97±11 μmol/h/100 g body weight in comparison with potassium load alone (47±9 μmol/h/100 g body weight, p<0.05). The data attest to a possible role of peptide regulators in normalization of potassium balance via renal mechanisms.
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Affiliation(s)
- A S Marina
- I. M. Sechenov Institute of Evolution Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
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Rusyniak DE, Durant PJ, Mowry JB, Johnson JA, Sanftleben JA, Smith JM. Life-threatening hyperkalemia from cream of tartar ingestion. J Med Toxicol 2012; 9:79-81. [PMID: 22926733 DOI: 10.1007/s13181-012-0255-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cream of tartar (potassium bitartrate) has a long history as a cooking aid and medicinal purgative. Despite containing large amounts of potassium, there are no well-documented cases of it causing toxicity. We report two cases in which intentional ingestions of cream of tartar resulted in life-threatening hyperkalemia. In addition, we briefly review the use of cream of tartar as a historical purgative. CASE REPORTS In both cases, individuals ingested a large quantity of cream of tartar in an effort to "clean themselves out". They manifested similar initial symptoms (vomiting), abnormal serum potassium (>8.0 mmol/L), and EKG's with peaked T waves. Both patients were treated for hyperkalemia and recovered without complication. A search for articles on an academic internet database failed to identify any cases specifically dealing with ill effects of potassium bitartrate and numerous websites continue to purport its beneficial health effects. CONCLUSION Ingestion of cream of tartar can potentially result in life-threatening hyperkalemia.
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Affiliation(s)
- Daniel E Rusyniak
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Nilsson TS, Malmgren J, Knudsen K. Parallel haemodialysis and surgery saves a life after massive overdose of potassium pills. BMJ Case Rep 2012; 2012:bcr.02.2012.5773. [PMID: 22778452 DOI: 10.1136/bcr.02.2012.5773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Severe poisoning with potassium pills is rare but patients may present with serious cardiovascular symptoms requiring immediate and effective treatment. A 30-year-old healthy woman presented to the emergency department after ingestion of 300 slow-release pills of potassium-chloride with serum potassium of 9.5 mmol/l, and poor cardiovascular function. Gastric lavage was performed with poor outcome. Despite intensive medical treatment serum potassium remained very high around 9 mmol/l. Haemodialysis was initiated but despite ongoing dialysis, potassium increased to 10.3 mmol/l. Hence, a parallel dialysis was started and after 4 h of parallel dialysis, serum potassium decreased to 6.4 mmol/l. An x-ray revealed large amounts of pills remaining in the stomach and the surgeon was able to remove about 200 pills through an acute laparotomy. The patient recovered slowly thereafter, but later developed a gastric stricture and pulmonary embolism.
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Affiliation(s)
- Tobias S Nilsson
- Anesthesia and Intensive Care, Surgical Sciences, Gothenburg, Sweden
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15
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Lo JCY, Ubaldo C, Cantrell FL. A retrospective review of whole bowel irrigation in pediatric patients. Clin Toxicol (Phila) 2012; 50:414-7. [DOI: 10.3109/15563650.2012.679277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gunja N. Decontamination and enhanced elimination in sustained-release potassium chloride poisoning. Emerg Med Australas 2012; 23:769-72. [PMID: 22151677 DOI: 10.1111/j.1742-6723.2011.01469.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Potassium chloride poisoning can be potentially life-threatening, particularly in massive ingestions of sustained-release preparations. Profound hyperkalaemia, developing over several hours, can lead to cardiac arrhythmias and death. This case series reports three episodes of sustained-release potassium chloride poisoning in two individuals requiring whole bowel irrigation or haemodialysis. The first two episodes, in the same patient, illustrate the contrast between the successful use of decontamination versus the need for haemodialysis. The second case, in a child, illustrates the need for tertiary level paediatric expertise in managing this type of poisoning. Whole bowel irrigation with polyethylene glycol is a resource-intensive procedure most beneficial when large numbers of radio-opaque tablets are seen in the stomach. In cases where most of the tablet matter has already been absorbed, extracorporeal methods of rapidly reducing the total body burden of potassium, such as haemodialysis, might be life-saving.
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Affiliation(s)
- Naren Gunja
- New South Wales Poisons, The Children's Hospital at Westmead, New South Wales, Australia.
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Abstract
INTRODUCTION Hyperkalemia is a common condition, particularly in the setting of renal dysfunction. Hyperkalemia due to intentional oral potassium overdose is not commonly reported. CASE REPORT We present a case of acute intentional potassium overdose in a patient with normal renal function resulting in significant hyperkalemia, with a maximum serum potassium concentration of 11 mEq/L. Despite an initial course complicated by various unstable cardiac rhythms, including ventricular tachycardia, ventricular fibrillation, and pulseless electrical activity, the patient was discharged from the hospital neurologically intact. Treatment for hyperkalemia included hemodialysis. DISCUSSION The role of dialysis in potassium overdose is poorly defined. CONCLUSION Based on this case and a review of the medical literature, we recommend hemodialysis for cases of potassium overdose with hemodynamic instability and significantly elevated serum potassium concentrations that do not respond promptly to medical therapy. Hemodialysis should also be considered in cases with underlying renal dysfunction.
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Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol 2011; 26:377-84. [PMID: 21181208 PMCID: PMC3061004 DOI: 10.1007/s00467-010-1699-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 10/01/2010] [Accepted: 10/04/2010] [Indexed: 12/13/2022]
Abstract
Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5.5 mmol/l. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space. In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction. Treatment has to be initiated immediately using different therapeutic strategies to increase potassium shift into the intracellular space or to increase elimination, together with reduction of intake. Knowledge of the physiological mechanisms of potassium handling is essential in understanding the causes of hyperkalemia as well as its treatment. This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options.
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Affiliation(s)
- Anja Lehnhardt
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistr. 5, 20246 Hamburg, Germany
| | - Markus J. Kemper
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistr. 5, 20246 Hamburg, Germany
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Höjer J, Forsberg S. Successful whole bowel irrigation in self-poisoning with potassium capsules. Clin Toxicol (Phila) 2008; 46:1102-3. [PMID: 18951269 DOI: 10.1080/15563650802415165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Quang LS, Colombo G, Lobina C, Maccioni P, Orru A, Gessa GL, Maher TJ, Carai MAM. Evaluation for the withdrawal syndrome from gamma-hydroxybutyric acid (GHB), gamma-butyrolactone (GBL), and 1,4-butanediol (1,4-BD) in different rat lines. Ann N Y Acad Sci 2007; 1074:545-58. [PMID: 17105952 DOI: 10.1196/annals.1369.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A severe and life-threatening gamma-hydroxybutyric acid (GHB) withdrawal syndrome, clinically similar to the alcohol withdrawal syndrome, is increasingly being reported in GHB addicts. We investigated for the occurrence of withdrawal in Wistar and Sprague-Dawley rats, and in the selectively bred lines of GHB-sensitive (GHB-S) and Sardinian alcohol-preferring (sP) rats, following chronic administration of GHB, gamma-butyrolactone (GBL), and/or 1,4-butanediol (1,4-BD). Using validated rodent alcohol withdrawal scoring scales, little to no spontaneous or pharmacologically precipitated withdrawal effects were observed in Wistar, Sprague-Dawley, or GHB-S rats. Conversely, sP rats displayed both spontaneous and precipitated audiogenic seizures following abrupt cessation of chronic GHB or 1,4-BD administration and following pharmacological challenge with the GABA(B) receptor-selective antagonist, SCH 50911, respectively.
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Affiliation(s)
- Lawrence S Quang
- Division of Pediatric Pharmacology & Critical Care, Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Abstract
Carbon dioxide is a physiologically important gas, produced by the body as a result of cellular metabolism. It is widely used in the food industry in the carbonation of beverages, in fire extinguishers as an 'inerting' agent and in the chemical industry. Its main mode of action is as an asphyxiant, although it also exerts toxic effects at cellular level. At low concentrations, gaseous carbon dioxide appears to have little toxicological effect. At higher concentrations it leads to an increased respiratory rate, tachycardia, cardiac arrhythmias and impaired consciousness. Concentrations >10% may cause convulsions, coma and death. Solid carbon dioxide may cause burns following direct contact. If it is warmed rapidly, large amounts of carbon dioxide are generated, which can be dangerous, particularly within confined areas. The management of carbon dioxide poisoning requires the immediate removal of the casualty from the toxic environment, the administration of oxygen and appropriate supportive care. In severe cases, assisted ventilation may be required. Dry ice burns are treated similarly to other cryogenic burns, requiring thawing of the tissue and suitable analgesia. Healing may be delayed and surgical intervention may be required in severe cases.
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Abstract
Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI should be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting greater than two hours after drug ingestion. WBI should be considered for patients who have ingested substantial amounts of iron as the morbidity is high and there is a lack of other options for gastrointestinal decontamination. The use of WBI for the removal of ingested packets of illicit drugs is also a potential indication. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients or in patients with medical conditions that may be further compromised by its use. The concurrent administration of activated charcoal and WBI may decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain. A review of the literature since the preparation of the 1997 Whole Bowel Irrigation Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
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