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McLendon K, Wiggins M, Hunt D, Gauthier A, Thoppil D. Unsuspecting Dietary Factors in Hyperkalemia: A Case Report on Why History Matters. Clin Pract Cases Emerg Med 2020; 4:247-250. [PMID: 32426685 PMCID: PMC7220004 DOI: 10.5811/cpcem.2020.3.43095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/28/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction We present a case of hyperkalemia secondary to excessive dietary intake of hard caramel candies. Case Report An 88-year-old male who presented with acute abdominal pain and vomiting was found to have hyperkalemia of 6.9 milliequivalents per liter. He was stabilized, treated, and discharged the following day after resolution. The cause was identified as his daily consumption of 200 hard caramel candies. Discussion The patient had been consuming sugar-free candies, which induced a chronic diarrhea. This led to potassium wasting and augmentation of his home medications. When he transitioned to eating regular caramel candies, he retained too much potassium leading to his presentation. Conclusion While often overlooked, dietary history is a crucial part of history-taking to ensure that the underlying cause for illness is discovered and addressed.
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Affiliation(s)
- Kevin McLendon
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi.,William Carey University College of Osteopathic Medicine, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Matthew Wiggins
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Derek Hunt
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Alex Gauthier
- Merit Health Wesley, Department of Internal Medicine, Hattiesburg, Mississippi
| | - Deepu Thoppil
- Merit Health Wesley, Department of Internal Medicine, Hattiesburg, Mississippi
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Raina R, Grewal MK, Blackford M, Symons JM, Somers MJG, Licht C, Basu RK, Sethi SK, Chand D, Kapur G, McCulloch M, Bagga A, Krishnappa V, Yap HK, de Sousa Tavares M, Bunchman TE, Bestic M, Warady BA, de Ferris MDG. Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup. Pediatr Nephrol 2019; 34:2427-2448. [PMID: 31446483 DOI: 10.1007/s00467-019-04319-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/28/2019] [Accepted: 07/24/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intentional or unintentional ingestions among children and adolescents are common. There are a number of ingestions amenable to renal replacement therapy (RRT). METHODS We systematically searched PubMed/Medline, Embase, and Cochrane databases for literature regarding drugs/intoxicants and treatment with RRT in pediatric populations. Two experts from the PCRRT (Pediatric Continuous Renal Replacement Therapy) workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and two expert toxicologists, and expert panel recommendations were developed. RESULTS AND CONCLUSIONS We have presented the recommendations concerning the use of RRTs for treatment of intoxications with toxic alcohols, lithium, vancomycin, theophylline, barbiturates, metformin, carbamazepine, methotrexate, phenytoin, acetaminophen, salicylates, valproic acid, and aminoglycosides.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA. .,Akron Nephrology Associates/Cleveland Clinic Akron General, 224 W. Exchange St., Akron, OH, 44302, USA.
| | - Manpreet K Grewal
- Akron Nephrology Associates/Cleveland Clinic Akron General, 224 W. Exchange St., Akron, OH, 44302, USA
| | - Martha Blackford
- Division of Clinical Pharmacology & Toxicology, Akron Children's Hospital, Akron, OH, USA
| | - Jordan M Symons
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Christoph Licht
- Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rajit K Basu
- Department of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sidharth Kumar Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Deepa Chand
- Division of Pediatric Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gaurav Kapur
- Department of Pediatric Nephrology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Arvind Bagga
- Division of Paediatric Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Krishnappa
- Akron Nephrology Associates/Cleveland Clinic Akron General, 224 W. Exchange St., Akron, OH, 44302, USA
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Timothy E Bunchman
- Pediatric Nephrology & Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle Bestic
- Division of Clinical Pharmacology & Toxicology, Akron Children's Hospital, Akron, OH, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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