title: Hyperkalaemia and diarrhoea in a patient with surreptitious ingestion of potassium sparing diuretics.
abstract: We report a patient who presented with the unusual combination of chronic diarrhoea and hyperkalaemia. The patient was admitted to our hospital after repeated negative evaluations elsewhere including exploratory laparotomy. The patient had a long history of diarrhoea with hypokalaemia which was documented on several occasions in the past. Several months before admission to our hospital for evaluation of diarrhoea the patient developed hyperkalaemia. Her daily stool output reached 1200 g and her serum potassium was as high as 6.0 mmol/l. Extensive evaluation revealed surreptitious ingestion of the diuretics triamterene, hydrochlorothiazide and spironolactone as the cause of hyperkalaemia and diarrhoea. In addition, she had melanosis coli which was interpreted to be the consequence of surreptitious ingestion of anthraquinone-containing laxatives in the past although no current laxative intake could be proven. We postulate that diarrhoea in our patient was mainly due to the decreased sodium absorption in the small intestine and colon caused by diuretics. Serum aldosterone levels were more than eight times the upper limit of normal. Increased aldosterone levels presumably arose secondary to volume contraction and sodium chloride depletion, but presumably were not able to affect renal and colonic electrolyte transport because of blockage of mineralocorticoid receptors by spironolactone. Thus, the unusual combination of diarrhoea and hyperkalaemia resulted.
authors.affiliation: Department of Internal Medicine, Karl Franzens University, Graz, Austria.
authors.forename: V M
authors.initials: VM
authors.lastname: Stepan
authors.forename: H F
authors.initials: HF
authors.lastname: Hammer
authors.forename: G J
authors.initials: GJ
authors.lastname: Krejs
mesh_terms: D002908:Chronic Disease; D003967:Diarrhea / Q000139:chemically induced* / Q000150:complications; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects; D006929:Hyperaldosteronism / Q000139:chemically induced / Q000150:complications; D006947:Hyperkalemia / Q000139:chemically induced* / Q000150:complications; D008875:Middle Aged; D013148:Spironolactone / Q000009:adverse effects; D014223:Triamterene / Q000009:adverse effects
chemical_list: D004232:Diuretics; D006852:Hydrochlorothiazide; D013148:Spironolactone; D014223:Triamterene