Sustained-release potassium chloride overdose.
BACKGROUND
Although ingestion of sustained-release potassium supplements can cause life-threatening hyperkalemia in patients with abnormal renal function, only a few previous reports suggest that this may occur in patients with normal renal function. We report 2 cases of hyperkalemia in patients with normal renal function who developed hyperkalemia after ingesting sustained-release potassium preparations and describe the use of radiography and whole-bowel irrigation in their care.


METHODS
The first patient is a 50-year-old woman who ingested 100 K-Dur tablets (each tablet containing 750 mg KCl or 10 mEq potassium) in a suicide attempt 1 hour prior to presenting to the emergency department. She developed a peak serum potassium level of 9.7 mEq/L and had transient, potentially life-threatening electrocardiographic changes. The second patient was a 17-year-old man who ingested 20 to 30 Klor-Con tablets (each tablet containing 750 mg KCl or 10 mEq potassium) in a suicide attempt 10 hours prior to presentation. Although he developed a peak serum potassium level of 6.1 mEq/L, he had a persistently normal electrocardiogram. In both patients, the tablets were visualized on abdominal radiographs and the gastrointestinal tracts of both were successfully decontaminated using whole-bowel irrigation.


CONCLUSIONS
Although the sensitivity and specificity are unknown, the abdominal radiograph appears to be useful in detecting sustained-release potassium tablets. Whole-bowel irrigation as a primary method of gastrointestinal decontamination also appears to be effective although its use is not previously reported for sustained-release potassium overdoses.
Su
M
M
New York City Poison Control Center, NYU/Bellevue Hospital Center, Department of Emergency Medicine, New York 10016, USA. MarkSMD@aol.com
Stork
C
C
Ravuri
S
S
Lavoie
T
T
Anguish
D
D
Nelson
L S
LS
Hoffman
R S
RS
D000293:Adolescent; D003692:Delayed-Action Preparations; D062787:Drug Overdose / Q000000981:diagnostic imaging; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006556:Heroin Dependence / Q000150:complications; D006801:Humans; D006947:Hyperkalemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D011189:Potassium Chloride / Q000506:poisoning*; D011859:Radiography
D003692:Delayed-Action Preparations; D011189:Potassium Chloride