Fatal hyperkalemia related to combined therapy with a COX-2 inhibitor, ACE inhibitor and potassium rich diet.
We describe the case of a 77-year old mildly hypertensive woman with no underlying renal disease who was admitted to the Emergency Department (ED) in a comatose state with fever. The patient had been on low dose enalapril and a potassium rich diet. Five days before admission, rofecoxib, a new selective COX-2 inhibitor nonsteroidal anti-inflammatory drug (NSAID), was added for leg pain. She was found to have severe hyperkalemia and died 90 min after her arrival. We cannot absolutely determine whether the COX-2 inhibitor was the dominant contributor to the development of hyperkalemia or the combination itself, with an intercurrent infection and some degree of dehydration. Physicians should be aware of this possible complication and only prescribe NSAIDs, including the new COX-2 drugs, to the elderly under close monitoring of kidney function and electrolyte tests.
Department of Emergency Medicine, Barzilai Medical Center, Ashkelon, Israel.
Emile
E
Hay
Hashmonai
H
Derazon
Natalia
N
Bukish
Leonid
L
Katz
Igor
I
Kruglyakov
Michael
M
Armoni
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004032:Diet / Q000009:adverse effects*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D006973:Hypertension / Q000188:drug therapy; D007783:Lactones / Q000009:adverse effects*; D028521:Musa; D010146:Pain / Q000188:drug therapy; D013450:Sulfones
D000806:Angiotensin-Converting Enzyme Inhibitors; D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D004656:Enalapril