title: Hyperkalemia with concomitant watery diarrhea: an unusual association.
abstract: Four patients presented to the emergency room with life-threatening hyperkalemia and concomitant watery diarrhea. Hypovolemia, acidosis, and renal insufficiency were present in all 4 cases. In 2 patients, hyperkalemia followed initiation of angiotensin-converting enzyme (ACE) inhibitor therapy, whereas 1 patient experienced hyperkalemia after a dose increase of an ACE inhibitor, and the fourth patient was on continuous ACE-inhibitor therapy at the time of the hyperkalemia episode. Two of the 3 patients with functioning kidneys required hemodialysis to correct the hyperkalemia, whereas the other patient was on long-term hemodialysis therapy. In the 2 patients in whom transtubular potassium (K+) gradients were available, their values ranged far below normal, indicating tubular failure to secrete K+. This abnormality was attributed to decreased distal delivery of sodium and water and to renin/angiotensin II/aldosterone blockade. It has been proposed that aldosterone blockade impairs the capacity of the colonic epithelial cells to secrete K+. In all 4 patients the watery diarrhea ceased in parallel with the correction of serum K+ to normal values. It is suggested that hyperkalemia, most likely by stimulating intestinal motility, induced the watery diarrhea in all 4 patients. The watery diarrhea, however, failed to compensate for the renal tubular failure to secrete K+.
authors.affiliation: Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: Jeremy G C
authors.initials: JG
authors.lastname: Taylor
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Zwillich
authors.forename: William D
authors.initials: WD
authors.lastname: Kaehny
authors.forename: Moshe
authors.initials: M
authors.lastname: Levi
authors.forename: Mordecai M
authors.initials: MM
authors.lastname: Popovtzer
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000150:complications* / Q000628:therapy; D017706:Lisinopril / Q000009:adverse effects; D008297:Male; D006435:Renal Dialysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril