title: Severe hypokalemia caused by oral and rectal administration of bentonite in a pediatric patient.
abstract: BACKGROUND
  Bentonite is a clay substance that has been used as a homeopathic cathartic. Oral ingestion of bentonite in large quantities has the potential to cause gastrointestinal obstruction and electrolyte abnormalities. We present a case of severe hypokalemia in a pediatric patient who received both oral and rectal administrations of bentonite.
  
  
  METHODS
  A 3-year-old girl presented with a chief complaint of vomiting, constipation, lethargy, and weakness over several days. On initial evaluation, the child was mildly dehydrated and had a serum potassium of 0.9 mmol/L. Electrocardiographic findings were also consistent with hypokalemia. Upon further questioning, the parents reported that they had been administering a home remedy, containing colloidal bentonite, both orally and rectally as treatment for persistent constipation. The child received intravenous antibiotics, a normal saline bolus, and multiple boluses of potassium chloride, resulting in eventual normalization of her electrolyte abnormalities.
  
  
  CONCLUSIONS
  Ingestion of large quantities of clay substances, such as bentonite, can result in gastrointestinal binding of essential electrolytes and possible obstruction. Symptoms and laboratory values often resolve with replacement of electrolytes and cessation of bentonite intake. Although cases of oral ingestion of clay-like substances resulting in electrolyte abnormalities have been reported, there are no previously reported human cases of hypokalemia caused specifically by bentonite administration. This may be due to the unique rectal administration seen in this child, which has not previously been described.
authors.affiliation: Department of Developmental-Behavioral Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA. bennettam@email.chop.edu
authors.forename: Amanda
authors.initials: A
authors.lastname: Bennett
authors.forename: Glenn
authors.initials: G
authors.lastname: Stryjewski
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D001546:Bentonite / Q000008:administration & dosage / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced*; D012720:Severity of Illness Index
chemical_list: D001546:Bentonite