title: Palmaria palmata (Dulse) as an unusual maritime aetiology of hyperkalemia in a patient with chronic renal failure: a case report.
abstract: BACKGROUND
  Hyperkalemia is rare in individuals with normal renal function, regardless of dietary intake. This is due to the ability of the kidneys to adapt to increasing serum potassium concentrations. In patients with renal compromise, potassium homeostasis can become impaired. Palmaria palmata (dulse) is an edible seaweed known to be very rich in potassium. We report a case of hyperkalemia precipitated by the consumption of dulse by a patient with known renal disease.
  
  
  METHODS
  A 66-year-old Caucasian woman with diabetes and chronic renal disease presented to our emergency department with nausea, vomiting, and worsening malaise, which had been present for less than a day. She had undergone electrocardiogram monitoring, which showed bradycardia, and periods of asystole. Our patient denied any other symptoms. Laboratory analysis revealed a serum potassium level of 8.6 mmol/L (normal range 3.5 to 4.9 mmol/L). Although our patient was taking some medications known to influence renal function, the only recent change that she could recount was that she had consumed approximately 200 g of dulse within the preceding 24 hours. A diagnosis of hyperkalemia was made, and the patient was treated successfully, and discharged home in her pre-morbid state.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first published report of hyperkalemia due to dulse consumption. Dulse is high in potassium, with concentrations upwards of 34 times greater than that found in bananas. Caution should be taken in prescribing medications with potential adverse renal effects for patients with known renal impairment. In such instances, renal function should be monitored closely. Patients should be counseled to avoid dietary sources high in potassium, with particular attention paid to unusual geographical dietary variations.
authors.affiliation: Department of Medicine (General Internal Medicine), Dalhousie University, and Saint John Regional Hospital, Department of Medical Education, 3DS, 400 University Avenue, PO Box 2100, Saint John, NB, E2L 4L2, Canada. brent.mcgrath@dal.ca.
authors.forename: Brent M
authors.initials: BM
authors.lastname: McGrath
authors.forename: John Paul
authors.initials: JP
authors.lastname: Harmon
authors.forename: Graham
authors.initials: G
authors.lastname: Bishop
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