title: Carvedilol-induced hyperkalemia in a patient with chronic kidney disease.
abstract: A 69-year-old male was admitted to the hospital with a chief complaint of abdominal pain, nausea, and vomiting. He had an extensive past medical history, including diabetes mellitus type 2 and chronic kidney disease stage III. Prior to admission, the patient was taking carvedilol 3.125 mg twice daily with no abnormality in his serum potassium. During hospitalization, his carvedilol was increased to 6.25 mg twice daily. The patient's serum potassium then rose from 4.8 to 6.7 mEq/L, with no improvement following administration of sodium polystyrene sulfonate. Nephrology concluded the carvedilol could be contributing to the hyperkalemia. The dose was decreased back to 3.125 mg twice daily, leading to the potassium normalizing to 4.4 mEq/L. The reported incidence of beta-blocker-induced hyperkalemia is less than 5%. A literature search revealed several cases of beta-blocker-induced hyperkalemia, but to the authors' knowledge, this is the first case describing carvedilol specifically. Utilization of the Naranjo probability scale indicated a possible probability that the carvediol was the cause.
authors.affiliation: Belmont University, College of Pharmacy, Nashville, TN, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hahn
authors.affiliation: Skyline Medical Center, Department of Pharmacy, Nashville, TN, USA martin.hahn@hcahealthcare.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Hahn
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy; D002227:Carbazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077261:Carvedilol; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D008297:Male; D011188:Potassium; D011412:Propanolamines / Q000009:adverse effects* / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011188:Potassium
keywords: adult; antihypertensive agents/adverse effects; carvedilol/adverse effects; humans; hyperkalemia/chemically induced; kidney failure