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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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Oral potassium overdose: a case series.

Arushi Madan1,2,3, Christopher Morris1,3, Anna Goggin4

  • 1Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, Australia.

Clinical Toxicology (Philadelphia, Pa.)
|March 23, 2021
PubMed
Summary

Severe hyperkalaemia from oral potassium overdose is rare but requires urgent treatment. Aggressive medical therapy to shift potassium intracellularly is effective in patients with normal kidney function, with early decontamination potentially limiting peak levels.

Keywords:
Potassium chloridedialysisendoscopyhyperkalaemiaoverdose

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Area of Science:

  • Clinical Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • Severe toxicity from oral sustained-release potassium overdose is uncommon.
  • Acute hyperkalaemia necessitates prompt intervention due to cardiac risks.
  • Optimal management strategies for potassium overdose lack established clinical consensus.

Purpose of the Study:

  • To characterize the clinical manifestations of acute oral potassium overdose.
  • To describe the management approaches for severe potassium ingestions.

Main Methods:

  • Retrospective case series of patients with oral potassium overdose (≥6000mg) from 2009-2020 in Queensland, Australia.
  • Data extracted from Poisons Information Centre and Clinical Toxicology Unit databases, supplemented by medical records.

Main Results:

  • Thirteen presentations in eleven patients over 12 years.
  • Severe hyperkalaemia (>7mmol/L) occurred in five patients, particularly with large ingestions (≥60,000mg).
  • Treatments included intracellular potassium shifting, pharmacobezoar removal, whole bowel irrigation, and haemodialysis.

Conclusions:

  • Aggressive medical therapy for intracellular potassium shifting is the primary treatment for patients with normal renal function.
  • Early decontamination may reduce peak potassium concentrations.
  • The benefit of haemodialysis in patients with normal renal function remains uncertain.