Life-threatening hyperkalemia induced by arginine

Area of Science:

• Clinical Medicine
• Pharmacology
• Nephrology

Background:

• Arginine monohydrochloride is used therapeutically.
• Spironolactone is a potassium-sparing diuretic.
• Hepatic and renal insufficiency impair drug metabolism and excretion.

Observation:

• Two patients with severe hepatic disease and moderate renal insufficiency developed marked hyperkalemia during and after arginine monohydrochloride infusion.
• Both patients had prior spironolactone treatment.
• One patient experienced a fatal cardiac arrhythmia secondary to hyperkalemia.

Findings:

• Arginine shifts potassium extracellularly, increasing serum concentration.
• Impaired arginine metabolism and potassium excretion in patients with hepatic and renal insufficiency can lead to profound hyperkalemia.
• Arginine-induced hyperkalemia can be life-threatening, particularly in patients with compromised organ function.

Implications:

• Caution is advised when administering arginine monohydrochloride to patients with hepatic or renal insufficiency.
• Monitoring of serum potassium levels is crucial in patients receiving arginine with pre-existing liver or kidney disease.
• This case series underscores the potential risks of arginine administration in vulnerable patient populations.