In a retrospective study from two databases in Australia, the authors described oral potassium overdoses greater than or equal to six grams, over twelve year period. All 12 ingestions were 600 mg sustained-release tablets of potassium chloride. What percentage of patients had severe hyperkalemia with a potassium greater than 7.0 mmol/L?
5/13 presentations (38%) had severe hyperkalemia. The median dose ingested for all of the presentations was 24 grams (6-120 grams), the median peak potassium concentration was 5.8 mmol/L (4.1-9.4 mmol/L), and the median time to peak concentration was 4.0 hr (0.5-7.3h). In the five severe cases, four developed ECG changes, three of the five (K 9.0, 8.2 and 7.5 mmol/L) were managed in the ICU with CVVHD and had endoscopic removal of pharmacobezoars after an abdominal radiograph confirmed the presence of tablets in the stomach. One patient had WBI.
Madan A, Morris C, Goggin A, Isoardi KZ. Oral potassium overdose: a case series. Clinical Toxicology 2021; 59 (11): 963-968
Submitted by: Kirk Cumpston, DO, FAACT on behalf of Virginia Commonwealth University Medical Toxicology Fellowship