Hypokalemic metabolic acidosis attributed to cough mixture abuse

This report describes a patient with mixed normal anion gap hyperchloremic metabolic and respiratory acidosis associated with hypokalemia attributed t o cough mixture abuse. Metabolic acidosis was likely related to an overdose of ammonium chloride, whereas respiratory acidosis was probably related to the effect of hypokalemia on respiratory muscles, causing hypoventilation, Hypokalemia was caused by a transcellular shift of potassium Induced by ep hedrine and pseudoephedrine. Both ammonium chloride and ephedrine were prob ably present in the cough mixture obtained by our patient as an over-the-co unter medication. Physicians should be aware of the potential for cough mix ture abuse to cause major electrolyte disturbances that may carry the risk for major cardiac arrhythmias, particularly in youth. (C) 2001 by the Natio nal Kidney Foundation, Inc.