Sustained-release potassium chloride overdose

Background: Although ingestion of sustained-release potassium supplements c an cause life-threatening hyperkalemia in patients with abnormal renal func tion, only a few previous reports suggest that this may occur in patients w ith normal renal function. We report 2 cases of hyperkalemia in patients wi th normal renal function who developed hyperkalemia after ingesting sustain ed-release potassium preparations and describe the use of radiography and w hole-bowel irrigation in their care. Case Reports: The first patient is a 5 0-year-old woman who ingested 100 K-Dur(R) tablets (each tablet containing 750 mg KCl or 10 mEq potassium) in a suicide attempt 1 hour prior to presen ting to the emergency department. She developed a peak serum potassium leve l of 9.7 mEq/L and had transient, potentially life-threatening electrocardi ographic changes. The second patient was a 17-year-old man who ingested 20 to 30 Klor-Con(R) tablets (each tablet containing 750 mg KCl or 10 mEq pota ssium) in a suicide attempt 10 hours prior to presentation. Although he dev eloped a peak serum potassium level of 6.1 mEq/L, he had a persistently nor mal electrocardiogram. In both patients, the tablets were visualized on abd ominal radiographs and the gastrointestinal tracts of both were successfull y decontaminated using whole-bowel irrigation. Discussion: Although the sen sitivity and specificity are unknown, the abdominal radiograph appears to b e useful in detecting sustained release potassium tablets. Whole-bowel irri gation as a primary method of gastrointestinal decontamination also appears to be effective although its use is not previously reported for sustained- release potassium overdoses.