Abstract
BackgroundHypokalemia induced by diuretic abuse is a life-threatening emergency.Case presentationA 22-years-old female nurse with a body mass index 18 suffered from myalgias, vomiting and diarrhea. Blood tests revealed hypokalemia with a lowest value of 1.1 mmol/l, moderate hyponatremia, metabolic alkalosis, mild renal insufficiency and creatinphosphokinase-elevation. Since hypokalemia and alkalosis were unexplained, she was asked for diuretic-intake. She confessed that she has taken 250 mg furosemide/day for the last 4 months to improve the shape of her muscles. Furosemide tablets were given to her by a physician attending the gym where she exercised. After electrolyte substitution, laboratory abnormalities regressed and no cardiac arrests were observed. Psychiatric investigation diagnosed an adjustment disorder.ConclusionFurosemide abuse has to be considered even in underweight individuals, especially if they have a psychiatric instability or work in health care institutions.
Highlights
Hypokalemia induced by diuretic abuse is a life-threatening emergency.Case presentation: A 22-years-old female nurse with a body mass index 18 suffered from myalgias, vomiting and diarrhea
Furosemide-induced hypokalemia is characterized by hypernatremia, hypocalcemia, hypomagnesemia, high urine calcium creatinine ratio, high urine sodium excretion and high urine calcium/creatinine ration
After 7 days she left the hospital and returned for blood tests after one week. This patient with severe hypokalemia is interesting for the following reasons: It is extremely rare that serum potassium levels decrease below 2 mmol/l and that such low levels are tolerated without cardiac arrests
Summary
Chronic abuse of furosemide as cause of hypokalemia has been repeatedly reported [1,2,3,4,5]. Furosemide-induced hypokalemia may present without these electrolyte abnormalities and only be detected by the history, as shown by the following case. Case presentation A 22-years-old female nurse was admitted because of myalgias since 10 days, vomiting and diarrhea since 4 days, and generalized weakness and dizziness since 3 days. She had a history of Raynaud’s disease and of a restless leg syndrome since 9 years. A psychiatric investigation excluded suicidality, depression or eating disorder, diagnosed an adjustment disorder and recommended psychotherapy Her heart rhythm was monitored during 7 days and did not show any arrhythmias. After 7 days she left the hospital and returned for blood tests after one week
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