Kidney Week

Abstract: PUB127

Laxative Use in Acute Hyperkalemia

Session Information

• Publication Only

Category: Trainee Case Report

• 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Abdulameer, Faisal, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Faisal Abdulameer,

• Wall, Barry M., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Barry M. Wall,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Introduction

The most effective treatment of severe hyperkalemia is hemodialysis. Treatment options for patients who are not candidates for renal replacement therapy are limited. Oral potassium binders, available for treatment of chronic hyperkalemia, are not approved for acute hyperkalemia. We describe a stage 5 CKD patient with severe hyperkalemia who was not a hemodialysis candidate in whom lactulose was used after other measures failed to lower serum potassium (K⁺).

Case Description

66 year old female with stage 5 CKD who was not a candidate for renal replacement therapy due to severe schizoaffective disorder was being managed medically. Her serum K⁺ was controlled with patiromer 8.4 mg/day during the previous year. She presented with volume overload and uremic encephalopathy with hyperkalemia (K⁺, 5.7 meq/l), high anion gap metabolic acidosis ( serum CO₂ 10 mEq/L) and serum creatinine, 20 mg/dl. She received 10 units of insulin with D50, 150 mEq of IV sodium bicarbonate, furosemide 60 mg IV daily, and patiromer 8.4 g/day. Her serum K⁺ decreased to 5.3 meq/l after 24 hr, but increasesd to 7.0 mEq/L after 72hr. Patiromer dose was doubled to 16.8 g/day, and sodium bicitrate was added. Serum K⁺ initially decreased to 6.7 meq/l, but subsequently progressively increased despite improvement of metabolic acidosis, repeated administration of insulin+D50 and albuterol, patiromer, and use of high dose loop diuretics, peaking at 9.3 mEq/L on day 11. Daily lactulose dose of 17 g daily was added, resulting in diarrhea and gradual decline in serum K⁺ at an average rate of 0.7 mEq/L/day, reaching a nadir of 6.9 mEq/L after 72 hr. The patient unfortunately passed away on that day due to other uremic complications.

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Discussion

Lactulose is a non absorbable disaccharide metabolized by colonic bacteria to noncarbohydrate organic acids, which acts as an osmotic cathartic. In this case lactulose was successfully implemented in treating severe hyperkalemia when all other measures failed. Controlled use of laxatives can be considered as a means to control hyperkalemia in patients who are not candidates for renal replacement therapy.