Hyperkalemia Caused by Potassium-Enriched Salt in a Hospitalized Patient

TL;DR

An elderly patient with kidney disease developed dangerous high potassium levels after consuming a potassium-enriched salt substitute, highlighting the risks for those with impaired kidney function.

Contribution

This case emphasizes the need for dietary monitoring and education about potassium-based salt substitutes in hospitalized CKD patients.

Findings

An 88-year-old CKD patient developed severe hyperkalemia (7.5 mEq/L) from a potassium-enriched salt substitute.

Treatment with glucose-insulin, fluids, diuretics, and sodium polystyrene sulfonate normalized potassium levels.

The case underscores the risks of unregulated dietary potassium in patients with compromised renal function.

Abstract

Hyperkalemia is a potentially life-threatening condition, particularly in patients with chronic kidney disease (CKD). Potassium-enriched salt substitutes are increasingly promoted as a dietary intervention for hypertension, but may pose risks in patients with impaired renal function. We report the case of an 88-year-old male with CKD who developed asymptomatic but marked hyperkalemia (7.5 mEq/L) during hospitalization for osteomyelitis. The patient had unknowingly consumed a potassium-enriched salt substitute brought in by his family to improve the taste of hospital meals. His renal function had previously declined due to septic and prerenal acute kidney injury. Following identification of the hyperkalemia, the patient was treated with glucose-insulin therapy, intravenous fluids, diuretics, and sodium polystyrene sulfonate, leading to normalization of serum potassium levels. This case highlights the importance of monitoring dietary potassium sources in hospitalized patients with CKD and underscores the need for patient and caregiver education regarding the risks of unregulated dietary supplements, especially potassium-based salt substitutes.