Severe Hyperkalemia Caused by Excessive Consumption of Dried Orange Juice in a Patient With Normal Renal Function

TL;DR

A man with normal kidney function developed severe high potassium levels from drinking too much dried orange juice, showing the importance of checking diet in unexplained cases.

Contribution

Demonstrates that excessive potassium intake from dietary sources can cause severe hyperkalemia in individuals with normal renal function.

Findings

A 40-year-old man with normal renal function developed life-threatening hyperkalemia (9.4 mmol/L) from excessive dried orange juice consumption.

Discontinuation of the potassium-rich beverage led to sustained normalization of potassium levels and symptom resolution.

The case emphasizes the need for a thorough dietary history in evaluating unexplained hyperkalemia.

Abstract

Hyperkalemia is a potentially life-threatening electrolyte abnormality most commonly associated with impaired renal excretion, medication effects, or metabolic disturbances. Severe hyperkalemia resulting from dietary potassium intake alone is uncommon in individuals with preserved renal function due to normally effective renal excretion mechanisms. We report a case of a 40-year-old man with no known past medical history who presented with progressive neuromuscular symptoms, palpitations, and syncope and was found to have life-threatening hyperkalemia with serum potassium levels rising to 9.4 mmol/L and characteristic electrocardiographic changes, including peaked T waves and QRS widening. Renal function, acid-base status, and medication history were unremarkable, and pseudohyperkalemia was excluded. The patient required intensive care unit admission and was treated with intravenous calcium, insulin with dextrose, beta-agonist therapy, and potassium binders, resulting in prompt clinical and biochemical improvement without the need for renal replacement therapy. Further history revealed excessive daily consumption of large volumes of a dried orange juice powder reconstituted as a beverage over several weeks. Discontinuation of the potassium-rich beverage led to sustained normalization of serum potassium levels and complete resolution of symptoms. This case highlights that extreme and sustained intake of potassium-rich liquid dietary sources can overwhelm physiologic compensatory mechanisms and cause severe hyperkalemia even in patients with normal renal function. A thorough dietary history is essential when evaluating unexplained hyperkalemia to ensure timely diagnosis and prevent potentially fatal complications.