Hyperkalemia, Orange Juice, and Paralysis

[Green Dot]

Life-threatening hyperkalaemia developing following excessive ingestion of orange juice in a patient with baseline normal renal function - PubMed

Hyperkalaemia is a less-recognised life-threatening cause of paralysis. We describe a 51-year-old African-American man, who suffered from muscle weakness progressing to ascending symmetric paralysis, and inability to masticate. Physical examination revealed flaccid paralysis with areflexia of...

pubmed.ncbi.nlm.nih.gov

Hyperkalaemia is a less-recognised life-threatening cause of paralysis. We describe a 51-year-old African-American man, who suffered from muscle weakness progressing to ascending symmetric paralysis, and inability to masticate. Physical examination revealed flaccid paralysis with areflexia of the four limbs. Computed tomography of the brain and cervical spine did not demonstrate any organic lesions. Laboratory investigations revealed serum potassium 9.0 mEq/L (not haemolysed), blood urea nitrogen 34 mg/dL, and serum creatinine 2.0 mg/dL. Electrocardiography showed typical features of hyperkalaemia. After emergent treatment for hyperkalaemia was initiated, serum potassium was rapidly-normalised to 5 mEq/L and all neuromuscular symptoms reversed within one hour. Upon reviewing his food and medication history, he admitted drinking 2.5 litres of orange juice (which contains about 450 mg of potassium in 1,000 ml) per day for the past three weeks to quench his thirst. Hyperkalaemia should be borne in mind in the differential diagnosis of acute paralysis. Hidden sources of potassium intake, such as orange juice, should not be overlooked, even in patients with baseline normal renal function.

 

[methylenewhite]

That's some kind of BS. 2,5 L of orange juice would give 1350 mg of potassium only. Not enough to cause hyperkalemia. Maybe he doesn't drink water at all.

 

[redsun]

That's some kind of BS. 2,5 L of orange juice would give 1350 mg of potassium only. Not enough to cause hyperkalemia. Maybe he doesn't drink water at all.

Theres some kind of measurement error you are doing 2.5 L = 10.567 cups of orange juice gives ~5200mg of potassium. Even the researchers must have done something wrong. They say 1000ml of OJ has 450mg but it should be 2093 mg. His sodium was also right at the bottom of the range of 135 mEq/l.

 

[yerrag]

More like kidney problem that keeps him from excereting potassium, made worse by high potassium intake.

 

[Blaze]

More like kidney problem that keeps him from excereting potassium, made worse by high potassium intake.

This. Exactly..............

 

[Peatress]

I wonder if this man was on a salt restricting diet?

 

[yerrag]

This. Exactly..............

I wonder though if the kidney is still fine.

And that the ecf (extracellular fluids) is just too acidic that the kidney simply resorbs back into blood the potassium K+ions in exchange for hydronium ions H+, for excretion.

Said patient must also be hyperkalemic and also suffer from tachycardia from having low potassium in the cellular membranes that the cell cannot regulate calcium entry well. The resulting lower gradient between cellular and extracellular calcium would result in inefficient heart pumping leading to tachycardia.

So the problem could be systemic poor acid base balance rather than sick kidneys.

 

[Blaze]

I wonder though if the kidney is still fine.

And that the ecf (extracellular fluids) is just too acidic that the kidney simply resorbs back into blood the potassium K+ions in exchange for hydronium ions H+, for excretion.

Said patient must also be hyperkalemic and also suffer from tachycardia from having low potassium in the cellular membranes that the cell cannot regulate calcium entry well. The resulting lower gradient between cellular and extracellular calcium would result in inefficient heart pumping leading to tachycardia.

So the problem could be systemic poor acid base balance rather than sick kidneys.

Certainly one possiblity............... and a much better situation if the kidney function is a symptom of those things rather than irreversibly damaged.