Oral potassium overdose: a case series.

OBJECTIVE: Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach. METHODS: This is a retrospective case series of patients presenting following oral potassium overdose of ≥6000mg between January 2009 and December 2020 in Queensland, Australia as recorded in the state's Poisons Information Centre database and a tertiary Clinical Toxicology Unit database. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. RESULTS: Thirteen presentations in eleven patients occurred in the twelve-year period. The median age was 35 years (range 14-55 years). The median dose ingested was 6.4 mmol/kg (range 0.9-30.8 mmol/kg). Severe hyperkalaemia >7mmol/L occurred in five patients, four with ingestions ≥60,000mg. All patients with hyperkalaemia received multiple modes of intracellular potassium shifting therapy. Four patients had endoscopic removal of pharmacobezoars. One also underwent whole bowel irrigation. Three presentations were managed with haemodialysis. All patients were discharged home with a median length of stay of 20 h. CONCLUSION: Aggressive medical therapy to shift potassium into cells appears to be the mainstay of treatment in patients with normal renal function. Early decontamination may limit peak potassium concentrations. It is unclear if haemodialysis provides significant additional benefit in patients with normal renal function.

Fatal intravenous injection of potassium: Is postmortem biochemistry useful for the diagnosis?

Fatal cases of potassium overdoses have traditionally been considered indemonstrable due postmortem biochemical investigation limits (mainly potassium determination in postmortem serum and vitreous humor). Nevertheless, some authors have expressed a divergent opinion over the years based on the results of their own investigations. In this study, we investigated left vitreous, right vitreous, postmortem serum from peripheral blood, postmortem serum from cardiac blood, urine, pericardial and cerebrospinal fluid potassium concentrations in 21 forensic autopsy cases. One of these was a case of accidental, fatal intravenous potassium injection in a hospitalized patient. The other twenty cases were subjects with various causes of death unrelated to potassium administration and comparable postmortem intervals. Our aim was to assess whether postmortem biochemical investigations performed in several biological samples may be useful in diagnosing exogenous potassium administration. No statistically significant differences were observed between the measured concentrations in the fatal case of potassium intravenous administration and the control cases in any of the tested samples. Potassium concentrations in the investigated case of exogenous potassium injection were within the range of those measured in the control cases, irrespective of the tested biological sample. Our findings corroborate the conclusions of former authors who highlighted that circumstantial evidence provides the greatest diagnostic contribution in situations of suspected potassium poisoning. This is due to the objective limitations demonstrated by postmortem biochemical investigations in such cases, even when potassium measurements are carried out in several biological samples of satisfying quality and within a relatively short postmortem interval.

Acute oral potassium overdose: the role of hemodialysis.

INTRODUCTION: Hyperkalemia is a common condition, particularly in the setting of renal dysfunction. Hyperkalemia due to intentional oral potassium overdose is not commonly reported. CASE REPORT: We present a case of acute intentional potassium overdose in a patient with normal renal function resulting in significant hyperkalemia, with a maximum serum potassium concentration of 11 mEq/L. Despite an initial course complicated by various unstable cardiac rhythms, including ventricular tachycardia, ventricular fibrillation, and pulseless electrical activity, the patient was discharged from the hospital neurologically intact. Treatment for hyperkalemia included hemodialysis. DISCUSSION: The role of dialysis in potassium overdose is poorly defined. CONCLUSION: Based on this case and a review of the medical literature, we recommend hemodialysis for cases of potassium overdose with hemodynamic instability and significantly elevated serum potassium concentrations that do not respond promptly to medical therapy. Hemodialysis should also be considered in cases with underlying renal dysfunction.

[Corpus of biochemical changes after death by potassium intoxication in rabbits].

OBJECTIVE: To explore the objective evidence of the corpus biochemical changes in rabbits for postmortem diagnosis of potassium intoxication. METHODS: Rabbits were sacrificed by Infusion of 0.3% KCl at full speed push or 1% KCl at 100 drip/min, respectively, with normal rabbits used as control. Cardiac blood and urine samples were collected before and after potassium infusion to examine the concentrations of various electrolytes (K+, Na+, Ca2+, Mg2+, Cl-, and HCO3-) and to observe the antemortem and postmortem biochemical changes. RESULTS: The mean lethal infusion time in the 0.3%KCl group was longer than that in the 1% KCl group (P = 0.006). The serum concentration of K+ increased while the serum concentrations of Na+, Ca2+, Cl-, and HCO3- decreased after the infusion. There were no statistically significant differences in the whole blood concentration of K+ as well as the serum concentration of Mg2+ between the two groups (P = 0.062). There were statistically significant differences in the concentrations of whole blood K+, as well as serum Na+, Mg2+, and Cl-, but not in the serum K+, Ca2+, and HCO3-. There were no statistically significant differences seen in the urine volumes and the concentrations of all the urine electrolytes between the groups. CONCLUSION: Examination of the concentrations of K+ both in the whole blood and serum, as well as Mg2+ in the serum may be helpful for postmortem diagnosis of potassium intoxication.

[Morphological changes in rabbits died of potassium intoxication].

OBJECTIVE: Morphologic features of the corpse of rabbits died of potassium intoxication were studied in order to elucidate an objective evidence for forensic determination of death caused by potassium intoxication. METHODS: Macroscopic, microscopic, and ultrastructural (by transmission electron microscopy) changes were observed in the heart, brain, and kidney of rabbits killed by intravenous push or continuous infusion at 100 drips per minute with 0.3% and 1% KCl, respectively. Normal rabbits without any treatment killed by bleeding were used as controls. RESULTS: Macroscopically, cardiac dilatation and congestion/stasis as well as ischemic and hypoxic changes in various organs were observed in rabbits died of potassium injection. Microscopically and ultrastructurally, there were destruction of the cardiac fibers with thickening, concentrating, or disappearing of the Z-line, constriction of the glomerular capillaries, enlargement of the Bowman capsule, thinning and fusion of foot processes, as well as apoptosis with phagocytosis in brain observed, particularly in the group infused with 1% KCl. CONCLUSION: The morphologic changes observed in the heart and kidney appear to be characteristic, supporting death caused by potassium intoxication.

Corpus of biochemical changes after death by potassium intoxication in rabbits / 法医学杂志

OBJECTIVE@#To explore the objective evidence of the corpus biochemical changes in rabbits for postmortem diagnosis of potassium intoxication.@*METHODS@#Rabbits were sacrificed by Infusion of 0.3% KCl at full speed push or 1% KCl at 100 drip/min, respectively, with normal rabbits used as control. Cardiac blood and urine samples were collected before and after potassium infusion to examine the concentrations of various electrolytes (K+, Na+, Ca2+, Mg2+, Cl-, and HCO3-) and to observe the antemortem and postmortem biochemical changes.@*RESULTS@#The mean lethal infusion time in the 0.3%KCl group was longer than that in the 1% KCl group (P = 0.006). The serum concentration of K+ increased while the serum concentrations of Na+, Ca2+, Cl-, and HCO3- decreased after the infusion. There were no statistically significant differences in the whole blood concentration of K+ as well as the serum concentration of Mg2+ between the two groups (P = 0.062). There were statistically significant differences in the concentrations of whole blood K+, as well as serum Na+, Mg2+, and Cl-, but not in the serum K+, Ca2+, and HCO3-. There were no statistically significant differences seen in the urine volumes and the concentrations of all the urine electrolytes between the groups.@*CONCLUSION@#Examination of the concentrations of K+ both in the whole blood and serum, as well as Mg2+ in the serum may be helpful for postmortem diagnosis of potassium intoxication.

Morphological changes in rabbits died of potassium intoxication / 法医学杂志

OBJECTIVE@#Morphologic features of the corpse of rabbits died of potassium intoxication were studied in order to elucidate an objective evidence for forensic determination of death caused by potassium intoxication.@*METHODS@#Macroscopic, microscopic, and ultrastructural (by transmission electron microscopy) changes were observed in the heart, brain, and kidney of rabbits killed by intravenous push or continuous infusion at 100 drips per minute with 0.3% and 1% KCl, respectively. Normal rabbits without any treatment killed by bleeding were used as controls.@*RESULTS@#Macroscopically, cardiac dilatation and congestion/stasis as well as ischemic and hypoxic changes in various organs were observed in rabbits died of potassium injection. Microscopically and ultrastructurally, there were destruction of the cardiac fibers with thickening, concentrating, or disappearing of the Z-line, constriction of the glomerular capillaries, enlargement of the Bowman capsule, thinning and fusion of foot processes, as well as apoptosis with phagocytosis in brain observed, particularly in the group infused with 1% KCl.@*CONCLUSION@#The morphologic changes observed in the heart and kidney appear to be characteristic, supporting death caused by potassium intoxication.

[Severe mixed poisoning with diltiazem, potassium and magnesium: a case report]. / Ciezkie zatrucie mieszane diltiazemem, potasem i magnezem--opis przypadku.

We report the case of 52-year-old woman, who ingested 3.6 g of diltiazem, 16 g of potassium chloride and 6.5 g of magnesium, in a suicide attempt 4 hours before admission. She developed cardiorespiratory failure, with severe hypotonia and acute renal failure, in ECG third degree atrioventricular block was stated. The highest potassium concentration was 8.0 mmol/l, magnesium 2.15 mmol/l. As a result of multiple pharmacologic intervention, including intravenous fluids, calcium, glucagon, dopamine, dobutamine, norepinephrine, transvenous pacing and peritoneal dialysis (haemodynamic instability makes haemodialysis noneffective) the haemodynamic stabilization of cardiovascular system and normalization of potassium and magnesium concentration were achieved. The diltiazem concentration was measured using liquid chromatography, the result was 0.89 microgram/ml. She was discharged in a good clinical condition on day 26th.

Fatal intravenous injection of potassium in hospitalized patients.

We describe 4 cases of fatal intravenous injection of potassium in the hospital setting. These cases illustrate the subtlety of findings in such deaths and remind the forensic pathologist to consider this type of event in sudden, unexpected death of hospitalized patients.

Pico de fluxo expiratório em trabalhadores de fábricas de fogos de artifício / Expiratory peak flow in employees of firework factories

A pólvora é uma mistura explosiva constituída por 75 por cento de salitre (nitrato de potássio), 12 por cento de carväo e 13 por cento de enxofre, moídos em conjunto. O objetivo deste trabalho foi verificar um possível acometimento das vias aéreas de trabalhadores de fábricas de fogos de artifício por pólvora inalada. Foram medidos os picos de fluxo expiratório de 234 pessoas do Município de Santo Antônio do Monte, Minas Gerais: 41 sem exposiçäo profissional à pólvora (grupo controle) e 193 trabalhadores de fábricas de fogos de artifício. Os parâmetros utilizados foram: idade, sexo, estatura, peso, tabagismo e tempo de exposiçäo à pólvora. Todos os indivíduos pertencentes ao grupo controle tiveram seus níveis de pico de fluxo expiratório dentro da normalidade. Em 50 (25,9 por cento) trabalhadores houve reduçäo desse fluxo, sendo que 34 (68 por cento) eram tabagistas, 10 (20 por cento) tinham entre 5 e 10 anos de exposiçäo e 10 (20 por cento) tinham mais de 10 anos de exposiçäo. Concluindo, a pólvora parece ser um fator relacionado à reduçäo de pico de fluxo expiratório, principalmente em indivíduos tabagistas.

Poisoning with antihypertensive drugs: diuretics and potassium supplements.

Diuretics are widely prescribed to treat hypertension and oedema. The increasing use of these drugs opens the possibility of an increase in deliberate or accidental self-poisoning. However, experience with overdosage and toxicity with the diuretics remains very limited. In general, supportive therapy by the reduction of gastrointestinal absorption, monitoring of vital signs and the correction of hypertension and electrolyte abnormalities are indicated.

Incidental cardiac rhabdomyomas: a significant finding necessitating additional investigation at the time of autopsy.

Cardiac rhabdomyomas are rare lesions forming part of the tuberous sclerosis complex that may be responsible for sudden death. As well as remaining clinically occult for variable periods of time, they may, along with other manifestations of tuberous sclerosis, be quite difficult to detect clinically and pathologically. A patient is described in whom multiple cardiac rhabdomyomas were an incidental finding at autopsy following fatal potassium fluoride poisoning. Other gross pathological lesions typical of tuberous sclerosis were present but were quite subtle in appearance. Awareness of the association of cardiac rhabdomyomas with tuberous sclerosis is important so that full examination of organ systems for characteristic lesions can be undertaken during the autopsy, and so that fresh and frozen tissue can be obtained at the time of dissection for further investigation.

[Data on establishing the MPEL for the dust of a polymineralic potassium ore in the air of a work area]. / Materialy k obosnovaniiu PDK pyli polimineral'noi kaliinoi rudy v vozdukhe rabochei zony.

The article contains data on the norming principles for and the biologic action of polymineralic potassium dusts. The analysis and comparison of experimental and clinical data presented potassium ore as a substance characterized by low toxicity and weak fibrogenic action. In animal studies, the general toxic action of potassium aerosols exceeded the fibrogenic effects. MAC was suggested for working zone areas at 5 mg/m3 (3rd class of hazards).

[Noncirrhotic liver fibrosis after chronic arsenic poisoning]. / Nicht-zirrhotische Leberfibrose nach chronischer Arsenintoxikation.

A 67-year-old woman with portal hypertension, splenomegaly without portal vein thrombosis, leucopenia and thrombocytopenia of splenic origin had repeated episodes of life-threatening haemorrhage from esophageal varices. Since childhood she had suffered from psoriasis and had been treated over a period of 15 years with Fowler's solution (in all about 25 g of arsenic trioxide). She had the characteristic skin lesions of arsenical poisoning-palmar hyperkeratoses and two basal cell carcinomas on the trunk. Histological examination of a wedge biopsy from the liver showed definite structural changes with fibrosis around the central veins and in the portal tracts. There was no evidence of cirrhotic alteration. The hepatocytes were normal by light microscopy and electron microscopy. This case of noncirrhotic hepatic fibrosis is considered to have been caused by chronic arsenical poisoning.

[Poisoning with a wood preservative]. / Vergiftung mit einem Holzschutzmittel.

Autopsy findings and the results of chemical-toxicological analysis are presented on a case of suicide with a wood preservative containing potassium fluoride. The highest amounts of fluoride were found in kidney and urine; there was no increase of fluorides amount in the brain. The analysis was done by colorimetry after micro-diffusion.