A 52-year-old male with multiple comorbidities presented with a chronic history of hypokalemia due to drinking Cola every day for several years!
A 52-year-old male with a history of hypertension, gastroesophageal reflux disease, O2-dependent COPD, idiopathic gastroparesis, and chronic low back pain presented with medical reports showing persistent hypokalemia in the range between 2.7–3.3 meq/L for more than 2 years. He also complained of chronic generalized weakness, fatigue, and occasional loose stools, however, he did not have nausea or vomiting. Dietary history revealed that he consumed approximately 4L of Pepsi-Cola every day for the past several years. He used to sip cola slowly but continuously.
He smoked one-half pack of cigarettes per day, but he denied alcohol consumption.
The doctors decided to discontinue his diuretic medications and fludrocortisone, which he was taking for hypertension and orthostatic hypotension. The patient received aggressive oral potassium supplementation (up to 120 meq per day), however, there was no improvement.
History revealed that his serum potassium normalized when he was hospitalized thrice before and received supplemental potassium. However, the hypokalemia promptly recurred after discharge from the hospital.
His medications included:
- Paroxetine
- Trazodone
- Pregabalin
- Morphine
- Loratadine
- Isosorbide mononitrate,
- Lisinopril
- Metoprolol
- Simvastatin
- Omeprazole
- Metoclopramide
- Potassium chloride
- Calcium/vitamin D tablets
- Alendronate
- Mometasone
- Tiotropium
- Albuterol inhalers.
Physical examination revealed an ill-appearing male who was wearing a nasal cannula, weighed 205 pounds and was 69 inches tall. Vital signs were a body temperature of 98.6 degrees, a pulse rate of 95, respiratory rate of 14, blood pressure of 128/73. Moreover, the examination was negative for cushingoid facies, buffalo hump, abdominal striae, thyromegaly or lymphadenopathy.
Chest auscultation revealed decreased breath sounds and mild expiratory wheezes bilaterally. Heart sounds were regular with no murmurs or added sounds. Additionally, abdominal examination revealed a soft, non-tender, non-distended abdomen with no masses or organomegaly. Extremities showed no oedema, clubbing or cyanosis.
Neurological examination revealed mild generalized muscular weakness, but normal deep tendon reflexes.
Serology revealed serum sodium 137 mg/dL, potassium 3.0 mg/dL, chloride 95 mmol/L, CO2 30.0 mmol/L, blood urea nitrogen 5 mg/dL, creatinine 0.8 mg/dL, calcium 9.3 mg/dL, phosphorus 4.1 mg/dL, albumin 3.6 g/dL, ferritin 126 ng/mL, hemoglobin 12.7 g/dL, white blood cell count 10.6 K/cmm, and platelet count 160 K/cmm. Moreover, his serum aldosterone was 4.8 ng/dL and the plasma renin activity was 0.33 ng/mL/hr.
Spot urine potassium was 8.6 mEq/L, urine sodium was < 10 mEq/L, and urine chloride was 16 mmol/L.
The explanation for normal serum potassium levels during hospitalization would be that he stopped drinking cola during those days.
Therefore, with this working diagnosis, the patient was counselled to gradually stop drinking cola. He decreased his cola intake to 2 litres per day. subsequently, his serum potassium levels increased from 3.0 to 3.5 mg/dL.
Reference:
Packer CD. Chronic hypokalemia due to excessive cola consumption: a case report. Cases J. 2008;1(1):32. Published 2008 Jul 14. doi:10.1186/1757-1626-1-32
