Hyperkalemic cardiac arrhythmia resulting from short-term ingestion of potassium citrate for the management of ureter stones

Excerpt

An 82-year-old female patient was transferred from a regional hospital to our emergency department for the management of obstructive uropathy. Computed tomography revealed multiple stones in the right renal pelvis and proximal ureter with ipsilateral hydronephrosis. An urgent percutaneous nephrostomy was performed to relieve the obstruction of right kidney. She was treated with meropenem for urinary tract infection. On day 16, she underwent extracorporeal shock wave lithotripsy (ESWL) targeted to right ureter stone. We prescribed potassium (K) citrate to effectively prevent stone recurrence and growth following ESWL. At this time, her serum levels of K, urea, and creatinine were 4.2, 7.1, and 150 µmol/L, respectively. On day 18, she complained of dizziness and nausea. Her systolic blood pressure and heart rate were 80 mmHg and 50 beats/min, respectively. An urgent electrocardiogram revealed markedly widened QRS complexes with peaked T waves, loss of P waves, and right bundle branch blocks (Fig. 1). Her serum K level was >10.0 mmol/L. After treatment of hyperkalemia, her hemodynamic parameters were stable and electrocardiogram returned to baseline.

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