Furosemide-Induced Severe Hypokalemia With Rhabdomyolysis Without Cardiac Arrest

Wolfgang Ruisz; Claudia Stöllberger; Josef Finsterer; Franz Weidinger

BMC Womens Health. 2013;13(30)

Background

Chronic abuse of furosemide as cause of hypokalemia has been repeatedly reported.^[1–5] Extreme furosemide-induced hypokalemia with a serum potassium level of 1.1 mmol/l, is rare and associated with life-threatening cardiac arrest and rhabdomyolysis.^[6–8] Typically, furosemide-induced hypokalemia is characterized by hypernatremia, hypocalcemia, hypomagnesemia, high urine calcium creatinine ratio, high urine sodium excretion and high urine calcium/creatinine ration. Furosemide-induced hypokalemia may also present without these electrolyte abnormalities and only be detected by the history, as shown by the following case.

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Table 1. Laboratory findings
Parameter	Reference value	Day 1	Day 1	Day 2	Day 2	Day 3	Day 3	Day 5	Day 7	Day 8	Day 15
		12:02	22:58	05:47	21.38	07:42	18:10	09:45	10:42	08:08	12:21
BUN	9.0–20.0 mg/dl	25	21	21	NM	12	9	4	6	8	14
Creatinine	−1.1 mg/dl	1.64	1.15	NM	NM	0.87	1.00	0.74	0.80	0.84	0.81
GFR	>90 ml/min/1.73 m	42	63	NM	NM	87	74	104	95	90	94
Sodium	136.0–145.0 mmol/l	130	129	132	132	138	136	137	140	140	139
Potassium	3.3–5.1 mmol/l	1.1	1.6	1.5	1.4	1.7	2.8	4.5	5.4	4.9	5.0
Chloride	98.0–106.0 mmol/l	90	92	97	98	101	97	100	NM	NM	99
Calcium	2.1–2.7 mmol/l	2.66	2.0	2.0	2.0	2.1	2.0	2.1	NM	NM	2.8
pH	7.33–7.42	7.549	7.514	7.468	7.454	7.357	7.453	7.467	NM	NM	7.371
HCO₃ ⁻	22–26 mmol/l	31.4	28.6	29.0	28.4	25.3	30.9	33.3	NM	NM	29.0
P_CO2	38–42 mmHg	36.1	34.2	40.9	42.3	52.1	48.0	35.7	NM	NM	57.0
CK	−144.0 U/l	15966	13143	11570	NM	9882	12043	5703	1867	1070	102
Leukocytes	4.0–9.0/nl	18.1	NM	NM	NM	9.5	8.9	NM	NM	5.5	5.9
Erythrocytes	4.0–5.2/pl	5.19	NM	NM	NM	3.28	3.48	NM	NM	3.54	3.55
Hemoglobin	12.0–16.0 g/dl	16.6	NM	NM	NM	10.4	11.2	NM	NM	11.4	12.1
Hematocrit	38.0–48.0%	42.7	NM	NM	NM	27.8	29.6	NM	NM	35.0	35.2

GFR = glomerular filtration rate, estimated according the Modified Diet in Renal Disease formula; CK = Creatinphosphokinase.

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Furosemide-Induced Severe Hypokalemia With Rhabdomyolysis Without Cardiac Arrest

Background

Tables

References

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Authors and Disclosures

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