heroin and Hyperkalemia

After reviewing the available data on drug-induced hyperkalemia, we conclude that the situation has not improved since Lawson quantitatively documented the substantial risks of potassium chloride over a decade ago (90). As discussed, the risk of developing hyperkalemia in hospital remains at least at the range of 1 to 2% and can reach 10%, depending on the definition used (Table 2). Potassium chloride supplements and potassium-sparing diuretics remain the major culprits but they have been joined by a host of new actors, e.g., salt substitutes, beta-blockers, converting enzyme inhibitors, nonsteroidal antiinflammatory agents, and heparin, among others. Readily identifiable risk factors (other than drugs) for developing hyperkalemia are well-known but seem to be consistently ignored, even in teaching hospitals. The presence of diabetes mellitus, renal insufficiency, hypoaldosteronism, and age greater than 60 years results in a substantial increase in the risk of hyperkalemia from the use of any of the drugs we have reviewed. If prevention of hyperkalemia is the goal, as it should be, the current widespread and indiscriminate use of potassium supplements and potassium-sparing diuretics will need to end. We remain intrigued by Burchell's prescient pronouncement of over a decade ago that "more lives have been lost than saved by potassium therapy" (28).

Topics: Adrenergic Agonists; Adrenergic beta-Antagonists; Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Arginine; Body Fluid Compartments; Cyclosporins; Digitalis Glycosides; Diuretics; Glucose; Heparin; Heroin; Hormones; Humans; Hyperkalemia; Hypertonic Solutions; Kidney; Kidney Transplantation; Lithium; Lithium Carbonate; Middle Aged; Potassium; Potassium Chloride; Prostaglandins; Risk; Transfusion Reaction

Severe hyperkalemia developed in two pregnant intravenous drug abusers during prolonged parenteral magnesium sulfate therapy in the absence of any obvious cause. The serum potassium concentration returned to normal after magnesium therapy was discontinued. Hypermagnesemia, acting through several possible mechanisms, was probably responsible for the reversible hyperkalemia observed.

Topics: Adult; Cocaine; Female; Heroin; Humans; Hyperkalemia; Magnesium; Magnesium Sulfate; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Substance Abuse, Intravenous

Topics: Adult; Heroin; Humans; Hyperkalemia; Illicit Drugs; Male

Topics: Adult; Heroin; Humans; Hyperkalemia; Male; Potassium; Sodium

Topics: Adult; Heroin; Heroin Dependence; Humans; Hyperkalemia; Male; Methadone