pica and Hyperkalemia

Topics: Alum Compounds; Calcium Sulfate; Causality; Diagnosis, Differential; Electrolytes; Female; Humans; Hyperkalemia; Hypokalemia; Kidney Failure, Chronic; Middle Aged; Pica; Renal Dialysis; Sodium Bicarbonate; Starch

A male patient undergoing hemodialysis in whom the cause of severe hyperkalemia (more than 8 mmol/liter) was found to be an unusual pica is described. His pica consisted of ingestion of burnt match heads (cautopyreiophagia). The potassium content of his daily consumption of burnt matches added 80 mmol to his 45 mmol dietary potassium intake. Hypogeusia and hypozincemia were documented. Oral zinc supplementation (zinc sulfate 220 mg per day for 10 weeks) normalized his plasma zinc level and taste acuity. He abandoned his pica and his plasma potassium level dropped significantly to 5.5 to 6 mmol/liter. It is suggested that inquiry about pica should be part of the dietary history in patients with renal failure.

Topics: Adult; Humans; Hyperkalemia; Kidney Failure, Chronic; Male; Pica; Potassium; Renal Dialysis; Sulfates; Taste Disorders; Zinc; Zinc Sulfate

We investigated geophagia in the black population of rural Holmes County, Mississippi. Twenty-five sources of geophagical clays were located and most of the sources are associated with rural settlements throughout the county. Clays are taken from subsurface soil horizons, and all but one of the sources come from the upland portion of the county. Geophagia occurs among 57% of women and 16% of children of both sexes, but it is not found among adult males or adolescents. Average daily comsumption of clay is 50 g. Our data indicate geophagia is not correlated with hunger, anemia, or helminthic problems, but it may contribute to the common problem of hypertension. Geophagia has been suggested as one of the factors leading to hyperkalemia, but our data do not support this notion.

Topics: Adolescent; Age Factors; Black or African American; Child; Child, Preschool; Cultural Characteristics; Female; Humans; Hyperkalemia; Hypertension; Infant; Male; Mississippi; Nutrition Surveys; Pica; Pregnancy; Sex Factors; Soil

Geophagia has been associated with life-threatening hyperkalemia in five patients with chronic renal failure. All five patients were black and had been born in the southeastern United States. Four had had frequent hyperkalemia requiring at least one hospitalization, and two had had hyperkalemia with serum potassium concentration as high as 9.8 mEq/liter, resulting in cardiac arrest in one and paralysis, disorientation, and cardiac arrythmia in the other. Since riverbed clay contains as much as 100 mEq of potassium in 100 gm of clay, much of which is exchangeable at acid pH, the mechanism of geophagia-induced hyperkalemia appears to be the absorption of potassium released from clay after ingestion. After discontinuing geophagia, no new hyperkalemic episodes occurred in these patients.

Topics: Adult; Aged; Arrhythmias, Cardiac; Black People; Female; Heart Arrest; Humans; Hyperkalemia; Kidney Failure, Chronic; Male; Middle Aged; Paralysis; Pica; Potassium; Soil; United States

Topics: Black People; Humans; Hyperkalemia; Pica; Potassium; Soil; United States