Introduction. Hypokalemia is often discovered accidentally during routine check-ups. In some cases, however, it may be accompanied by severe symptoms like rhabdomyolysis, potentially leading to life-threatening cardiac rhythm disturbances.
Clinical case. We report the case of a 60-year-old woman admitted to the emergency department with marked anorexia, general weakness, diarrhea, and abdominal pain, which had progressively worsened over the last few weeks. Initial blood analyses showed hypokalemia (1.44mmol/L) as well as rhabdomyolysis (CK 6561 U/L). The cause of her condition could not be identified based on etiological investigations, whereas thorough history taking revealed massive chronic ingestion of cola (10 liters a day).
Discussion. The consumption of high quantities of cola can lead to hypokalemia through the effects of caffeine, glucose, and fructose. Caffeine induces severe hypokalemia by two mechanisms: intracellular redistribution of potassium and increased renal excretion of potassium. Additionally, substances with high fructose content cause osmotic diarrhea with secondary hypokalemia. The high glucose concentration in cola also induces hyperinsulinism, which is associated with intracellular redistribution of potassium.
Conclusion. Chronic and massive consumption of cola can lead to hypokalemia through intracellular potassium shifts, along with osmotic diarrhea caused by high fructose concentrations. Primary care physicians should inquire about soda consumption among their patients when confronted with unexplained cases of refractory hypokalemia.
Key Words
Diarrhea, hypokalemia, rhabdomyolysis
What is already known about the topic?
Hypokalemia has different causes, including renal and extra-renal potassium losses, as well as intracellular shifts. Renal and extra-renal (mostly digestive) causes are diagnosed easily. However, hypokalemia due to intracellular potassium shifts secondary to beta-adrenergic stimulation, hyperinsulinism, caffeine consumption, and alkalosis is less common. Abusive and chronic consumption of large amounts of cola may lead to hypokalemia by these various mechanisms.
What does this article bring up for us?
- This article describes an uncommon case of hypokalemia secondary to cola abuse.
- Some cases have been described in the media, but much less so in the scientific literature.
- Hypokalemia induced by chronic cola consumption, although rare, should be systematically considered in case of unexplained refractory hypokalemia.
- Its treatment consists in stopping cola intake.