Adverse drug event of hypokalaemia‐induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports

Abstract

What is known and objective The imbalance in serum potassium caused by laxatives can negatively affect the cardiovascular system, leading to life‐threatening consequences. Our objective was to evaluate the reported evidence of adverse events related to the cardiac system due to laxative‐induced hypokalaemia from case reports. Methods A systematic electronic literature search of PubMed, Embase, the Cochrane Library and Science Direct was conducted for the period 1995‐2019. In these databases, search terms describing hypokalaemia and cardiotoxicity were combined with the term laxative use. Results and discussion Over the 23 years, 27 incidents were identified in 12 countries. There were 19 female and eight male patients, with ages ranging from 1 month to 93 years. The frequency of reported cases according to severity was the following: severe hypokalaemia 48%, moderate hypokalaemia 44.4% and mild hypokalaemia 7.4%. In 70% of patients, the effect of laxative on the heart was typical hypokalaemic electrographic changes, 7.4% showed abnormal changes in cardiac rhythm, whereas in 18.5%, the cardiotoxicity observed was a very serious kind. Two patients died due to severe cardiac effects. What is new and conclusion The laxatives—along with the involvement of some other contributing factors—caused mild‐to‐severe hypokalaemic cardiotoxicity. These factors were non‐adherence of the patient to the recommended dosage, laxative abuse, drug‐drug and drug‐disease interactions, non‐potassium electrolyte imbalances and the use of herbal laxatives. We recommend that laxatives and aggravating factors should be taken into account in the assessment of patients with suspected hypokalaemic cardiotoxicity.

Acute Kidney Injury Impacts on Hypokalemia Associated with Yokukansan Preparation: A Retrospective Observational Study

“…Moreover, drug-induced hypokalemia was reported to contribute to life-threatening cardiotoxicity such as serious arrhythmia. 32) Therefore, we suggest that medical staff be aware of the occurrence of secondary hypokalemia with Yokukansan preparation after AKI.…”

“…medications such as diuretics and laxatives. 30) However, many patients have hypoalbuminemia and delirium, it is thought that sensitivity to diuretics (e.g., furosemide) may be scarce 31) and patients receive generous support from medical staff under admission. Moreover, drug-induced hypokalemia was reported to contribute to life-threatening cardiotoxicity such as serious arrhythmia.…”

Hipocalemia: fisiopatología, diagnóstico y manejo clínico

“…Los aminoglucósidos y el medicamento antitumoral cisplatino causan la pérdida renal de K+ al agotar los niveles de magnesio (20). Laxantes en exceso causan hipocalemia por pérdidas gastrointestinales de potasio (21). La hipocalemia es una consecuencia inevitable de la alcalosis metabólica.…”

Inconvenient topic: laxative abuse. review and clinical case

“…З гіпокаліємією також пов'язують ураження ниркових канальців та втрату ними концентраційної здатності, що, у свою чергу, збільшує виве-дення калію з сечею [10,42,47], можливе утворення каменів [36]. На додачу, гіпокаліємія може спровокувати розвиток токсичної кардіоміопатії з порушеннями ритму серця [16] та типові зміни на ЕКГ: поява зубця U, зменшення амплітуди зубця Т, депресія інтервалу ST, іноді інверсія зубця Т та подовження інтервалу P-R [6]. До порушень серцевого ритму, які пов'язані із низьким рівнем калію, належать синусова брадикардія, пароксизмальна шлуночкова тахікардія та шлуночкова тахікардія по типу torsades de pointes [43].…”