Chronic hypokalemia due to excessive cola consumption: a case report

Abstract

A 52-year-old man was noted to have severe chronic hypokalemia despite discontinuation of diuretic treatment for hypertension and aggressive oral potassium supplementation. His serum potassium normalized temporarily when he was hospitalized, but hypokalemia recurred after discharge. He complained of generalized weakness and fatigue, and occasional loose stools. Physical examination showed mild generalized muscle weakness. Laboratory testing ruled out renal potassium wasting. A dietary history revealed that he was consuming 4 liters of cola per day, with a calculated fructose load of 396 grams per day. Since fructose absorption in the small bowel is relatively inefficient, this probably led to an osmotic diarrhea and GI potassium wasting. Physicians should ask their patients about soft drink consumption when they encounter unexplained hypokalemia.

Cola-induced hypokalaemia: pathophysiological mechanisms and clinical implications

“…The take-home message is that the chronic consumption of large amounts of cola soft drinks may adversely affect potassium homeostasis and result in potentially severe conditions such as hypokalaemic myopathy. case studies varied from 2 to 9 l per day, whereas the most common complaints were muscular in origin and ranged from mild weakness to profound paralysis (8)(9)(10)(11). All studied individuals had abnormally low serum potassium concentrations that could not be attributed to other more common causes of hypokalaemia.…”

“…In addition to the pregnancy‐related cases of cola‐induced hypokalaemia, several other reports on non‐pregnant individuals emphasise the adverse effects of cola overconsumption on potassium metabolism (Table 1). The quantities of cola consumed in these case studies varied from 2 to 9 l per day, whereas the most common complaints were muscular in origin and ranged from mild weakness to profound paralysis (8–11). All studied individuals had abnormally low serum potassium concentrations that could not be attributed to other more common causes of hypokalaemia.…”

“…All studied individuals had abnormally low serum potassium concentrations that could not be attributed to other more common causes of hypokalaemia. Fortunately, all patients had a rapid and complete recovery after the discontinuation of cola ingestion and the oral or intravenous supplementation of potassium (8–11, Table 1).…”

“… Glucose‐induced hypokalaemia: cola soft drinks may contain large amounts of glucose (up to 11 g of sugar per dl in regular colas) (11). Thus, the excessive consumption of these preparations may lead to osmotic diuresis and inappropriate urinary potassium loses.…”

Cola-induced hypokalaemia: a super-sized problem

“…He was not willing to stop drinking cola, but he did agree to reduce his intake to 2 l per day. His potassium then rose to the normal range, and his weakness improved (2).…”