Hypokalemia in opiate overdose

Abstract

Hypokalemia in opiate overdose is an event concerning which no previous references have been made. Twenty-four addicts to parenteral drugs without recent withdrawal, admitted consecutively to the emergency room of University Hospital of Salamanca, were studied. All patients had the clinical criteria of acute opiate intoxication (acute alteration of mental status, respiration of 12 or less per minute, miotic pupils); the questionnaire study, conducted after recovery, confirmed the diagnosis of intravenous heroin overdose, which nine cases coexisted with intravenous cocaine administration. No other psychodepressant drugs, such as benzodiazepines, alcohol, or barbiturates, were associated. All the subjects were treated with the opiate antagonist naloxone, given at an initial dose of 0.4 mg intravenously; this was repeated after 3-10 minutes if no response occurred. No supplements of potassium were added. Blood samples were obtained from all subjects before naloxone administration. Values are expressed as means_+ SE. Pair-wise comparisons were analyzed using the Wilcoxon or Mann-Whitney tests for paired or unpaired observations, respectively.The mean plasma potassium concentration of all patients at admission was 3.43 +0.12 mmol/1 (range 2.30-5.10 mmol/1); 14 patients (58.3%) were hypokalemic (K+< 3.5 mmol/1). Arterial blood gases and the acid-base balance measured at admission showed a decrease in both pH (7.20_+0.04) and bicarbonate (22.40 _+ 2.11 mmol/1), with hypoxemia (pO2 = 56.4 ± 3.35 mmHg) and hypercapnia (pCO2 = 57.2_+ 4.42 mmHg). There was a relationship between the level of consciousness and kalemia: the deep coma patients (n= 17) had plasma potassium concentrations that were significantly lower than patients with obnubilation, but who responded to painful stimuli (n=7; 3.21_+0.11 mmol/1 vs 4.01 _+ 0.28 mmol/1, P <0.01); also, significantly lower plasma potassium concentrations were observed in the patients who needed more than 0.8 mg naloxone for recovery of consciousness than those who needed lower doses of the antagonist (2.95_+0.16 mmol/1 vs 3.60_+0.42 mmol/1, P<0.02). Plasma potassium concentrations were higher in combined heroin and cocaine overdose than in heroin overdose alone. In six patients it was possible to determine plasma potassium concentrations just after recovery of consciousness after naloxone administration, showing a decrease of kalemia with respect to its values at admission (Fig. 1); spontaneous normalization -without potassium supplements of kalemia in these patients was verified 4-6 h after recovery from the overdose episode.Experimental studies have shown a dissociation of the sympathetic nervous system and adrenal medullary responses fol-lowing sympathoadrenal stimulus in acute hypoxia [2] and after the administration of naloxone to rats chronically treated with morphine [1]. The hypokalemiant action of epinephrine due to stimulation of 132-adrenergic receptors and the hyperkalemiant action of norepinephrine (cz-adrenergic stimulus) [3]. These observations led us to hypothesize t...

Opium and Heroin Alter Biochemical Parameters of Human's Serum

“…Hypokalemia has been reported in addict patients by Laso et al (30). It has been proposed that increased epinephrine level in addicts leads to the production of a pathogenic factor of hypokalemia through α and β2-adrenergic receptors (31).…”

Critical Hypokalemia: A Complex Clinical Journey

“…Extreme hypokalemia is rare. Severe hypokalemia often presents with paralysis, cardiac arrest, and may lead to death if urgent medical attention is not provided [6]. However, in this case, the patient presented with no obvious symptoms, highlighting that symptoms alone are not a sufficient marker of clinically significant hypokalemia.…”