Life‐threatening hypokalaemia associated with ibuprofen‐induced renal tubular acidosis

Ibuprofen‐induced distal (type 1) renal tubular acidosis and hypokalaemia: the dangers of ibuprofen–codeine combination over‐the‐counter preparations

“…It usually affects young males, with a male:female ratio of 8:1, and presents a diagnostic challenge. 1 We report a case of SPM in a 19-year-old white woman who presented with gradual worsening of dyspnoea, dysphagia and neck tightness. Radiological signs on the initial chest Xray were missed and the patient was treated for pneumonia.…”

“…The characteristic features of distal (type 1) renal tubular acidosis (RTA) include impaired distal hydrogen ion (H+) excretion, (usually) reduced serum [K+], urine pH >5.5 and a positive urine anion gap. 1 The exact mechanism of how ibuprofen causes distal-RTA is not known. The working hypothesis is that it is related to the inhibition or deficiency of carbonic anhydrase (CA) activity, specifically CA type-II, which is the predominant type found in the kidneys.…”

“…2 Since 2003 there have been 13 cases of ibuprofenrelated hypokalaemia and RTA, 14 including Patient 1. [1][2][3][4][5][6][7] Due to the accessibility of combination ibuprofencodeine in non-prescription formulations in Australia and Britain, these are the only regions of such reports. The biochemistry and patient data are summarised in Table 2.…”

Low Dialysate Potassium Concentration: An Overrated Risk Factor for Cardiac Arrhythmia?

“…Moreover, literature search for instances of fatal, lethal or life-threatening hypokalemia finds only a limited number of case reports. The hypokalemia put patients at risk due to severe muscle weakness (2,3,(53)(54)(55)(56)(57)(58) seemingly as often as due to life-threatening arrhythmias (59)(60)(61)(62)(63)(64)(65). Serum potassium levels were quite low in these cases with serious hypokalemic manifestations, between 1 and 2.4 mEq/l.…”

Regulatory responses to over‐the‐counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom

“…Cases of misuse and dependence on OTC codeine‐ibuprofen resulting in life‐threatening morbidity including gastric ulceration and haemorrhage, renal tubular acidosis and severe hypokalaemia have been reported in Australia, 6–13 NZ 14–16 and the UK 17–22 . A common pathway to high dose dependence on OTC codeine analgesics is by commencement at therapeutic doses for pain treatment (recommended maximum daily dose six tablets), then gradual escalation to higher‐than‐recommended doses to achieve effective analgesia or euphoric effects 11,19,23 .…”