Citation

Iijima S. World J. Clin. Cases 2020; 8(8): 1463-1470.

Affiliation

Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan. sige_pd@yahoo.co.jp.

Copyright

(Copyright © 2020, Baishideng Publishing Group)

DOI

10.12998/wjcc.v8.i8.1463

PMID

32368538

PMCID

PMC7190950

Abstract

BACKGROUND: Congenital chloride diarrhea (CCD) is a rare inherited disorder of intestinal electrolyte transport that results in a large wastage of electrolytes and water. Advances in substitution therapy using sodium chloride (NaCl) and potassium chloride (KCl) have dramatically improved survival for patients with CCD. Slow-release KCl is widely prescribed as a potassium supplement; however, it has also occasionally been used in suicide attempts, as potassium poisoning can generate life-threatening hyperkalemia. CASE SUMMARY: A 26-year-old female presented to the emergency department (ED) with self-poisoning, having taken 30 tablets of slow-release KCl (total: 240 mmol potassium) following an auditory hallucination. The patient had been undergoing substitution therapy with NaCl and KCl for CCD and been followed up in the pediatric department. One month prior, she developed insomnia and anxiety and had consulted a psychiatrist. At the ED, although her general condition was good, she appeared agitated. Her serum potassium level was 7.0 mmol/L, indicating hyperkalemia, and electrocardiographic changes showed tenting of the T-waves. She responded to the administration of calcium gluconate, sodium bicarbonate, and insulin with glucose, and the serum potassium level improved. Finally, she was diagnosed with schizophrenia.

CONCLUSION: In CCD management, physicians should pay careful attention to patients' extraintestinal issues, including psychological disorders that may emerge in adulthood.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Language: en

Keywords

Case report; Congenital chloride diarrhea; Potassium overdose; Schizophrenia; Substitution therapy; Suicide