Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1463
Peer-review started: December 17, 2019
First decision: February 26, 2020
Revised: March 2, 2020
Accepted: April 10, 2020
Article in press: April 10, 2020
Published online: April 26, 2020
Processing time: 129 Days and 5.9 Hours
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.
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.
In CCD management, physicians should pay careful attention to patients’ extraintestinal issues, including psychological disorders that may emerge in adulthood.
Core tip: The main treatment for congenital chloride diarrhea (CCD) is life-long substitution therapy using sodium chloride and potassium chloride. An oral potassium supplement overdose is rare but can cause life-threatening hyperkalemia in cases of intentional high-dosage ingestion. We encountered an adult patient with CCD who developed hyperkalemia due to self-poisoning of prescribed potassium chloride tablets. In patients with CCD, physicians need to consider extraintestinal issues that patients can encounter as they get older, along with the challenges they face concerning life-long diarrhea. It is especially important to be aware of any potential psychiatric disorders that may cause life-threatening sequelae.