Oral potassium overdose: a case series

Madan, Arushi; Morris, Christopher; Goggin, Anna; Isoardi, Katherine Z

doi:10.1080/15563650.2021.1898631

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…Most patients survive because the ingestion of slow-release potassium tablets increases the blood potassium level slowly, providing more time for therapeutic interventions, such as gastric evacuation [ 22 ], the administration of calcium gluconate, glucose, and insulin, potassium exchange resins, hemodialysis, and cardiac pacing [ 12 , 42 , 43 ]. The gradual increase in serum potassium levels pushes the threshold of lethal serum potassium concentration to a higher level than in intravenous use [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature

Simon

2023

Diagnostics

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Potassium overdose usually occurs accidentally, but potassium is also used for judicial executions, assisted death, and, rarely, suicides. In addition to exogenous overdose, various drugs, and renal failure, diabetic ketoacidosis can cause hyperkalemia. Potassium tablets are used in most cases of suicidal potassium overdose. Suicide by intravenous administration of potassium is rare but usually fatal. The author reports a rare case of suicide with potassium infusion. Autopsy and histology findings, along with post-mortem biochemical analysis of different body fluids and fluid from the infusion set, are reported. Previously published reports of potassium overdose were reviewed, and the detection possibilities of potassium overdose are discussed. The detection possibilities of lethal hyperkalemia are very limited since hyperkalemia produces only nonspecific autopsy and histology findings. Post-mortem potassium concentrations are not indicative of ante-mortem potassium concentrations; therefore, post-mortem biochemical analysis has limited value in determining potassium overdose. The best way to prove potassium overdose is via the collection and analysis of circumstantial evidence.

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Section: Discussionmentioning

confidence: 99%

Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature

Simon

2023

Diagnostics

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“…However, considering the persistent toxicity of an SSRI overdose, gastrointestinal decontamination may be needed for severe cases such as cases requiring endotracheal intubation or high doses of vasopressors. Recently, there have been several case reports on the usefulness of endoscopic decontamination for critical overdoses such as potassium overdose [ 11 ]. Although the efficacy has not been established, it is theoretically possible to reduce the amount of absorbed drugs.…”

Section: Discussionmentioning

confidence: 99%

Unexpectedly Prolonged Serotonin Syndrome and Fatal Complications Following a Massive Overdose of Paroxetine Controlled-Release

Inoue,

Okazaki,

Ichiba

et al. 2023

Cureus

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Symptoms caused by a selective serotonin reuptake inhibitor (SSRI) overdose are often mild and can be managed with supportive care and close monitoring, even when complicated by serotonin syndrome. There are limited pharmacokinetic data regarding massive overdoses of paroxetine, and the severity of an SSRI overdose is likely to be underestimated. We describe a fatal case of severe serotonin syndrome and acute respiratory distress syndrome (ARDS) following an overdose of controlled-release paroxetine. A 53-year-old male with depression presented with altered consciousness. He had ingested controlled-release paroxetine along with other medications. On arrival, he had ocular flutter and myoclonus, and blood examinations revealed acute kidney injury and rhabdomyolysis, which suggested serotonin syndrome. Computed tomography (CT) showed pharmacobezoars in the esophagus and stomach. Symptoms of serotonin syndrome and hypotension persisted despite administration of high doses of vasopressors with endotracheal intubation. We performed endoscopic decontamination to remove pharmacobezoars from the stomach. Finally, he developed severe ARDS and died due to respiratory failure on day 23. Sequential serum concentrations of paroxetine were 5.38 µg/mL at admission and 3.21 µg/mL on day 7, both above lethal levels. This case highlights the potential for fatal complications and prolonged toxicity in the case of a massive overdose of controlled-release paroxetine. We should recognize that such an overdose may be lifethreatening and should consider aggressive interventions including endoscopic decontamination. A better understanding of the pharmacokinetics of a massive SSRI overdose would be helpful for optimal management.

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Gastro-esophageal pharmacobezoar

Byard

Grabowski

2021

Forensic Sci Med Pathol

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Oral potassium overdose: a case series

Cited by 5 publications

References 18 publications

Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature

Detection of Fatal Potassium Overdose: A Case Report and Review of the Literature

Unexpectedly Prolonged Serotonin Syndrome and Fatal Complications Following a Massive Overdose of Paroxetine Controlled-Release

Gastro-esophageal pharmacobezoar

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