Oral potassium poisoning: a retrospective review of the National Poison Data System 2010–2021

Abstract

Introduction

Oral potassium poisoning can be life-threatening. The study aimed to describe patterns of oral potassium poisoning in adult and pediatric populations and characterize its clinical presentation and management as reported by United States poison centers.

Methods

This is a retrospective review of the National Poison Data System from 1 January 2010 through 30 June 2021. We descriptively analyzed cases involving single substance, oral potassium salts. In a second step, we requested a subset of case-specific narratives for cases that resulted in major outcome or death, as well as cases where patients received any of the following therapies: whole bowel irrigation, sodium bicarbonate, calcium, insulin or hemodialysis. We classified hyperkalemia by expected toxicity: mild (peak potassium concentration <6.5 mEq/L), moderate (peak potassium concentration 6.5 to <8 mEq/L) or severe (peak potassium concentration ≥ 8mEq/L).

Results

The National Poison Data System included 1,820 cases, 52.3 percent being adults. Among adult cases, 20% (n = 189) resulted in a moderate effect, major effect or death. Among pediatric cases aged <10 years, all exposures were unintentional. Analysis of 49 case narratives showed a median peak potassium concentration of 7.1 mEq/L (interquartile range 5.4–8.6) and a moderate correlation with the dose ingested (r = 0.66). Severe hyperkalemia was associated with QRS complex widening (P < 0.001), peaked T-waves (P = 0.001), and neurological symptoms (P = 0.04). Whole bowel irrigation was associated with mild hyperkalemia (P = 0.011), and hemodialysis was associated with severe hyperkalemia (P < 0.001).

Discussion

Analysis of data showed that therapy to promote intracellular shift of potassium is the mainstay of management of oral potassium poisoning, followed by hemodialysis.

Limitations

Poison center data are susceptible to reporting bias. National Poison Data System data are affected by completeness and accuracy of reporting from health care providers and the lay public.

Conclusions

Single substance, oral potassium poisoning, reported to United States poison centers, is mostly unintentional and rarely results in hyperkalemia.

Keywords:

• Clinical management
• national poison data system
• oral potassium salts
• poison centers
• potassium poisoning

Disclosure statement

America’s Poison Centers maintains the National Poison Data System, which houses de-identified case records of self-reported information collected from callers during exposure management and poison information calls managed by the country’s poison centers. National Poison Data System data do not reflect the entire universe of exposures to a particular substance as additional exposures may go unreported to poison centers. Accordingly, National Poison Data System data should not be construed to represent the complete incidence of United States exposures to any substance. Exposures do not necessarily represent a poisoning or overdose and America’s Poison Centers is not able to completely verify the accuracy of every report. Findings based on National Poison Data System data do not necessarily reflect the opinions of America’s Poison Centers.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.