Hypokalemia Caused by Surreptitious Self-Administration of Diuretics

Abstract

A normotensive woman who had already undergone bilateral renal arteriography and renal vein catheterization for differential renin production was studied for her continuing hypokalemia. On the fourth day of a metabolic balance regimen she had a sudden diuresis, natriuresis, and kaliuresis. Urine analysis showed that she had surreptitiously taken at least 20 furosemide tablets, obtained from her employer, a pharmaceutical wholesaler. Psychiatric evaluation indicated underlying depression. A second patient, who was a nurse with a long-standing history of hypokalemia, had chlorthalidone, which she denied taking, detected in her urine. Another depressed woman with hypokalemia had furosemide in her urine more than 2 months after supposedly taking her last dose. Possible self-intoxication with diuretics to attain a slim figure should be considered in the differential diagnosis of obscure hypokalemia.