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Hypokalemia Caused by Surreptitious Self-Administration of Diuretics

[+] Article, Author, and Disclosure Information

Supported by a grant from The Population Council, New York, N.Y., and grant FR-51 from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health, Bethesda, Md.

▸Requests for reprints should be addressed to Fred H. Katz, M.D., Department of Medicine, Veterans Administration Hospital, Denver, Colo. 80220

B.S., Denver, Colorado

Ann Intern Med. 1972;76(1):85-90. doi:10.7326/0003-4819-76-1-85
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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.





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