Hypokalemic Nephropathy and Nephrogenic Diabetes Insipidus Due to Excessive Consumption of a Soft Drink
| Title: | Hypokalemic Nephropathy and Nephrogenic Diabetes Insipidus Due to Excessive Consumption of a Soft Drink |
|---|---|
| Authors: | Buridi, Abdul; Corman, Lourdes; Redinger, Richard |
| Publisher: | Southern Medical Journal |
| Date Published: | November 01, 1998 |
| Reference Number: | 199 |
Chronic diarrhea commonly causes hypokalemia. However, life-threatening hypokalemia due to chronic diarrhea has not been reported in the adult caused by chronic ingestion of a fructose beverage. We report an adult patient who had severe hypokalemia from chronic osmotic diarrhea as a result of drinking 4 to 6 liters of Big Red daily for several months. This resulted in sustained hypokalemia, complicated by hypokalemic nephropathy and subsequent nephrogenic diabetes insipidus. All abnormalities cleared with potassium replacement, salt restriction, modest thiazide treatment, and abstinence from Big Red.
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This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
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The patient was given sodium solution and potassium along with injections of a solution containing sodium chloride, potassium chloride and calcium chloride to replenish her body water and electrolyte supplies. Her dehydration and diarrhea subsided over the course of 2 days, but then she started to void large volumes of urine. Tests revealed the patient had acquired nephrogenic diabetes insipidus (NDI), a condition where the kidneys are unable to respond to the hormone, arginine vasopressin (AVP).
Because they cannot respond to AVP, the kidneys are unable to reabsorb body water or concentrate urine. The unabsorbed body water is voided in large quantities as dilute urine. The excessive urination leads to body water imbalance and the patient must drink large amounts of water to compensate for fluids lost through excessive urination.
The patient was placed on a 6-day regime of salt restriction, potassium supplements and the drug, hydrochlorothiazide. Her NDI reversed itself and the symptoms disappeared. Still, the doctors could not determine the cause of either the NDI or the excessive potassium loss until they discovered their patient had been drinking 4 - 6 liters of Big Red daily. Big Red is a soft drink sweetened with fructose. When fructose is ingested alone by a mechanism of facilitated transport (e.g. a soft drink such as Big Red) it is incompletely absorbed. A large amount of that fructose was unabsorbed and passed into her colon where it produced diarrhea. The diarrhea caused colonic potassium losses which added to urinary potassium losses resulting from the patient's use of the diuretic drug, furosimide.
This resulted in hypokalemic nephropathy, a kidney disease involving abnormally low levels of blood potassium. This disorder impaired the urine concentrating activity of the kidney. The kidney's concentrating ability was further reduced when NDI developed in response to the woman's imbalances. These imbalances interfered with cAMP activity in the principal cells of the kidney collecting duct. cAMP activity is necessary for the principal cells to be permeable enough to let the kidney reabsorb the body water flowing through the kidney collecting ducts. All these abnormalities reversed themselves within 10 days with appropriate fluid and potassium replacement, salt restriction and abstinence from Big Red.