To the Editor
As Gumz et al. correctly state, “the healthy kidney has a robust capacity to excrete potassium,” and most people can ingest very large quantities of potassium without clinically significant hyperkalemia. However, it is not widely known that excessive ingestion of potassium-rich foods or drinks because of a psychiatric disorder can cause clinically significant hyperkalemia in people with healthy kidneys and adrenal glands who do not have precipitating factors such as diabetes or the use of potassium-sparing medications. For example, in an adolescent with anorexia nervosa, recurrent hyperkalemia occurred with obsessive eating of up to 20 bananas per day.1 Hyperkalemia developed in another patient who had schizophrenia and psychogenic polydipsia when she replaced the water in her diet with orange juice.2 Finally, recurrent hyperkalemia due to excessive ingestion of dried fruits developed in a healthy person, possibly because of an undiagnosed eating disorder.3
Excessive consumption of potassium-rich foods or drinks because of a mental disorder should be considered in the differential diagnosis of unexplained hyperkalemia in otherwise healthy people. A careful history regarding the patient’s dietary habits should be obtained.3
Footnotes
The views expressed in this article are those of the author and do not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health, the Department of Health and Human Services, or the U.S. government.
No potential conflict of interest relevant to this letter was reported.
References
- 1.Tazoe M, Narita M, Sakuta R, et al. Hyperkalemia and hyperdopaminemia induced by an obsessive eating of banana in an anorexia nervosa adolescent. Brain Dev. 2007;29:369–372. doi: 10.1016/j.braindev.2006.11.002. [DOI] [PubMed] [Google Scholar]
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- 3.Pavletic AJ. Hyperkalemia induced by excessive consumption of dried fruits — manifestation of an undiagnosed eating disorder? . Psychosomatics. 2011;52:494–495. doi: 10.1016/j.psym.2011.01.011. [DOI] [PMC free article] [PubMed] [Google Scholar]