Life-threatening hyperkalemia after excessive ingestion of boiling water with Jerusalem artichoke extract: case report

Hyperkalemia is fatal and can be caused by various reasons. Electrocardiogram changes, such as peaked T waves, PR interval (PR) prolongation, bradyarrhythmias and QRS complex (QRS) interval widening, occur as the potassium level increases. We present a case of hyperkalemia that occurred in a 69-year-old patient who took Jerusalem Artichoke extract boiled with water. He had atrial fibrillation and was admitted to the hospital with chest discomfort. His systolic blood pressure (SBP) was 90 mmHg, while his heart rate was 32 bpm. An emergency medicine doctor used atropine for symptomatic bradycardia, although ineffective. The patient’s base creatinine was 1.4 mEq/L (normal: 0.5–1.3 mEq/L), indicating mild to moderate chronic kidney disease. His serum potassium was 8.1 mEq/L (normal: 3.5–5.1 mEq/L), blood urea nitrogen was 35.5 mg/dL (normal: 8–23 mg/dL), and serum creatinine was 2.71. At admission, systolic blood pressure was 70 mmHg, and we conducted transcutaneous pacing. Although SBP was elevated to 100 mmHg and potassium level was normalized, his rhythm could not be normalized without transcutaneous pacing. Thus, we inserted a temporary pacemaker, maintaining a heart rate above 70 beats per minute. History-taking revealed that the patient was taking spironolactone (a potassium-sparing agent), digoxin (which can cause hyperkalemia), propranolol and furosemide for atrial fibrillation in another local hospital for 10 years. He admitted frequently drinking water boiled with Jerusalem artichoke extract approximately >2 liters per day for 7 days. Considering that hyperkalemia is the leading fatal cause of idiopathic sinus bradycardia, if a patient has chronic kidney disease (CKD), the characteristics of food and medication should be carefully considered when providing in an outpatient setting if a patient has chronic kidney disease.

Jerusalem artichoke; Hyperkalemia; Electrocardiogram; Atrial fibrillation

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