MANUEL ENRIQUE ACOSTA MEZA, UMF 27 Instituto Mexicano del Seguro Social
15 July 2008
The case was very interesting for me reading, indeed in our developing countries like Mexico and especially in the border with the United States, the consumption of cola beverages and others are exaggerated high. This forces us that in and interrogation of these and other patients, to be exhaustive in the nutritional patterns and drinking consumption, since as in this case, this was the cause of hipokalemia. Thank you very much to share this case, since without a doubt it contributes to the enrichment of our daily clinical practice.
Competing interests
competing interest none
Hypokalemia due to excessive cola consumption
Vasilis Tsimihodimos, University of Ioannina
15 December 2008
Dear Sir<br><br>We read with great interest the case report recently described by Dr Packer of chronic hypokalemia due to excessive cola consumption [1]. The author suggested that excessive cola consumption is associated with an exaggerated fructose load leading to osmotic diarrhea and gastrointestinal potassium wasting . However, other mechanisms may also contribute to the decreased potassium levels such as 1) cola consumption is also associated with glucose loading resulting in hyperinsulinemia and potassium entry into cells, 2) caffeine is also one of the main ingredients of cola. It is well known that caffeine-induced hyperventilation as well as sympathetic overactivity is also associated with potassium entry in to cells whereas caffeine may also increase the renal excretion of potassium. In fact, several cases of hypokalemia due to cola-induced caffeine intoxication have been described in individuals not experiencing symptoms suggestive of osmotic diarrhea [2,3,4,5]. In conclusion, we propose that the etiology of cola-induced hypokalemia may be multifactorial and that apart from fructose overload other mechanisms may also contribute in the pathogenesis of this rare condition.<br><br>References<br><br>1. Packer CD: Chronic hypokalemia due to excessive cola consumption: a case report. Cases.J. 2008, 1: 32-<br><br>2. Lee HJ, Kim DW, Cho HS, Jung EY, Lee DW, Chang SH, Park DJ: Hypokalaemic paralysis induced by large amounts of cola consumption. Nephrol Dial Transplant 2007, 22: 2729.<br><br>3. Matsunami K, Imai A, Tamaya T: Hypokalemia in a pregnant woman with long-term heavy cola consumption. Int.J.Gynaecol.Obstet. 1994, 44: 283-284.<br><br>4. Appel CC,Myles TD: Caffeine-induced hypokalemic paralysis in pregnancy. Obstet.Gynecol. 2001, 97: 805-807.<br><br>5. Rice JE,Faunt JD: Excessive cola consumption as a cause of hypokalaemic myopathy. Intern.Med.J. 2001, 31: 317-318. <br><br>Vasillis Tsimihodimos and Moses Elisaf
Interesting case to share
15 July 2008
The case was very interesting for me reading, indeed in our developing countries like Mexico and especially in the border with the United States, the consumption of cola beverages and others are exaggerated high. This forces us that in and interrogation of these and other patients, to be exhaustive in the nutritional patterns and drinking consumption, since as in this case, this was the cause of hipokalemia. Thank you very much to share this case, since without a doubt it contributes to the enrichment of our daily clinical practice.
Competing interests
competing interest none
Hypokalemia due to excessive cola consumption
15 December 2008
Dear Sir<br><br>We read with great interest the case report recently described by Dr Packer of chronic hypokalemia due to excessive cola consumption [1]. The author suggested that excessive cola consumption is associated with an exaggerated fructose load leading to osmotic diarrhea and gastrointestinal potassium wasting . However, other mechanisms may also contribute to the decreased potassium levels such as 1) cola consumption is also associated with glucose loading resulting in hyperinsulinemia and potassium entry into cells, 2) caffeine is also one of the main ingredients of cola. It is well known that caffeine-induced hyperventilation as well as sympathetic overactivity is also associated with potassium entry in to cells whereas caffeine may also increase the renal excretion of potassium. In fact, several cases of hypokalemia due to cola-induced caffeine intoxication have been described in individuals not experiencing symptoms suggestive of osmotic diarrhea [2,3,4,5]. In conclusion, we propose that the etiology of cola-induced hypokalemia may be multifactorial and that apart from fructose overload other mechanisms may also contribute in the pathogenesis of this rare condition.<br><br>References<br><br>1. Packer CD: Chronic hypokalemia due to excessive cola consumption: a case report. Cases.J. 2008, 1: 32-<br><br>2. Lee HJ, Kim DW, Cho HS, Jung EY, Lee DW, Chang SH, Park DJ: Hypokalaemic paralysis induced by large amounts of cola consumption. Nephrol Dial Transplant 2007, 22: 2729.<br><br>3. Matsunami K, Imai A, Tamaya T: Hypokalemia in a pregnant woman with long-term heavy cola consumption. Int.J.Gynaecol.Obstet. 1994, 44: 283-284.<br><br>4. Appel CC,Myles TD: Caffeine-induced hypokalemic paralysis in pregnancy. Obstet.Gynecol. 2001, 97: 805-807.<br><br>5. Rice JE,Faunt JD: Excessive cola consumption as a cause of hypokalaemic myopathy. Intern.Med.J. 2001, 31: 317-318. <br><br>Vasillis Tsimihodimos and Moses Elisaf
Competing interests
None declared