Coma caused by oranges

According to news reports, a 44-year-old man ate 5 oranges in one breath. It didn’t take long for him to lose consciousness and almost jumped to a sudden stop. His life was saved thanks to timely medical treatment. After examination, his blood creatinine was as high as 1700 micromol/l (μmol/L), and his blood creatinine exceeded 700 micromol/L (μmol/L), which is uremia; blood potassium was as high as 7.2 mmol/l (mmol/l). ), the blood potassium exceeds 5.5 millimoles/liter (mmol/l), it is hyperkalemia, once the blood potassium exceeds 7 millimoles/liter (mmol/l), it will be life-threatening. The man himself suffered from high blood pressure, which caused uremia, which in turn caused hyperkalemia, and hyperkalemia caused coma, and oranges were just the “fuse” of hyperkalemia.

Why orange has become the “fuse” of hyperkalemia
Potassium comes from food, is stored in cells, and is mainly excreted from the body through the kidneys. Any problem in any link can cause hyperkalemia. Hemolysis, crush injury, extensive soft tissue injury, severe myolysis, etc., intracellular potassium entering the blood will cause hyperkalemia, but the most common clinical situation is chronic renal failure.

The kidney is the “rear valve” for blood potassium regulation. If potassium intake is high, the kidneys will excrete more potassium, if potassium intake is low, the kidneys will excrete less potassium. If the kidney function is normal, even if a large amount of high-potassium food is consumed, hyperkalemia will not usually occur. However, after renal function declines, if you eat a lot of potassium-rich foods, hyperkalemia is particularly prone to occur. Fruits rich in potassium ions include avocados, bananas, oranges, kiwi, papaya, grapes, oranges, longans, etc. Many vegetables such as mushrooms, fungi, seaweed, white bamboo shoots, potatoes, sweet potatoes, etc. also have high potassium ions. The traditional Chinese medicine dandelion is also rich in potassium ions, and patients with chronic renal failure are prone to hyperkalemia due to excessive intake. Low-sodium salt is also rich in potassium ions, because low-sodium salt is a salt mixed with a certain amount of potassium chloride and magnesium sulfate on the basis of ordinary salt (sodium chloride iodized salt). Long-term consumption of low-sodium salt can reduce the intake of sodium ions, help prevent high blood pressure and protect the heart and brain blood vessels. But for most patients with kidney disease, the potassium chloride in low-sodium salt is like an invisible bomb that may detonate at any time.

How to deal with hyperkalemia
Hyperkalemia is critically ill and should be dealt with immediately once discovered.

Intravenous infusion of glucose and insulin promotes glycogen synthesis and promotes potassium ions to enter the cells. It is the most reliable method for potassium ions to enter the cells and lower blood potassium.

Intravenous infusion of sodium bicarbonate solution corrects acidosis and promotes the transfer of potassium into the cells.

Intravenous use of diuretics furosemide, torasemide and other loop diuretics to promote the excretion of potassium from the kidneys. However, patients with renal failure have reduced or lack of sensitivity to diuretics, and the worse the renal failure, the worse the effect.

Hemodialysis treatment When the blood potassium concentration exceeds 6.5 millimoles/liter (mmol/l), hemodialysis treatment can be performed. Hemodialysis is the fastest and most effective method of reducing potassium, but it requires specific equipment and special operations.

Although the above-mentioned methods are effective, they can only be performed in the hospital. It is inconvenient for patients with chronic renal failure for long-term, chronic, and recurrent hyperkalemia.

In addition, one of the side effects of the commonly used kidney protection drugs Sartan antihypertensive drugs and Prili antihypertensive drugs is hyperkalemia. According to the National Database of the United States, 75% of patients with hyperkalemia reduce or discontinue sartan or pristine antihypertensive drugs that have a protective effect on the kidneys, thus failing to benefit patients from these drugs and causing deaths. The risk increased by more than 2 times.