SHM Converge Scientific Abstract ePoster Gallery-Where Did the K Pos-Sibly Go?

Pdf Summary

This case describes a 37-year-old man who developed severe, refractory hypokalemia while hospitalized for sarcoma resection. He had recently been treated for biopsy-proven mucormycosis with amphotericin B and posaconazole, then transitioned to posaconazole alone before surgery. During hospitalization, his potassium remained low despite replacement. He had mild hypertension but no vomiting, no clear symptoms of hypokalemia, and normal bicarbonate levels.<br /><br />The team suspected posaconazole-induced hypokalemia. This adverse effect is recognized in about 22% of patients taking posaconazole, though it is often mild. Most reported cases involve hypertension, but hypokalemia can also occur in normotensive patients. In this case, diarrhea developed later and may have contributed, but the hypokalemia was present before diarrhea began.<br /><br />The report reviews two proposed mechanisms for posaconazole-related mineralocorticoid excess: inhibition of 11β-hydroxylase and inhibition of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Both mechanisms can increase mineralocorticoid activity and lead to potassium wasting. Prior case reports have shown improvement with dose reduction, mineralocorticoid receptor antagonists, glucocorticoid supplementation, or stopping posaconazole.<br /><br />With aggressive potassium supplementation, the patient’s potassium improved to 3.5 mmol/L. He was discharged on oral potassium with infectious disease follow-up.<br /><br />Overall, the case highlights posaconazole as an important cause of refractory hypokalemia in hospitalized patients and emphasizes the need to consider medication-induced mineralocorticoid effects when evaluating persistent low potassium.

Asset Subtitle

Patricia Carey

Meta Tag

Author List Gretchen Colbenson, Patricia Carey

Category Clinical Vignettes

Concept Posaconazole

Concept Hypokalemia

Concept Refractory Hypokalemia

Concept Mineralocorticoids

Concept Hypertension

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Patricia Carey

Track Adult

Keywords

posaconazole

hypokalemia

mineralocorticoid excess

potassium wasting

amphotericin B

11β-hydroxylase inhibition

11β-HSD2 inhibition

refractory hypokalemia

sarcoma resection

mucormycosis

Posaconazole

Hypokalemia

Refractory Hypokalemia

Mineralocorticoids

Hypertension