Life-Threatening, Preventable Hyperkalemia in a Nursing Home Resident: Case Report and Literature Review

A 70-year-old male nursing home resident, hospitalized for weakness and lethargy, was found to have life-threatening hyperkalemia. Concomitant use of potassium chloride, spironolactone, and propranolol appeared the likely offending agents. Hyperkalemia is common in the elderly, resulting from a combination of potassium homeostasis disorders, disease processes and certain medications. In particular, older adults in the nursing home on spironolactone and potassium replacement preparations should have serum potassium monitored frequently, particularly in the presence of renal insufficiency and diabetes. Also included is a review of literature illustrating alterations in potassium regulation in older adults and a suggested approach to potassium-related disorders in the nursing home setting.