Hypokalaemia and renal tubular acidosis secondary to ibuprofen-codeine combination misuse

Background Hypokalaemic renal tubular acidosis (RTA) is a relatively rare but life-threatening condition which can be overlooked in clinical practice. This editorial discusses two case studies of severe hypokalaemic RTA linked to over the counter (OTC) medication misuse, highlighting important patient safety issues. Case presentations The first case describes a 59-year-old female, who incurred 42 hospital admissions over a 7-year period due to severe hypokalaemia and RTA. A prolonged misuse of a combination product containing ibuprofen-codeine in addition to codeine phosphate was later identified as the main contributor to her electrolyte abnormalities. The second case illustrates a 45-year-old female who was admitted to the critical care unit with flaccid paralysis and life-threatening hypokalaemia. Further discussions identified a significant intake of ibuprofen-codeine-containing tablets as the cause of her tubulopathy. Conclusions These cases highlight the significant morbidity associated with prolonged misuse of OTC non-steroidal anti-inflammatory drugs (NSAIDs) and codeine. The accessibility and misuse of these products is becoming a growing public health concern in Ireland. Further public education and awareness around the risks associated with NSAID and opioid combination tablets is warranted, along with more stringent regulation of their dispensing.