Key result
Arginine monohydrochloride infusion induced life-threatening hyperkalemia in two patients with severe hepatic disease and moderate renal insufficiency.
Why the study?
Does arginine infusion induce life-threatening hyperkalemia in patients with severe hepatic disease and moderate renal insufficiency?
Case Report (n=2)
Does arginine infusion induce life-threatening hyperkalemia in patients with severe hepatic disease and moderate renal insufficiency?
Arginine infusion can induce profound, life-threatening hyperkalemia in patients with renal or hepatic insufficiency, particularly those on potassium-sparing diuretics like spironolactone.
Answers are grounded in this paper and cite their sources.
May warrant potassium monitoring with arginine infusion in hepatic/renal disease; hypothesis-generating case report leaves confirmation open.
Marked hyperkalemia was observed during and immediately after an infusion of arginine monohydrochloride in two patients with severe hepatic disease and moderate renal insufficiency. Both patients had received brief courses of spironolactone before arginine treatment. In one of the patients, the hyperkalemia was associated with a fatal cardiac arrhythmia. Arginine has been shown to shift potassium from cells to the extracellular compartment, an effect directly related to its serum concentration. The profound hyperkalemia that occurred in these two patients is thought to be the result of an inability to metabolize the administered arginine and excrete the excess extracellular potassium. Caution is advised in administering arginine to patients with renal or hepatic insufficiency, or both.
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David A. Bushinsky (1978) conducted a case report in Severe hepatic disease and moderate renal insufficiency (n=2). Arginine monohydrochloride was evaluated on Hyperkalemia. Arginine monohydrochloride infusion induced life-threatening hyperkalemia in two patients with severe hepatic disease and moderate renal insufficiency.
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