Low potassium levels and cardiac arrest

Yes, this is a question that springs from the Schiavo case, but I do not want to discuss the particulars of that (this is the wrong forum anyway). I do have a question, though, of a scientific nature. The medical examiner found that her collapse was not the result of bulimia, and the low potassium levels could have been the result, not the cause, of her cardiac arrest.

My question is, what might have caused this collapse, if not bulimia? What else can cause low potassium levels, considering she wasn’t a drug abuser, hadn’t experienced any visible physical trauma, had no known illnesses? Or what could result in low potassium levels after a cardiac arrest? Clearly I don’t know a lot about these things, and I’m curious.

Thanks for any unbiased, factual enlightenment. Here’s a link to the Pinellas County ME’s report if that will help:

http://www.sptimes.com/2005/06/15/schiavoreport.pdf

Certain medications can cause hypokalemia, diuretics in particular.

I know this has nothing to do with this case but I can tell you what can give me low potassium levels.

Peritonial Dialysis. My dialysis fluid absorbs water and waste products from my blood. One of these things is potassium. So I need to make sure I eat a good amount of potassium foods.

As opposed to Hemo Dialyis (where they hook you up to a machine and filters your blood in which the potassium doesn’t get removed and you have to watch how much you eat.

Pages 3 and 4 of that report offer explanations for the low potassium levels and why cardiac arrest can mess with potassium and other values. Were you looking for additional reasons beyond those mentioned in the report, or did you need a less technical breakdown of their evaluation?

I heard she was drinking 15-20 glasses of ice tea every day. Could that have caused it?

Page 4, second paragraph. Caffeine toxicity considered unlikely unless she took it in pill form without anyone else’s knowledge; caffeine was not tested for at the time.

Sorry, the version I was reading (at http://www.thesmokinggun.com ) is the summary of the report - http://www.thesmokinggun.com/archive/0615051terri1.html

I assumed you’d linked to a similar document, not wanting to bring up Acrobat for the purpose, until I double-checked.

Page 3 and 4? Which pages 3 and 4? The .pdf document has page numbers, but then within the documents there are other documents with their own page numbers. The find function didn’t help either. So I didn’t see that info you’re mentioning, so if you could help me find it in that 40 page document, I’d appreciate it. A less technical breakdown would probably also help. Thanks.

Adapted from Cecil’s Essentials of Medicine (I start an ICU rotation in 3 weeks and I’m starting to brush up on this crap).

Hypokalemia differential diagnosis in the adult:
3 major categories – renal, extrarenal, and redistribution losses. So start by looking not only at blood K but urine K as well. If you are shedding potassium into the urine, you have a kidney problem.

Renal losses can be further divided into 3 categories based on the acid/base balance of the blood (metabolic acidosis, metabolic alkalosis, or normal). If you are acidotic, think renal tubular acidosis or organic acidosis with potassium following, or carbonic anhydrase inhibitors. If you are alkalotic, think diurectics, vomiting, low magnesium, hyperaldosteronism, hypercortisolism, or other more rare syndromes. Or hey, even a lot of licorice will do it to you. With normal blood pH, it could be acute tubular necrosis, postobstructive reflex diuresis, or a drug reaction.

Outside of the kidney (extrarenal), think diarrhea or laxative abuse or bulimia, or even decreased intake. Acid-base balance may also be affected.

Redistribution means forcing K into cells, and thus reducing blood levels. This can be done with many drugs, including insulin and albuterol. Also, pheochromocytoma or catecholamine excess will do it, as will regular alkalosis.

That covers most of the common ones. There are others as well, like certain inherited syndromes and other things that are less likely in a previously healthy adult. That said, the ME also mentioned that K was only checked, incredibly, after several rounds of epinephrine (a catecholamine, check the last paragraph!) and lots of IV fluids (which usually don’t contain potassium, just sodium and chloride). This confounds everything anyway, and makes a primary cause impossible to detect, unfortunately.

OK, would anyone care to speculate on what might have caused Schiavo’s collapse based on the ME’s report? What medical reason could have caused it? Or is it just impossible to tell at all?

Probably impossible to tell for sure. My unenlightened hypothesis: She drank too much (fluid, that is, not alcohol), which induced the hypokalemia (a la what sometimes happens to marathon runners who overhydrate). Possibly the drinking-too-much was a weight control technique, one that just got out of control.

I don’t know what caused her to fall out, but water intoxication and vomiting can both decrease potassium levels pretty dramatically. Combined, they would definately increase the risk.

Actually, that typically causes hyponatremia, low sodium levels.

I know. But low potassium levels (or even low blood calcium levels) are also possibilities.

Woof. Not much factual to add except, as someone who almost died from critically low potassium levels at one point… shiver it’s a bad way to go.

Did she die? I didn’t hear… When was this? Also, related to this: I missed this, too…did the courts rule she must suffer? Boy, am I out of it!!!

Then again, we had an unexpected loss in the imeediate family, and things haven’t been the same here…

…And, that’s why they call me the working dog, the best friend of the working man, I guess that’s what I am… (ala: pseudo lyrics of Rush)

  • Jinx :frowning:

I’m not trying to start anything. I just can’t find where the report says that “her collapse was not the result of bulimia.”

okay… okay makeing this movie is a little overdone :smack: but its easy :wink: weaird names like morty confusing :eek: i ushaley go on homestar runner . com and go on strong bad e-mails their :confused: tiering and :wally it’s cool i tell ya!
:slight_smile: one of my favorites is gutar IT IS HALARIOS!AND THE DRAGON COMES IN THE NIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIGGGGGGGGHHHHHHHHHHHHT!!!
one of the parts of that e-mail :stuck_out_tongue: another of my fave e-mails is the show
:smiley: it’s about him saying millions of cadogorys :smack:and that is :dubious: and it was starring the poopsmith and pom pom.

Holy crap. please ignore the last post. That’s my 6 year old daughter talking. She snuck on while I wasn’t looking. Sorry folks. Nothing to see here… please move on…

-kev
yeeeesh!

Everything I read said that they just couldn’t prove it one way or the other. I agree, I think the OP may be misunderstanding the results.