Severe Symptomatic Hypokalemia Caused By Oral Administration of Bentonite Cleansing Clay

Presentation Number: SUN 293
Date of Presentation: April 2nd, 2017

Erin Smallmon1, Mahmood Shahlapour2, Edward Markman3, Jyothi Punnam3 and Mohamad Hosam Horani*4
1Kirksville college of Msteopthic Medicine, 2Mercy Gilbert Hospital, 3Pioneer Hospitalist, 4Alsham Endocrinology, Chandler, AZ

Abstract

Background: Bentonite, also known as montmorillonite, is an organic aluminum silicate clay often used as a laxative homeopathic remedy, due to its ability to absorb water in the gastrointestinal tract. In addition, bentonite has previously been used in cases of gastrointestinal bacterial overgrowth for detoxification. In large amounts, bentonite can sequester essential electrolytes, such as potassium, and bind to specific medications. Here we will present a case of severe symptomatic hypokalemia in a male patient who was ingesting bentonite clay as a form of homeopathic medicine.

Case: A 65 year-old Caucasian male with a past medical history significant for essential hypertension, type 2 diabetes mellitus, and relapsing intermittent polyarthritis presented to the emergency department (ED) for evaluation of his symmetrical polyarthralgia, generalized weakness, and inability to ambulate. In the ED, the patient stated that his arthralgia and general weakness . His medications included enalapril, and metoprolol. Upon further questioning, the patient stated that he had been taking Vitamin D (80,000 units), Vitamin A (20,000 units) and 2 tablespoons of bentonite clay daily, as prescribed by his homeopathic physician. Fever, fatigue, weakness and joint pain were observed. His physical exam demonstrated tenderness to palpation of his knees and ankles bilaterally with mild edema; however, no erythema or warmth was appreciated. In addition, subcutaneous nodules were seen on the patient’s elbows bi laterally. His laboratory data demonstrated leukocytosis, severe hypokalemia (2.9 mmol/L), hypercalcemia (11.7 mg/dL, corrected for albumin), hypovolemic hyponatremia and hyperuricemia. His electrocardiogram demonstrated sinus tachycardia, enlarged P waves, shallow T waves, and prominent U waves, consistent with hypokalemia. . The patient’s vitamin A, and vitamin D were held on account of his severe hypokalemia and mild hypercalcemia. He was placed on colchicine, enalapril, metoprolol, methylprednisolone, sliding scale insulin, and a potassium replacement, and his clinical course was subsequently uncomplicated. Prior to discharge, his generalized weakness and arthralgia had completely resolved with the correction of his electrolyte abnormalities and the treatment of his suspected gout flare-up.

Discussion: Due to bentonite’s potential to bind positively charged ions, an important adverse effect of bentonite clay ingestion is hypokalemia. It is critical that patients who are prescribed bentonite clay be aware of signs and symptoms associated with hypokalemia. It is imperative they seek evaluation and prompt replacement in these circumstances, as severe hypokalemia can lead to cardiac arrhythmias and death. In conjunction with other potassium losing medications, like certain diuretics, bentonite may not be a safe alterative treatment.

 

Nothing to Disclose: ES, MS, EM, JP, MHH