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Death by Coconut
Abstract
Coconut water has become an increasingly popular sports drink because of its natural ingredients, electrolytes, and mineral content. Marketing has focused on the product’s low levels of fat, calories, and carbohydrates while promoting health benefits that are as-of-yet unproven. Coconut water, when consumed in excess, has been noted in case reports to cause severe hyperkalemia.1 We present a case of a 42-year-old otherwise healthy man who presented to our emergency department following an episode of exertional syncope after consuming multiple servings of coconut water.
A 42-year-old black man without any medical history presented to our hospital after a syncopal episode. He was playing tennis outdoors all day in temperatures in excess of 90° Fahrenheit. He reported drinking a total of eight 11-ounce bottles of coconut water throughout the day. He experienced the sudden onset of lightheadedness and was witnessed to have lost consciousness. He did not experience any significant head trauma and regained consciousness almost immediately. Afterward he complained of generalized weakness and lightheadedness.
He was brought to the emergency department by ambulance. There …
... Alkaline phosphatase was low when on CW, and it stayed below the RI in CW's absence. Serum copper was 14.3 mol/L (RI 10-22) and zinc 10.4 mol/L (RI [11][12][13][14][15][16][17][18]. There is no record of results for these trace metals pre-CW consumption. ...
... In health, CW consumption in moderation may provide and restore some lost micronutrients. However, increased intake of potassium by patients with diabetes, including those with reduced renal excretion [13][14][15][16][17][18][19] or on potassium-retaining medication, 5,20 has the potential to increase the risk from hyperkalaemia. These groups of people should be advised on the potential harm from consumption of excessive amounts of CW drinks. ...
Coconut water is available as a substitute for table water and as a sports rehydrating drink. Because of the nature of its micronutrients, it may lead to biochemical changes that may not be beneficial for all groups of people.
A patient with type 2 diabetes mellitus consumed daily around one litre of coconut water drink. As a result, there was a gradual increase in serum potassium. On cessation of beverage consumption, serum potassium decreased to within the reference interval. However, an increase in urea and creatinine concentration did not revert to the level seen prior to coconut water consumption. There was a decrease in serum alkaline phosphatase and zinc when consuming the beverage. Reduction occurred in diastolic blood pressure, estimated glomerular filtration rate, serum enzymes and zinc, while serum potassium concentration increased in this patient with type 2 diabetes. The observed changes resulted from consuming excessive quantities of coconut water drinks.
In patients with diabetes and renal impairment and on potassium‐retaining medication, there is a high risk of developing hyperkalaemia. Copyright © 2016 John Wiley & Sons.
... Coconut water, which is increasingly popular as sports drink, is reportedly a cause of fatal cardiac arrhythmia following severe hyperkalemia [12]. Eight ounces of coconut water contain 600 mg of potassium [13]. King coconut (Cocos nucifera "king") is a species of coconut which is native to Sri Lanka. ...
Background
Acute flaccid paralysis is an uncommon, but potentially life threatening, sequel of severe hyperkalemia. Reported primary aetiologies include renal failure, Addison's disease, potassium sparing diuretics, potassium supplements, and dietary excess. Coconut water, when consumed in excess, has been reported to cause severe hyperkalemia. We report the case of acute ascending flaccid paralysis secondary to hyperkalemia induced by multiple trigger factors—king coconut water, renal failure, diabetes, metabolic acidosis, and potassium sparing diuretics.
Case Presentation
A 78-year-old man presented with acute ascending type flaccid paralysis over five-hour duration and subsequently developed preterminal cardiac arrhythmias secondary to severe hyperkalemia (serum potassium: 7.02 mEq/L). He was on Losartan and Spironolactone for ischemic heart disease. Dietary history revealed excessive intake of king coconut water (Cocos nucifera) over past one week. Electrocardiogram returned to normal rhythm and serum potassium was 6.1 mEq/L within 2 hours of institution of emergency management for life threatening hyperkalemia. Neurological symptoms completely recovered within twenty-four hours without the need for dialysis. Electromyogram three days after the initial presentation revealed normal findings.
Conclusions
The report describes a rare case of secondary hyperkalemic flaccid paralysis induced by multiple trigger factors. It is important that patients with risk factors for hyperkalemia are educated regarding avoiding excess dietary potassium. Regular follow-up of these patients is mandatory with review of medication related side effects and serum electrolytes.
Background
Hyperkalemia−induced Brugada phenocopy is a transient electrocardiographic pattern that mimics the features of Brugada syndrome but is triggered by an elevation in serum levels of potassium. The objective of conducting this systematic review of case reports on hyperkalemia−induced BrP was to combine cases and increase the understanding base driving the clinical practice.
Methods
We conducted a literature search in PubMed, WOS, Cochrane, and Scopus up to July 2024 for case reports of BrP induced by hyperkalemia. We considered case reports of patients with hyperkalemia and Brugada-like changes on ECG that resolved with the correction of hyperkalemia for inclusion. Extracted data included patient demographics, clinical presentation, ECG findings, potassium levels, management, and the outcomes.
Results
Thirty-one case reports fit our inclusion criteria. Their ages ranged from 12 to 89years, with 60% being male. Most of the patients presented with symptoms of hyperkalemia such as weakness, palpitations, and chest pain. The ECG changes were typical of BrP and included the coved-type ST-segment elevation in leads V1–V3. The potassium levels at presentation varied from 6.1mmol/L to 9.5 mmol/L. The management strategies principally involved correction of hyperkalemia using intravenous calcium, insulin with glucose, and diuretics. In all patients, normalization of the potassium level was associated with resolution of the Brugada-like ECG pattern.
Conclusion
Systemic hyperkalemia may induce BrP, a condition frequently mimicked on the ECG by Brugada syndrome and which resolves by properly treating the hyperkalemia. Such awareness will facilitate the making of an accurate diagnosis and management of this condition, avoiding unnecessary interventions based on Brugada syndrome. Further studies should aim at explaining the underlying pathophysiological mechanisms and the legislation of diagnostic criteria for hyperkalemia-induced BrP.
Coconut water is a powerhouse of nutrition and its wide application is greatly due to its unique chemical composition providing phytohormones, enzymes, antioxidant compounds, vitamins, minerals, phenolic compounds etc., which are closely associated with its biological activities and pharmacological effects. Coconut water offers numerous medicinal properties. It has anti-microbial, anti-bacterial anti-inflammatory, anti-hypertensive, rejuvenation, hepatoprotective, hypolipidemic and diuretic properties. Coconut water has therapeutic effect on gastric dysfunction, dysentery and child malnutrition and provides control over hypertension. Results of many medical researches indicate that coconut water can aid in exercise performance, reduce swelling, dissolve kidney stones and improve kidney function, improve digestion, relieve constipation, reduce risk of heart disease, lower high blood pressure, and improve cholesterol levels. Consumption of tender coconut water reduces the risk of heart disease, helps to prevent AD pathologies, and prevent osteoporosis in experimental animals. The unique nutritional profile of coconut water also gives it the power to balance body chemistry, fight cancer etc. This chapter elaborates the health benefits of both tender and mature coconut water and their role in reducing the occurrence of life style diseases and providing a healthy life.
Hyperkalemia is a metabolic disturbance of the potassium balance that can cause potentially fatal cardiac arrhythmias. Kidney dysfunction and renin-angiotensin-aldosterone system inhibiting drugs are notorious for their tendency to induce hyperkalemia by decreasing the excretion of potassium. The role of dietary potassium intake in inducing hyperkalemia is less clear. We review and analyze the common presentation, laboratory, and electrocardiogram (ECG) findings and therapeutic options associated with dietary-induced hyperkalemia, and find evidence for hyperkalemia development in non-renal impaired patients. Thirty-five case reports including 44 incidences of oral intake-induced hyperkalemia were assessed, 17 patients did not suffer from kidney dysfunction. Mean age was 49 ± 20 years. Mean potassium concentration was 8.2 ± 1.4 mEq/l, most frequently caused by abundant intake of fruit and vegetables (n = 17) or salt substitutes (n = 12). In patients with normal kidney function, intake of salt substitutes or supplements was the main cause of hyperkalemia. Main symptoms encompassed muscle weakness (29.5%), vomiting (20.4%), and dyspnea (15.9%). When ECGs were performed (n = 30), abnormalities were present in 86.7% of cases. Treatment involved administration of insulin (n = 22), sodium/calcium polystyrene sulfonate (n = 14), and/or calcium gluconate (n = 14). Forty patients fully recovered. Three, non-renal impaired, patients passed away. These results offer insight into the clinical aspects of dietary-induced hyperkalemia and suggest that the common assumption that dietary-induced hyperkalemia is a condition of renal impaired patients might be incorrect.
Hyperkalaemia is a potentially life-threatening electrolyte disturbance because it causes cardiac dysrhythmias. Patients with renal impairment are at particular risk of potassium retention, often compounded by use of medications that inhibit potassium excretion, and are counselled to avoid potassium-rich foods.
Medical resources routinely used for intravenous hydration and resuscitation of critically ill patients may be limited in remote regions of the world. When faced with these shortages, physicians have had to improvise with the available resources, or simply do without. We report the successful use of coconut water as a short-term intravenous hydration fluid for a Solomon Island patient, a laboratory analysis of the local coconuts, and a review of previously documented intravenous coconut use. Copyright (C) 2000 by W.B. Saunders Company.
A few case reports have indicated that hyperkalemia can induce a Brugada pattern in the electrocardiogram. The specific clinical and electrocardiographic features of the hyperkalemic Brugada sign, however, have not been previously described.
A case series was collected from hospitalized hyperkalemic patients with a type I Brugada pattern in the electrocardiogram, and a literature review was performed. Electrocardiograms were examined for rhythm and morphology, and clinical characteristics were analyzed.
Nine new cases with the hyperkalemic Brugada sign were identified with an additional 15 cases found in the literature. Of the 9 cases, 8 were male patients, and all were critically ill; 5 of the 9 died within 48 hours. The mean (+/-SD) serum potassium level was 7.8 +/- 0.5 mEq/L. The mean QRS width was 144 +/- 31 milliseconds, and all had abnormal QRS axis. In 6 cases, there was a wide complex rhythm without visible P waves. The clinical and electrocardiographic characteristics of 15 cases found in the literature were remarkably similar to those in our series.
The hyperkalemic Brugada pattern differs in substantial ways from the electrocardiogram of patients with the genetic Brugada syndrome. Many patients have wide complex rhythms without visible P waves, marked QRS widening, and an abnormal QRS axis. Most patients are male, and many are critically ill. Prompt recognition of this clinical and electrocardiographic entity may expedite the initiation of appropriate treatment for hyperkalemia.