• Lin Wang, Yinglin Cui, Jianwei Zhang, and Qinsheng Zhang.
• Department of Nephropathy, The Second Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China.
• Medicine (Baltimore). 2017 Oct 1; 96 (42): e6933.

RationaleUrinary lithiasis is one of severe postoperative complications in patients undergoing renal transplantation, possibly leading to anuria, urinary infection, or even acute renal failure. Potassium sodium hydrogen citrate (PSHC), a potassium-bearing citrate, is commonly prescribed to prevent stone formation.Patient ConcernsA 25-year-old man (patient 1) and a 31-year-old man (patient 2) receiving renal transplantation for end-stage renal disease (ESRD) were enrolled in this study. They were given 10 g/day of PSHC granules from the ninth day to the 17th day after surgery. Patient 1 presented chest tightness, nausea, muscle weakness, and ascending paralysis on the 10th day. Patient 2 presented weak waves on EGG on the 17th day. Moreover, their serum potassium concentrations (SPCs) were 7.67 and 6.05 mmol/L, respectively.DiagnosisAcute hyperkalemia.InterventionsHemo-filtration was performed for patient 1, while patient 2 received 10% calcium gluconate 10 mL, 5% NaHCO3 125 mL, and 10% glucose 500 mL with the addition of 10 units of insulin through intravenous drip.OutcomesTheir SPCs dropped to the normal range.LessonsPhysicians should pay close attentions to potential risks caused by PSHC, and monitor the SPCs to minimize the occurrence of hyperkalemia.

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