Adverse drug event of hypokalemia-induced cardiotoxicity secondary to the use of laxatives: A systematic review of case reports

Abstract

What is known and objective: The imbalance in serum potassium caused by laxatives

can negatively affect the cardiovascular system, leading to life-threatening conse- quences. Our objective was to evaluate the reported evidence of adverse events re- lated to the cardiac system due to laxative-induced hypokalaemia from case reports.

Methods: A systematic electronic literature search of PubMed, Embase, the Cochrane

Library and Science Direct was conducted for the period 1995-2019. In these data- bases, search terms describing hypokalaemia and cardiotoxicity were combined with

the term laxative use.

Results and discussion: Over the 23 years, 27 incidents were identified in 12 coun- tries. There were 19 female and eight male patients, with ages ranging from 1 month

to 93 years. The frequency of reported cases according to severity was the following: severe hypokalaemia 48%, moderate hypokalaemia 44.4% and mild hypokalaemia 7.4%. In 70% of patients, the effect of laxative on the heart was typical hypokalaemic electrographic changes, 7.4% showed abnormal changes in cardiac rhythm, whereas in 18.5%, the cardiotoxicity observed was a very serious kind. Two patients died due to severe cardiac effects. What is new and conclusion: The laxatives—along with the involvement of some other

contributing factors—caused mild-to-severe hypokalaemic cardiotoxicity. These fac- tors were non-adherence of the patient to the recommended dosage, laxative abuse,

drug-drug and drug-disease interactions, non-potassium electrolyte imbalances and the use of herbal laxatives. We recommend that laxatives and aggravating factors

should be taken into account in the assessment of patients with suspected hypoka- laemic cardiotoxicity.