Furosemide-induced severe hypokalemia with rhabdomyolysis without cardiac arrest

BACKGROUND: Hypokalemia induced by diuretic abuse is a life-threatening emergency. CASE PRESENTATION: A 22-years-old female nurse with a body mass index 18 suffered from myalgias, vomiting and diarrhea. Blood tests revealed hypokalemia with a lowest value of 1.1 mmol/l, moderate hyponatremia, metabolic alkalosis, mild renal insufficiency and creatinphosphokinase-elevation. Since hypokalemia and alkalosis were unexplained, she was asked for diuretic-intake. She confessed that she has taken 250 mg furosemide/day for the last 4 months to improve the shape of her muscles. Furosemide tablets were given to her by a physician attending the gym where she exercised. After electrolyte substitution, laboratory abnormalities regressed and no cardiac arrests were observed. Psychiatric investigation diagnosed an adjustment disorder. CONCLUSION: Furosemide abuse has to be considered even in underweight individuals, especially if they have a psychiatric instability or work in health care institutions.