Intractable hyperkalemia due to nicorandil induced potassium channel syndrome

Nicorandil is a commonly used antianginal agent, which has both nitrate-like and ATP-sensitive potassium (K(ATP)) channel activator properties. Activation of potassium channels by nicorandil causes expulsion of potassium ions into the extracellular space leading to membrane hyperpolarization, closure of voltage-gated calcium channels and finally vasodilatation. However, on the other hand, being an activator of K(ATP) channel, it can expel K(+) ions out of the cells and can cause hyperkalemia. Here, we report a case of nicorandil induced hyperkalemia unresponsive to medical treatment in a patient with diabetic nephropathy.