Severe Hyperkalemia During Very-Low-Calorie Diets and Angiotensin Converting Enzyme Use

To the Editor.— The recent Commentary by Wadden et al 1 and subsequent letters to the editor 2 discussed complications associated with rapid weight loss using very-low-calorie diets. I report herein a complication occurring with the combination of angiotensin converting enzyme inhibitors and protein supplement very-low-calorie diets. Report of a Case.— A 64-year-old woman presented to the emergency department with weakness following intermittent vomiting for 36 hours. She had lost 33.8 kg over the previous 6 months, on a diet of five packages per day of a protein supplement and one dinner salad topped with lemon juice and salt substitute. She continued to ingest her supplement despite her vomiting. Hypertension, which had failed to resolve with weight reduction, was being treated with lisinopril, 10 mg daily, and she took 600 mg of theophylline daily. In the emergency department, she complained of severe weakness. Her serum potassium measurement was 9.7 mmol/L.