Hyperkalemia Occurring in a Patient With Psoriatic Arthritis Following Indomethacin Use

Abstract

Objective: To report a case of hyperkalemia possibly due to indomethacin use. Case Summary: A 52-year-old white woman with psoriatic arthritis for 16 years and diabetes mellitus for 3 years was admitted to the university hospital due to swelling and pain of wrists, elbows, knees and ankles for the last one month. The patient had been receiving methotrexate irregularly, but discontinued it 3 months ago. Physical examination and laboratory evaluations were compatible with diagnosis of exacerbation of psoriatic arthritis and type 2 diabetes mellitus. Two days after initiation of indomethacin and methotrexate, hyperkalemia developed with increase of blood urea nitrogen and decrease of creatinine clearance. Indomethacin was discontinued, and this resulted in normalization of laboratory findings between day 5 and 10 after discontinuation. Conclusion: The development of hyperkalemia caused by indomethacin is probably unusual, but it is important because indomethacin is a commonly used medication. This potentially serious complication can be prevented by careful attention to renal function and potassium balance in patients receiving indomethacin and other nonsteroidal anti-inflammatory drugs (NSAIDs), especially in patients with type 2 diabetes mellitus or preexisting renal disease.