ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: FR-PO850

Rare Case of Recurrent Hypokalemia in Pregnancy: Broaden Your Differentials

Session Information

Category: Women's Health and Kidney Diseases

  • 2200 Women's Health and Kidney Diseases


  • Cheema, Moazam M., Montefiore Medical Center, Bronx, New York, United States
  • Alzyood, Laith, Montefiore Medical Center, Bronx, New York, United States
  • Lee, Roy, Montefiore Medical Center, Bronx, New York, United States
  • Chen, Wei, Montefiore Medical Center, Bronx, New York, United States
  • Brogan, Maureen, Montefiore Medical Center, Bronx, New York, United States
  • Gupta, Sonali, Montefiore Medical Center, Bronx, New York, United States

Geller’s syndrome is in the differential diagnosis when a pregnant woman presents with hypertension and severe hypokalemia. Here, we present a case of a patient with severe hypokalemia and hypertension in recurrent pregnancies. Careful history taking, in this case however, revealed a unique cause of her symptoms.

Case Description

A 30 year old, G5P3013 presented at 39 weeks 5 days gestation in labor and found to have severe hypokalemia and HTN. Labs notable for K <2.0 mg/dl, Mg 1.6 mg/dl, calcium 9.1 mg/dl (corrected), phosphorus 4.2 mg/dl and Cr 0.67 mg/dl. EKG noted U-waves. She required aggressive replacement of potassium (IV and PO for 2 days). She had history of severe hypokalemia requiring aggressive potassium repletion in last two pregnancies except first and prior history of preeclampsia. Further workup revealed normal TSH and cortisol levels, with a renin level of 0.39 ng/mL/hr (0.167-5.380 ng/mL/hr) and suppressed aldosterone level (below 1 ng/dL). Urine K < 5 mEq/L at the same time when serum K was 2.6 mg/dl, which was negative for renal potassium wasting. The remaining labs and imaging studies were unremarkable. Within 72 hours following delivery, potassium levels improved and remained normal postpartum. Hypertension was again in setting of pre-eclampsia (had proteinuria with Urine protein/creatinine ratio of 625), with improvement in BP post-delivery. Genetic testing was negative for mutation in mineralocorticoid receptor which ruled out Geller syndrome. On further inquiry, she mentioned that she had been taking calabash, a type of chalk/clay multiple times a day, to ameliorate third trimester symptoms during pregnancy. Clay ingestion was identified as the cause of recurrent hypokalemia. Hypertension was due to recurrent pre-eclampsia and not related to the development of hypokalemia in this case.


Clay ingestion is a culturally imbedded common practice based on indigenous knowledge among certain cultures. It is important to be aware of its association with potential pregnancy complications. As in our patient who had normal potassium levels in her first pregnancy, when she did not eat clay, but her three subsequent pregnancies were complicated by severe hypokalemia when she consumed significant amounts of clay. Clay binds to potassium in the gut and leads to increased intestinal excretion of potassium, resulting in hypokalemia.