Abstract: TH-PO0424
A Rare Cause of Dyspnea: Diclofenac-Induced Severe Metabolic Acidosis and Hypokalemia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Pendyala, Reshub R., Johns Hopkins University Zanvyl Krieger School of Arts and Sciences, Baltimore, Maryland, United States
- Pendyala, Megha Eshani, Williamsville East High School, East Amherst, New York, United States
- Pendyala, Prashant, Buffalo General Medical Center, Buffalo, New York, United States
Introduction
Nephrotoxic effects of NSAIDs are well known. We describe a rare case of severe metabolic acidosis and severe hypokalemia after using diclofenac in the prescribed doses that presented with dyspnea on exertion. All the symptoms resolved within days of stopping Diclofenac.
Case Description
71 yr old lady presented to the emergency department with complaints of dyspnea on exertion. This had been going for one month and has been progressively getting worse. She denied any chest pain or edema or PND.
In the emergency department the lab work showed:
Bicarbonate of 12, potassium of 2.9. The sodium was 140 and chloride of 119. Albumin was normal at 4.1. Blood gas showed a Ph of 7.19. Creatinine 1.36 with GFR 43 and baseline CR of 1.1
Urine sodium 52, urine chloride 43 and urine potassium 32. Urine Ph 6.5
On further questioning the patient did admit to taking Diclofenac ER 100mg a day for the last 2 months for her shoulder pain.
This was stopped and patient was supplemented with potassium and IV bicarbonate initially. She improved well and in 5 days the potassium and bicarbonate came back to normal and the creatinine at discharge was 1.1
Discussion
Patient had non anion gap metabolic acidosis (NAGMA) with severe hypokalemia. Had positive urine anion gap with PH of 6.5 showing lack of urinary acidificaiton. However she did have mild renal insufficiency with GFR 43. This was not severe enough to explain the level of acidosis and hypokalemia.
Diclofenac by inhibition of Carbonic anhydrase II likely resulted in severe acidosis and hypokalemia. The inhibition of prostaglandins likely contributed too. Presence of the mild acute kidney injury further worsened the acidosis.
A systematic review found 50 cases of Ibuprofen causing similar clinical scenario, however there is only one another case report of Diclofenac causing NAGMA and Hypokalemia.
This is a rare but clinically significant side effect of Diclofenac to be considered and a thorough history of NSAID intake is necessary in such patients.