Octreotide Causing Hyperkalemia: A Case Report and Review of the Literature

Octreotide, a synthetic analog of somatostatin, is widely utilized for its inhibitory effects on various hormones, including growth hormone, insulin, and glucagon. Its applications span conditions such as acromegaly, carcinoid tumors, and gastrointestinal bleeding due to its ability to reduce portal venous pressure. Additionally, it serves a crucial role in nuclear medicine imaging and the management of hepatorenal syndrome. We report a case of a 44-year-old man with type 2 diabetes mellitus (T2DM) and stage 5 chronic kidney disease (CKD), not yet on hemodialysis, who presented with persistent severe hypoglycemia. Despite multiple oral glucose administrations, his blood glucose levels remained critically low. The patient was treated with octreotide for sulfonylurea-induced hypoglycemia. However, he developed hyperkalemia as a side effect of octreotide treatment. Traditional therapies for sulfonylurea-induced hypoglycemia often involve intravenous and oral dextrose and glucagon, which may lead to recurrent hypoglycemia due to their stimulatory effects on insulin release. Octreotide directly inhibits insulin release from the pancreas, thus preventing rebound hypoglycemia. However, its administration in patients with renal impairment poses a risk of hyperkalemia due to its suppression of insulin-mediated cellular potassium uptake, and it should be used with caution. This case highlights the potential for life-threatening hyperkalemia induced by octreotide in non-dialysis CKD patients. Physicians must be vigilant about this side effect, particularly in patients with underlying renal impairment. Close monitoring of potassium levels and appropriate management strategies are essential to ensure the safe use of octreotide. This case aims to raise awareness and contribute to a better understanding of octreotide-induced hyperkalemia in CKD patients.