Chasing Highs, Experiencing Lows: A Case of Hypokalemia Associated With Cannabis Use

Hypokalemia is a relatively common reason for admission from the Emergency Department, with cannabinoid utilization being a more rare, indirect cause, as excessive use can lead to vomiting and diarrhea. More recently, there has been growing interest in the possible association between cannabis use and hypokalemia, even in the absence of gastrointestinal (GI) losses. This case involves a 24-year-old female with a history of anxiety, depression, and heavy cannabis use, who presented to the Emergency Department with bilateral lower extremity weakness and medial leg pain for two days. She was found to have an initial potassium level of 1.8, which prompted immediate repletion and admission to the ICU. Electrocardiogram (EKG) showed QT prolongation and bradycardia. Her hospital stay was complicated with a low phosphorus level of 1.0 after fluid administration. No additional renal abnormalities, nor identifiable causes for the hypokalemia, were identified following a comprehensive nephrological workup. The patient was discharged with a potassium level of 4.0 and instructions to follow up with nephrology and begin supplementation. This case underscores the importance of considering cannabinoid ingestion in the differential diagnosis of unexplained hypokalemia without GI manifestations.