Sir,A 55-year-old lady presented to the outpatient clinic with a short history of tremulousness of hands. She was a known case of type 2 diabetes mellitus, hypertension, and diabetic nephropathy/CKD-5 on conservative treatment with a stable renal function (serum creatinine 4.0 mg/dl). On routine investigations, she was found to have hyperkalemia (serum K+ 8.3 meq/l). ECG showed tall T waves, but her vitals were stable. Perusal of her documents revealed no medication likely to cause hyperkalemia. Detailed questioning into her dietary practices revealed that she had started taking low sodium salt substitute - “TATA Lite” as it was advertised as being helpful for blood pressure control. Our patient could be managed successfully with anti-hyperkalemic measures and her symptoms resolved completely after correction of hyperkalemia.We have come across a number of cases where patients with renal diseases use “low salt” substitutes without being aware of its potential life threatening side effects and develop hyperkalemia. These salt substitutes are marketed as low sodium salt, but it is not appropriately highlighted that they contain potassium in higher amounts. The composition of “TATA Lite” is shown in Table 1. Hence, although patients were instructed to reduce potassium intake, they were unknowingly taking these salt substitutes with a high potassium content. There are case reports of patients of CKD on dialysis presenting with hyperkalemia secondary to the use of salt substitutes leading to asystole.[1]
Table 1
Composition of some commonly available salts in India (per 100 g)*
Composition of some commonly available salts in India (per 100 g)*One such salt substitute marketed in the western countries under the brand name “LoSalt” clearly mentions that their product should be avoided in patients with diabetes, cardiac, and renal diseases who are on medicines like ACE inhibitor or ARB. Such a warning should be printed in bold letters and in local dialect so that the consumer is aware of its possible side effects.Physicians and dietary councilors must warn the patients against using such salt substitutes if they are prescribed potassium restriction.