Hypokalemic myopathy in pregnancy caused by clay ingestion

BACKGROUND: We present a case of severe hypokalemic myopathy during pregnancy caused by clay ingestion. CASE: A multigravida presented with fatigue, muscle weakness, and a 3-day history of extremity pain. Serum potassium levels were 1.5 mEq/L, requiring intravenous potassium replacement. The initial evaluation was unrewarding for the cause of the patient's hypokalemia until a family member reported that the patient frequently ate large quantities of clay. Discontinuation of clay ingestion led to normalization of potassium levels. CONCLUSION: Pica, the persistent ingestion of nonnutritive substances, can cause a number of medical problems. Pica of clay, called geophagia, can bind potassium in the intestine, leading to severe hypokalemic myopathy. Clinicians caring for pregnant women with fatigue, muscle weakness, and hypokalemia should consider geophagia as a possible cause.