An 80-year-old woman was hospitalized for anorexia, nausea and emesis. She was suffering from diabetes mellitus and treated with insulin therapy.

At the entrance to the ward she had marked abdominal distension, and contrast x-rays of the abdomen showed abnormal increase in the volume of the stomach (Figure 1).The subsequent esophagogastroduodenoscopy only described indirect signs of possible gastroparesis. Laboratory tests were normal, with the exception of severe hypokalemia (1.6 mEq/L), which was not accompanied by changes in the electrocardiogram.

The clinical history showed an abuse of loop diuretics for the treatment of heart failure. The kalemia was corrected by parenteral infusion of potassium and the clinical picture was completely normalized (Figure 1) (Gumz 2015 [1]Kovesdy 2015 [2]).