Hypokalemia can induced Psychotic symptoms even before the physiological manifestations appears. An association is established between hypokalemia and acute psychosis in this case.

To Identify the clinical, physiological and metabolic risk factors for all the patients presenting with psychiatric disturbances.

To do medical and base line laboratory investigations to all the patients presenting with acute psychiatric disturbances.

A 74 years old gentleman assessed in emergency department following emergency refferal by a general practioner, for an acute psychotic decompensation and suicidal ideation. Patient had a histroy of psychotic episode 30 years ago with one week hospitalization and six month priscription of psychotropic medication. Patient had a relatively stable functioning without any further contact with the psychiatric services till the current episode. After psychiatric assessment patient was discharge home with a priscription of olanzapine 2.5mg and citalopram 10mg, for further assessment and investigations by psychiatry of old age.

One week later patient presented to Emergency Department with shortness of breath and chest dyscomfort. Detailed medical and laboratory investigations revealed Hypokalemia with potassium level at 2.0mmol/L.The patient showed a prompt improvement in psychosis following intravenous potassium replacement.

This case highlights the importance of thorough medical and laboratory evaluation when assessing a psychotic patient. A narrow focuss on psychosis and ignoring organic and metabolic factors can be potentially dangerous to a patient.