Acute Ascending Muscle Weakness Secondary to Medication-Induced Hyperkalemia

Abstract

Secondary hyperkalemic paralysis is an uncommon but potentially life-threatening consequence of drug-induced disease. We report a case of a 53-year-old female with history of chronic kidney disease presenting to the emergency department with a one-day history of upper and lower extremity weakness and paresthesias. Serum potassium concentration on admission was greater than 8 mEq/L, and serum creatinine was elevated above baseline. Electrocardiogram showed first-degree atrioventricular block with peaked T waves. The patient reported compliance with daily lisinopril 10 mg, spironolactone 25 mg, and 40 mEq twice daily of potassium chloride. Symptoms and electrocardiogram returned to baseline within 24 hours of presentation and serum potassium returned to 4.2 mEq/L at approximately 36 hours without the need for dialysis. This case emphasizes the importance of including such a condition in the differential diagnosis of patients with ascending paralysis and the importance of close monitoring of patients placed on potassium-elevating agents.

Acute hyperkalemia leading to flaccid paralysis: a review of hyperkalemic manifestations

“…Management of hyperkalemia involves addressing three different aspects: ( 1 ) preventing immediate complications; ( 2 ) correcting the serum K+ level to a physiologically stable level; and ( 3 ) elimination of excess potassium from the body. Most immediate complications are due to cardiac arrhythmias.…”

“…Hyperkalemia can present with a spectrum of clinical manifestations ranging from asymptomatic to life-threatening arrhythmias and secondary hyperkalemic paralysis ( 1 ) depending on the serum concentration and the underlying comorbidities, such as concomitant renal failure. Prompt diagnosis and treatment can lead to complete resolution of symptoms and termination of arrhythmias and paralysis, whereas delays can lead to death.…”

Hyperkalemia Causing Severe Muscle Weakness in a Patient With Renal Insufficiency

“…Weakness of muscles follow, with the feet being the first to be affected, followed by the trunk and arms, and finally the facial and respiratory muscles. 3,4 Despite muscle paralysis, the patient is normally awake till a cardiovascular incident happens. After getting the potassium level back on track, these modifications reverse, which was the precise chain of actions in our case.…”

Hyperkalemia – how to protect your patient? Case report

“…hiperkalemia, upośledzona funkcja nerek, osłabienie siły mięśniowej WSTĘP Hiperpotasemia jest zaburzeniem elektrolitowym, mogącym doprowadzić do ciężkich następstw, a nawet być stanem zagrożenia życia [1]. Stężenie potasu powyżej 6,5 mmol/l jest już istotnym czynnikiem, zwiększającym ryzyko nagłego zgonu.…”