Marzo Aprile 2021 - Nefrologo in corsia

Hyperkalemia-induced acute flaccid paralysis: a case report

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Martina D’Ercole

Martina D’Ercole1,2, Leda Cipriani1,2, Daniela Picciotto1, Stefania Bianzina3, Elisa Russo1,2, Francesca Viazzi1,2, Pasquale Esposito1,2

1 Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
2 Department of Internal Medicine, University of Genova, Genova, Italy
3 Neonatal and Pediatric Intensive Care Unit, G. Gaslini Institute, Genova, Italy

Corrispondenza:
Prof. Pasquale Esposito
UO Nefrologia Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino
Largo Rosanna Benzi 10Vi dei Martiri 20
16132 Genova, Italia
Tel +39 010 5555365
Fax +39 010 5556555
E-mail: pasqualeesposito@hotmail.com

 

Abstract

Acute flaccid paralysis is a medical emergency that may be caused by primary neuro-muscular disorders, metabolic alterations, and iatrogenic effects. Severe hyperkalemia is also a potential cause, especially in elderly patients with impaired renal function. Early diagnosis is essential for appropriate management.

Here, we report the case of a 78-year-old woman with hypertension and diabetes presenting to the emergency department because of pronounced asthenia, rapidly evolving in quadriparesis. Laboratory examinations showed severe hyperkalemia of 9.9 mmol/L, metabolic acidosis, kidney failure (creatinine 1.6 mg/dl), and hyperglycemia (501 mg/dl). The electrocardiography showed absent P-wave, widening QRS, and tall T-waves. The patient was immediately treated with medical therapy and a hemodialysis session, presenting a rapid resolution of electrocardiographic and neurological abnormalities. This case offers the opportunity to discuss the pathogenesis, the clinical presentation, and the management of hyperkalemia-induced acute flaccid paralysis.

Keywords: hyperkalemia, acute flaccid paralysis, hemodialysis, diabetes

Ci spiace, ma questo articolo è disponibile soltanto in inglese.

Introduction

Hyperkalemia is associated with poor outcomes and a high mortality rate among the general population, and among patients with cardiac and renal disease [1,2]. Hyperkalemia-related clinical complications and deaths are determined mainly by the cardiac electrophysiological effects of elevated potassium levels [3]. Indeed, hyperkalemia may result in ventricular arrhythmias and sudden death. Moreover, hyperkalemia may also cause other physiologic perturbations, such as muscle weakness and paralysis, paraesthesia, and metabolic acidosis.

Here, we report a case of severe hyperkalemia presenting with dramatic neurological manifestations in the form of acute flaccid paralysis (AFP).

 

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