Document Type: Case Report

Authors

1 Emergency Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

2 Emergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, Iran

Abstract

Hypokalemic periodic paralysis is anautosomal dominantdisease characterized by muscle weakness or paralysis with a matching fall in blood potassium levels. Paralysis attacks often occur in adolescence and are induced by strenuous exercise followed by rest, high carbohydrateor high sodiummeal content, sudden changes in temperature, and even excitement, noise, flashing lights and cold temperatures. Despite global daily use of intravenous and oral potassium in the treatment of patients, data about intravenous bolus potassium is rare. Here we report a 29-year-old man complaining of weakness in the upper and lower limbs. By initial diagnosis of periodic hypokalemic paralysis, potassium chloride was ordered by oral route. After a few minutes, we heard patient screaming in pain. He complained of severe acute pain in peripheral intravenous line, palpitation and dyspnea. We noticed that potassium chloride vial was infused directly via cubital vein in few minutes erroneously. Physical exam revealed sinus tachycardia and hypertension. We began hyperkalemia treatment immediately. With appropriate treatment,the patient was discharged with good condition after 12 hours of admission.

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  1. Kung AW. Clinical review: thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab 2006; 91(7): 2490-5. doi: 10.1210/jc.2006-0356.
  2. Segal MM, Jurkat-Rott K, Levitt J, Lehmann-Horn F. Hypokalemic periodic paralysis - an owner’s manual. Available from: http://simulconsult.com/resources/hypopp. html.
  3. Kim JB, Kim MH, Lee SJ, Kim DJ, Lee BC. The genotype and clinical phenotype of Korean patients with familial hypokalemic periodic paralysis. J Korean Med Sci 2007; 22(6): 946-51. doi: 10.3346/jkms.2007.22.6.946.
  4. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM. Tintinalli’s Emergency Medicine. 7th ed. New York: McGraw-Hill Medical; 2011. p. 121-122.
  5. Rardon DF, Fisch C. Electrolytes and the heart. In: Schlant RC, Alexander RW, eds. Hurst’s the Heart. 8th ed. New York: McGraw-Hill; 1994. p. 759-74.
  6. Alfonzo AV, Isles C, Geddes C, Deighan C. Potassium disorders--clinical spectrum and emergency management. Resuscitation 2006; 70(1): 10-25. doi:10.1016/j. resuscitation.2005.11.002.
  7. McCann B, Hunter R, McCann J. Cocaine/heroin induced rhabdomyolysis and ventricular fibrillation. Emerg Med J 2002; 19(3): 264-5.
  8. Ochoa-Gómez J, Villar-Arias A, Aresti I, Marco-Aguilar P. A case of severe hyperkalaemia and compartment syndrome due to rhabdomyolysis after drugs abuse. Resuscitation 2002; 54(1): 103-5.
  9. Nathan A, Ganesh A, Godinez RI, Nicolson SC, Greeley WJ. Hyperkalemi cardiac arrest after cardiopulmonary bypass in a child with Duchenne muscular dystrophy. Anesth Analg 2005; 100(3): 672-4. doi: 10.1213/01. ANE.0000146533.21771.2F.
  10. Wetherton AR, Corey TS, Buchino JJ, Burrows AM. Fatal intravenous injection of potassium in hospitalized patients. Am J Forensic Med Pathol 2003; 24(2): 128-31. doi: 10.1097/01.paf.0000068224.31539.a9.
  11. Nilsson TS, Malmgren J, Knudsen K. Parallel haemodialysis and surgery saves a life after massive overdose of potassium pills. BMJ Case Rep 2012. doi: 10.1136/bcr.02.2012.5773.
  12. Battefort F, Dehours E, Vallé B, Hamdaoui A, Bounes V. Suicide attempt by intravenous potassium self-poisoning: a case report. Case Rep Emerg Med 2012; 2012: 323818. doi: 10.1155/2012/323818.
  13. Bertol E, Politi L, Mari F. Death by potassium chloride intravenous injection: evaluation of analytical detectability. J Forensic Sci 2012; 57(1): 273-5. doi: 10.1111/j.1556- 4029.2011.01907.x.