Case Report: A patient with extreme hyperkalemia beats all the odds

Abstract

Hyperkalemia is a common finding in patients in hemodialysis and is typically classified as mild, moderate or severe. Severe hyperkalemia is a complex and life-threatening clinical entity, closely associated with increased mortality rates. It generally presents with ascending muscle weakness and paralysis, cardiac arrhythmias and specific ECG changes. Herein, we present the case of a 30-year-old patient with end-stage renal disease, on hemodialysis. He presents to his hemodialysis session with complaints of progressive weakness and paralysis of his lower extremities, palpitations and dyspnea. His last session was 5 days prior to his ER presentation, after having missed 2 sessions. Laboratory studies revealed a serum potassium level of 10.9 mg/ dL. Intravenous calcium infusion was administered urgently and subsequently underwent urgent hemodialysis. The next day he underwent another session due to the post-hemodialysis rebound effect, but on physical examination the lower limb paralysis had improved and normal, sinus rhythm was present. Considering its silent development and ambiguous clinical presentation, hyperkalemia should invariably be considered in patients with CKD presenting with cardiac and neurological symptoms. Reported cases of severe hyperkalemia with potassium concentrations higher than 10 mg/dL, as in the case of our patient, are sparse and represent rapidly deteriorating, life-threatening conditions, requiring emergent medical interventions to prevent fatal cardiac arrhythmias.