Complete Heart Block during Potassium Therapy in Thyrotoxic Periodic Paralysis

Abstract

BackgroundAlthough cardiac dysrhythmia is common in patients with thyrotoxic periodic paralysis (TPP), high-degree atrioventricular (AV) block complicated by cardiogenic shock, even under KCl supplementation, is rarely described. ObjectivesTo present a case of TPP in a patient who developed complete AV block with severe consequences due to paradoxical hypokalemia during KCl therapy. In addition, the management of acute hypokalemia in TPP is reviewed. Case ReportA 41-year-old Chinese man with TPP presented to the Emergency Department with a 2-day history of paralysis in the extremities. He developed complete AV block with cardiogenic shock and respiratory failure, necessitating ventilatory support when plasma K+ level decreased from 1.7mmol/L to 1.3mmol/L during KCl replacement of 30mmol in 2h. The administration of another 60mmol KCl over 3h achieved a plasma K+ level of 2.1mmol/L, resulting in the resolution of AV block and successful weaning. However, rebound hyperkalemia (K+ 5.6mmol/L) upon recovery was evident and uneventfully corrected. ConclusionA paradoxical fall in serum K+ concentration with potentially life-threatening complication is still underappreciated in patients with TPP on KCl supplementation. Early recognition and prompt therapy prevent untoward consequences.