Abstract
BackgroundHyperkalaemic paralysis due to renal failure is a rare but potentially life threatening event.Case presentationWe present a patient who had sudden onset ascending flaccid paralysis. The EMS first diagnosis was acute ST-elevation myocardial infarction based on an EKG. In the emergency room (ER) due to careful history taking, serum electrolytes and repeat EKG a correct diagnosis was made and both hyperkalemia and paralysis were treated on time.ConclusionHyperkalaemic paralysis is rare. One must keep it in the back of the mind especially in the case of renal failure patients to avoid misdiagnosing a rapidly fatal but yet completely reversible condition.
Highlights
Hyperkalaemic paralysis due to renal failure is a rare but potentially life threatening event.Case presentation: We present a patient who had sudden onset ascending flaccid paralysis
The EKG changes seen could be typical for hyperkalaemia or could be normal
There is no correlation of the EKG changes to the level of serum potassium levels
Summary
Hyperkalaemia is seen commonly in patients with renal failure, especially in patients who are receiving hemodialysis. The patient had end stage renal failure due to poorly controlled diabetes and hypertensive heart disease for many years He had been on routine hemodialysis thrice a week with each dialyzing session lasting for four hours for the past three years. Central nervous system examination revealed an alert, awake and oriented patient with normal cranial nerve function He had symmetrical and equal weakness of the lower limbs more than in the upper limbs. After three hours of dialysis, the patient recovered completely from his weakness and was able to walk. His post dialysis potassium level was 4.0 mEq/L, BUN was 47 mg/dl and creatinine was 3.57 mg/dl. The EKG had reversed back to sinus rhythm, heart rate of 88 per minute, normal T waves and ST segment (Figure 5)
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