Hyperkalemic intermittent paralysis associated with spironolactone in a patient with cardiac cirrhosis

Abstract

Intermittent hyperkalemic weakness and flaccid paraplegia were observed during chronic spironolactone treatment in a case of refractory ascites due to cardiac cirrhosis. The patient was treated also with steroid and there was no azotemia. The increase of potassium excretion by treatment with a combination of aldosterone, furosemide, and acetazolamide was temporarily advantageous, because it diminished hyperkalemia and abolished paralysis. Renal and extrarenal influences are considered that may be involved in the regulation of serum potassium level during chronic treatment with spironolactone and its combination with diuretics.