Lazy lips: hyperkalemia and acute tetraparesis-a case report from an urban emergency department.

Christian T Braun,Bianca Maria Engelhardt,Aristomenis K Exadaktylos,Gregor Lindner,David S Srivastava

doi:10.1155/2014/160396

Christian T Braun, Bianca Maria Engelhardt + Show 3 more

Open Access

https://doi.org/10.1155/2014/160396

Copy DOI

Abstract

A 58-year-old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II–XII intact, muscle strength of the lower extremities was 4/5, and a minimal sensory loss of the left hemisphere was found. In addition, the patient complained about lazy lips. During ongoing examinations, the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient's neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.

Highlights

Hyperkalemia is common in emergency department patients with a prevalence rate of about 9%
We present the rare case of a severe neurologic manifestation of profound hyperkalemia
Hyperkalemia often appears without any clinical symptoms, despite diagnostic signs like ECG changes including tall and peaked T waves, flattened and broadened P waves, and widened QRS complexes

Summary

Introduction

Hyperkalemia is common in emergency department patients with a prevalence rate of about 9%. About 3/4 of cases of hyperkalemia in emergency department patients were described to be caused by either acute or chronic renal failure or medications linked to this condition [1]. Hyperkalemia often appears clinically asymptomatic, and most often the electrolyte disorder gets only symptomatic when hyperkalemia is severe. Clinical features range from mild to life-threatening manifestations such as weakness to malign cardiac arrhythmias. We present the rare case of a severe neurologic manifestation of profound hyperkalemia

Case Presentation

Discussion