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      Hyperkalemic Recurrent Bilateral Lower Extremity Weakness in a Patient on Hemodialysis

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          Abstract

          Hyperkalemia is a severe life-threatening electrolyte disorder that commonly affects the cardiac conductivity and contractility. Ascending paralysis affecting the extremities with focal neurological deficit as well as quadriparesis and a seizure associated with hyperkalemia has been reported in the literature. Here, we describe a case of isolated recurrent lower extremity paralysis and an episode of seizure in an 83-year-old patient with end-stage renal disease on hemodialysis.

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          Most cited references19

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          Secondary hyperkalaemic paralysis.

          Besides the hereditary hyperkalaemic paralysis, a secondary form exists which often mimicks Guillain-Barre syndrome. A 62 year old patient is reported on who developed severe hyperkalaemic paralysis on the basis of mild renal failure and additive spironolactone intake. Neurophysiological examinations disclosed normal muscle fibre activity but delayed nerve conduction velocities indicating that the mechanism underlying secondary hyperkalaemic paralysis is different from channelopathies. Haemodialysis led to complete recovery. Review of the medical literature showed that spironolactone intake is the most common cause of secondary hyperkalaemic paralysis. Typical symptoms are flaccid tetraplegia sparing the cranial nerves with only mild or lacking sensory impairment. Symptoms promptly resolve after haemodialysis or after glucose and insulin infusion. Only three out of 18 patients reviewed died, because of cardiopulmonary complications. Thus the prognosis of secondary hyperkalaemic paralysis is good.
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            Hyperkalemia-induced ECG abnormalities in patients with reduced renal function.

            Hyperkalemia is a potentially lethal condition to be aware of in the presence of ECG abnormalities especially in patients with reduced renal function. However, ECG abnormalities are not always dependent on the degree ofhyperkalemia but may be aggravated by the rapidity of the development of hyperkalemia and by associated electrolyte disorders. We describe 3 patients with renal failure and different ECG changes induced by hyperkalemia. More severe changes were observed when hyperkalemia developed rapidly, but not in presence of electrolyte disorders. Even minor ECG abnormalities must alarm physicians in patients with renal failure since severe hyperkalemia is not always associated with critical ECG changes.
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              Hyperkalaemic paralysis resembling Guillain-Barré syndrome.

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                Author and article information

                Journal
                Case Rep Emerg Med
                Case Rep Emerg Med
                CRIM.EM
                Case Reports in Emergency Medicine
                Hindawi Publishing Corporation
                2090-648X
                2090-6498
                2012
                13 May 2012
                : 2012
                : 243501
                Affiliations
                Department of Emergency Medicine, Metropolitan Hospital Center, NYMC, 1901 First Avenue, New York, NY 10029, USA
                Author notes
                *Getaw Worku Hassen: getawh@ 123456yahoo.com

                Academic Editors: L. Bojić, O. Kose, J.-N. Lin, and M. Redondo

                Article
                10.1155/2012/243501
                3542952
                23326707
                9a8c2a1b-5383-4f2c-b969-397522af8718
                Copyright © 2012 Getaw Worku Hassen et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 February 2012
                : 5 March 2012
                Categories
                Case Report

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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