Hyperkalemic Paralysis with Unexplained Causes: A Case Report

Cho, Hyeong Do; Yi, Joo Hark; Kim, Young Hoon; Han, Sang Woong; Kim, Ho Jung

Abstract

Hyperkalemic paralysis can be either a rare hereditary form due to channelopathies or common secondary ones related to various medications interfering potassium homeostasis upon underlying renal impairment. We hereby describe a 36-yr-old woman presented with the first episode of sudden hyperkalemic paralysis due to severe hyperkalemia, 8.6 mEq/L, but which resolved quickly to the normalization of serum potassium level by the conventional remedies, including calcium gluconate, insulin and glucose, and potassium-binding resin for severe hyperkalemia over 10 hours and remained normokalemic without any medications or dialysis for the next 10 days in hospital. The discernible history of medications or potassium-rich food intakes was denied on repeated interrogation. Other diagnostic work-ups to investigate its etiologies responsible for this acute hyperkalemic paralysis including neurological examination, serial biochemical data, and endocrinologic diagnostic work-ups for underlying causes failed, but only revealed only a transient hyperkalemic episode with appropriate response of renal potassium excretion. Therefore, we report a puzzling case of hyperkalemia with unexplained causes in a young woman, though the evidences are in favor of acute intracellular potassium shift based on the short duration of reversible hyperkalemia with intact response of increased renal potassium excretion.