Main Article Content
Abstract
Hypokalemia is a common electrolyte abnormality often encountered in daily practice. While mild hypokalemia often asymptomatic, moderate-to-severe hypokalemia usually manifested as significant symptoms such as muscle weakness. In this paper, we presented a case of 23-years-old male coming to our emergency department because of muscle weakness in all his four limbs when he woke up in the morning. Physical examinations were all within normal limit, except that his muscle strength decreased in all four extremities. Laboratory measures showed severe hypokalemia (1.9 mmol/L), hence patient was treated with potassium infusions. During hospitalization, thyroid function tests revealed hyperthyroidism. Therefore, in patient with paralysis, in which laboratory finding showed hypokalemia, hyperthyroidism should be considered as one of the potential diagnosis especially in younger patient, even in patient without previous history of hyperthyroidism. Merely treating hypokalemia in patient with underlying hyperthyroidism could be a dangerous boomerang.
Keywords
Article Details
References
- Greco A, Rabito G, Pironi M, Bissig M, Parlato S, Andreocchi L, et al. Hypokalaemia in hospitalised patients. Swiss Med Wkly. 2016;146(June). https://doi.org/10.4414/smw.2016.14320
- Udensi UK, Tchounwou PB. Potassium Homeostasis, Oxidative Stress, and Human Disease. Int J Clin Exp Physiol [Internet]. 2017;4(3):111–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29218312 doi: 10.4103/ijcep.ijcep_43_17
- Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocr Connect [Internet]. 2018 Apr;7(4):R135–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29540487 doi: 10.1530/EC-18-0109
- Viera AJ, Wouk N. Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam Physician. 2015;92(6):487–95.
- Greenlee M, Wingo CS, McDonough AA, Youn J-H, Kone BC. Narrative Review: Evolving Concepts in Potassium Homeostasis and Hypokalemia. Ann Intern Med. 2009;150(9):619–25.
- Stieger HLC, Hosein N. Thyrotoxic periodic paralysis: A review of cases in the last decade. AACE Clin Case Reports. 2015;1(3):182–6. https://doi.org/10.4158/EP14304.CR
- Vanholder R, Van Biesen W, Nagler E V. Treating potassium disturbances: kill the killers but avoid overkill. Acta Clin Belg [Internet]. 2019 Jul 4;74(4):215–28. Available from: https://www.tandfonline.com/doi/full/10.1080/17843286.2018.1531206 doi: 10.1080/17843286.2018.1531206
- Lewis KL, Malouff TD, Kesler AM, Harris DM. Hypokalemic periodic paralysis – the importance of patient education. Rom J Intern Med [Internet]. 2019 Sep 1;57(3):263–5. Available from: https://www.sciendo.com/article/10.2478/rjim-2019-0004 doi: 10.2478/rjim-2019-0004
- Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA, et al. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve [Internet]. 2018 Apr 29;57(4):522–30. Available from: https://onlinelibrary.wiley.com/doi/10.1002/mus.26009 doi: 10.1002/mus.26009
- Hallas J, Annmarie D, Lassen T. Hypokalemia in acute medical patients: risk factors and prognosis. Am J Med [Internet]. 2014; Available from: http://dx.doi.org/10.1016/j.amjmed.2014.07.022 doi: 10.1016/j.amjmed.2014.07.022
- Patel K, Mccoy J V, Davis PM. Recognizing thyrotoxic hypokalemic periodic paralysis. 2018;31–4. https://doi.org/10.1097/01.JAA.0000527697.21783.5a
- Lim S. Approach to Hypokalemia. Acta Med Indones. 2007;39(1):56–64.
- Lulsegged A, Wlodek C, Rossi M. Thyrotoxic Periodic Paralysis: Case Reports and an Up-to-Date Review of the Literature. Case Rep Endocrinol. 2011;2011:1–4. https://doi.org/10.1155/2011/867475
- Garla VV, Gunturu M, Kovvuru KR, Salim SA. Thyrotoxic periodic paralysis: case report and review of the literature. Electron Physician [Internet]. 2018 Aug 25;10(8):7174–9. Available from: http://www.ephysician.ir/index.php/browse-issues/10/8/1078-7174 doi: 10.19082/7174
- Ryan DP, Dias da Silva MR, Soong TW, Fontaine B, Donaldson MR, Kung AWC, et al. Mutations in Potassium Channel Kir2.6 Cause Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis. Cell [Internet]. 2010 Jan;140(1):88–98. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0092867409015712 doi: 10.1016/j.cell.2009.12.024
References
Greco A, Rabito G, Pironi M, Bissig M, Parlato S, Andreocchi L, et al. Hypokalaemia in hospitalised patients. Swiss Med Wkly. 2016;146(June). https://doi.org/10.4414/smw.2016.14320
Udensi UK, Tchounwou PB. Potassium Homeostasis, Oxidative Stress, and Human Disease. Int J Clin Exp Physiol [Internet]. 2017;4(3):111–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29218312 doi: 10.4103/ijcep.ijcep_43_17
Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocr Connect [Internet]. 2018 Apr;7(4):R135–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29540487 doi: 10.1530/EC-18-0109
Viera AJ, Wouk N. Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam Physician. 2015;92(6):487–95.
Greenlee M, Wingo CS, McDonough AA, Youn J-H, Kone BC. Narrative Review: Evolving Concepts in Potassium Homeostasis and Hypokalemia. Ann Intern Med. 2009;150(9):619–25.
Stieger HLC, Hosein N. Thyrotoxic periodic paralysis: A review of cases in the last decade. AACE Clin Case Reports. 2015;1(3):182–6. https://doi.org/10.4158/EP14304.CR
Vanholder R, Van Biesen W, Nagler E V. Treating potassium disturbances: kill the killers but avoid overkill. Acta Clin Belg [Internet]. 2019 Jul 4;74(4):215–28. Available from: https://www.tandfonline.com/doi/full/10.1080/17843286.2018.1531206 doi: 10.1080/17843286.2018.1531206
Lewis KL, Malouff TD, Kesler AM, Harris DM. Hypokalemic periodic paralysis – the importance of patient education. Rom J Intern Med [Internet]. 2019 Sep 1;57(3):263–5. Available from: https://www.sciendo.com/article/10.2478/rjim-2019-0004 doi: 10.2478/rjim-2019-0004
Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA, et al. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve [Internet]. 2018 Apr 29;57(4):522–30. Available from: https://onlinelibrary.wiley.com/doi/10.1002/mus.26009 doi: 10.1002/mus.26009
Hallas J, Annmarie D, Lassen T. Hypokalemia in acute medical patients: risk factors and prognosis. Am J Med [Internet]. 2014; Available from: http://dx.doi.org/10.1016/j.amjmed.2014.07.022 doi: 10.1016/j.amjmed.2014.07.022
Patel K, Mccoy J V, Davis PM. Recognizing thyrotoxic hypokalemic periodic paralysis. 2018;31–4. https://doi.org/10.1097/01.JAA.0000527697.21783.5a
Lim S. Approach to Hypokalemia. Acta Med Indones. 2007;39(1):56–64.
Lulsegged A, Wlodek C, Rossi M. Thyrotoxic Periodic Paralysis: Case Reports and an Up-to-Date Review of the Literature. Case Rep Endocrinol. 2011;2011:1–4. https://doi.org/10.1155/2011/867475
Garla VV, Gunturu M, Kovvuru KR, Salim SA. Thyrotoxic periodic paralysis: case report and review of the literature. Electron Physician [Internet]. 2018 Aug 25;10(8):7174–9. Available from: http://www.ephysician.ir/index.php/browse-issues/10/8/1078-7174 doi: 10.19082/7174
Ryan DP, Dias da Silva MR, Soong TW, Fontaine B, Donaldson MR, Kung AWC, et al. Mutations in Potassium Channel Kir2.6 Cause Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis. Cell [Internet]. 2010 Jan;140(1):88–98. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0092867409015712 doi: 10.1016/j.cell.2009.12.024