Hyperkalemia-induced periodic paralysis, a rare presentation of ascending flaccid paralysis: A case report and review of literature

Severe hyperkalemia is a life-threatening complication of kidney disease in acute or chronic states. Hyperkalemia-induced muscle paralysis is a manifestation of severe hyperkalemia, usually seen when serum potassium levels rise above 6.5 mEq/L, along with cardiac arrhythmia requiring emergency management. A 60-year-old Asian male presented in the medical emergency with paraparesis for 6 hours. On examination, he had flaccid paraparesis without any sensory loss. His ECG showed changes of hyperkalemia, and his potassium levels came out to be 8.1 mEq/L. The weakness resolved following the correction of hyperkalemia with a regimen containing an insulin-dextrose infusion and salbutamol nebulizations. Although rare, severe hyperkalemia is a cause of periodic paralysis, especially in patients with risk factors such as end-stage renal disease (ESRD). Prompt treatment of hyperkalemia can resolve paralysis even before hemodialysis. The report aims to educate physicians about an essential differential of flaccid paralysis.