LIFE-THREATENING HYPOKALEMIA WITH RARE EKG FINDINGS

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: Factitious use of insulin, thyroxine, decongestants, laxatives, cocaine, and heroin have been reported to cause hypokalemia. Severe hypokalmeia < 2 mg/L can rhabdomyolysis, arrythmias, seizures warrenting rapid correction. CASE PRESENTATION: A 22-year-old male with recent cocaine presented intractable vomiting, ascending weakness tingling for 1 week. Examination revealed flaccid paralysis his lower extremities preserved sensory deep tendon reflexes. Laboratory findings include acute kidney injury, severe hyponatremia (Na 122mEq/L), hypokalemia (K 1.7mEq/L), hypochloremia (Chol<75mEq/L), metabolic alkalosis (bicarbonate 33mEq/L-43mEq/L). Urine electrolytes osmolarity ruled out factitious diuretic use. No family history periodic paralysis. EKG notched T waves, Q-T interval prolongation, visible U wave mild ST depression which corrected upon repletion 380mEq potassium. DISCUSSION: Flaccid quadriparesis rhabdomyolysis described (potassium<2mEq/L) following concomitant heroin. Cocaine causes beta-adrenergic hyperactivity, increased sodium-potassium ATPase activation leading intracellular shift Additionally, direct toxic effect on myocytes coupled has postulated rhabdomyolysis. blocks the influx sodium during depolarization, increasing calcium, these contracting skeletal muscles require blood flow is achieved by concentrations potassium in interstitial fluid, a phenomenon that limited presence significant Heroin itself does not hypokalemia, however, an adulterent Clenbuterol implicated promotes transcellular shifts resulting muscle weakness. CONCLUSIONS: This case highlights danger substance life-threatening DISCLOSURE: Nothing declare. KEYWORD: # waves