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Acquired hyperkalaemia leading to periodic paralysis: an emergency department perspective
  1. Preh Arbab,
  2. Zofishan Anwar,
  3. Raveeha Aamir and
  4. Fareed Ahmed
  1. Emergency Medicine, The Aga Khan University Hospital Main Campus, Karachi, Sindh, Pakistan
  1. Correspondence to Dr Preh Arbab; dr.prehqadir{at}


Hyperkalaemia is one of the common electrolyte imbalances dealt with in the emergency department and is caused by extracellular accumulation of potassium ions above normal limits usually greater than 5.0–5.5 mmol/L. It is found in a total of 1–10% of hospitalised patients usually associated with chronic kidney disease and heart failure. The presentation can range from being asymptomatic to deadly arrhythmias. The appearance of symptoms depends on the rate of change rather than just the numerical values. The rare presentation includes periodic paralysis characterised by the sudden onset of short-term muscle weakness, stiffness or paralysis. Management goals are directed towards reducing potassium levels in emergency settings and later on avoiding the triggers for future attacks. In this case, we present a man in his 50s with the generalised weakness later on diagnosed as hyperkalaemic periodic paralysis secondary to tumour lysis syndrome. Emergency physicians dealing with common electrolyte imbalances should keep a sharp eye on their rare presentation and their precipitating factors and should act accordingly.

  • Cancer - see Oncology
  • Emergency medicine
  • Dialysis

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  • Contributors PA, RA and ZA were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing of original diagrams and algorithms and critical revision for important intellectual content. PA, RA, FA and ZA gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.