Tetraparesis and Failure of Pacemaker Capture Induced by Severe XXXX : Case Report and Systematic Review of Available Literature.

@entity1 @entity3045 @entity16 @entity425 @entity591 @entity177 @entity972 @entity413 @entity583 @entity943 @entity1370 @entity912 @entity4144 @entity10492
BACKGROUND: In severe @entity4144 , @entity16 are described more rarely than cardiac manifestations. We report a clinical case; present a systematic review of available literature on secondary hyperkalemic @entity912 (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options. CASE REPORT: A 75-year-old @entity1 presented to the emergency department complaining of @entity10492 . Her serum @entity972 level was 11.4 mEq/L. Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes. After emergency treatment to restore cell membrane potential threshold and lower serum @entity972 , neurologic and ECG signs completely disappeared. An acute @entity583 subsequently occurred, possibly linked to @entity591 induced by @entity3045 therapy. We reviewed 99 articles (119 patients). Mean serum @entity972 was 8.8 mEq/L. In most cases, ECG showed the presence of tall T waves; loss of PMK atrial capture was documented in 5 @entity1 . In 94 @entity1 , flaccid @entity912 was described and in 25, severe @entity425 ; in 65 @entity1 , these findings were associated with other symptoms. Concurrent @entity177 was often documented. The most frequent treatments were dialysis and infusion of insulin and @entity413 . Eighty-seven percent of @entity1 had complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Severe @entity4144 is always a life-threatening medical emergency, as it can precipitate fatal @entity943 and @entity912 . SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with @entity177 or who is taking medications that may worsen renal function. The presence of a PMK does not necessarily impede hyperkalemic @entity1370 .
