Abstract
Acute flaccid paralysis is an uncommon, but potentially life threatening, sequel of severe hyperkalemia. Reported primary aetiologies include renal failure, Addison's disease, potassium sparing diuretics, potassium supplements, and dietary excess. Coconut water, when consumed in excess, has been reported to cause severe hyperkalemia. We report the case of acute ascending flaccid paralysis secondary to hyperkalemia induced by multiple trigger factors-king coconut water, renal failure, diabetes, metabolic acidosis, and potassium sparing diuretics. A 78-year-old man presented with acute ascending type flaccid paralysis over five-hour duration and subsequently developed preterminal cardiac arrhythmias secondary to severe hyperkalemia (serum potassium: 7.02 mEq/L). He was on Losartan and Spironolactone for ischemic heart disease. Dietary history revealed excessive intake of king coconut water (Cocos nucifera) over past one week. Electrocardiogram returned to normal rhythm and serum potassium was 6.1 mEq/L within 2 hours of institution of emergency management for life threatening hyperkalemia. Neurological symptoms completely recovered within twenty-four hours without the need for dialysis. Electromyogram three days after the initial...Continue Reading
References
Nov 3, 1979·Lancet·I R Livingstone, W J Cumming
Apr 1, 1989·Postgraduate Medical Journal·J M Sowden, D Q Borsey
May 1, 1985·Journal of Neurology, Neurosurgery, and Psychiatry·H ShinotohJ Suzuki
Jul 24, 1971·British Medical Journal·V SitprijaC Benyajati
Sep 1, 1980·Journal of Neurology, Neurosurgery, and Psychiatry·J J VilchezT Villarroya
Nov 1, 1994·Journal of Neurology, Neurosurgery, and Psychiatry·M NaumannC Schneider
Jan 1, 1996·Nephron·T SakemiO Rikitake
Dec 31, 1997·The American Journal of the Medical Sciences·C EffiongJ Mattana
Mar 7, 1998·Journal of Neurology, Neurosurgery, and Psychiatry·S EversM Hund
Feb 13, 2001·Postgraduate Medical Journal·D DuttaA McClung
May 23, 2002·Brain : a Journal of Neurology·Matthew C KiernanHugh Bostock
Nov 30, 2002·Lancet·Eric MauryGeorges Offenstadt
Jan 6, 2005·Clinical Nephrology·C EspositoA Dal Canton
Oct 2, 2009·Pharmacotherapy·Nikita S WilsonChristopher K Finch
Nov 6, 2012·British Journal of Hospital Medicine·Richard ReesMarc George
Jan 26, 2013·Annals of Indian Academy of Neurology·Karkal R NaikMallikarjun S Khanpet
Jan 1, 2011·Journal of Community Hospital Internal Medicine Perspectives·Yelena MushiyakhDavid Tompkins
Feb 20, 2014·Circulation. Arrhythmia and Electrophysiology·Justin HakimianTodd C Kerwin