Secondary Hyperkalemic Paralysis: a Case Report and an Update Review of 128 Cases

Acute flaccid paralysis (AFP) is characterized by progressive weakness with signs of impairment of the lower motoneuron. Secondary hyperkalemic paralysis is a cause of AFP that must be quickly recognized to prevent cardiac and neurological deterioration. Methods: We present a case of secondary hyperkalemic paralysis admitted to the emergency department and then we updated a systematic review of published cases of secondary hyperkalemic paralysis published in 2015, including case reports published from 2014 to 2021. Results: We present a 69-years-old man admitted to the emergency department due to acute ascending generalized weakness. The neurological examination showed symmetrical tetraparesis (strength 2/5 in lower limbs and 4/5 in the upper limbs). Sensory and cranial nerves testing were unremarkable. He also had intense fasciculations in the cervical region and in the proximal muscles of the upper limbs. Initial laboratory showed potassium of 9.3 mEq/dL. The correction of hyperkalemia led to a complete reversal of weakness and fasciculations. Our patient was diagnosed with renal impairment secondary to a systemic lupus erythematosus was the cause of the secondary hyperkalemic paralysis. Discussion: We found 128 cases of secondary hyperkalemic paralysis in Literature. The most common symptom was flaccid tetraparesis. Sensory and cranial nerves testing are usually unremarkable. Electrocardiogram is abnormal in almost all patients, particularly with a tall peaked T wave or wide QRS complex. Renal failure is the most common cause of secondary hyperkalemic paralysis. Correction of hyperkalemia is associated with excellent motor outcomes.