Jacobs Journal of Clinical Case Reports

Multiple Organ Dysfunction during Treatment of a Severe Hypokalemia in an Aged Female Patient: A Case Report

* Zhao Xiaojing
Department Of Emergency Medicine, The Second Affiliated Hospital Of Xian Jiaotong University, China

*Corresponding Author:
Zhao Xiaojing
Department Of Emergency Medicine, The Second Affiliated Hospital Of Xian Jiaotong University, China
Email:zxj47@aliyun.com

Published on: 2015-05-04

Abstract

Hypokalemia is one of the most severe electrolyte imbalances in emergency which can lead to malignant arrhythmias and even cardiac arrest with serious consequences. Given that the aged patients with hypokalemia have been committed one or more chronic diseases, rapid reverse of hypokalemia with much amount of diluent administered in a short period might invoke multiple organ dysfunction. One 85-aged woman with severe hypokalemia and frequent ventricular fibrillation was treated with electrical cardioversion, anti-hypertension, and potassium infiltration orally and intravenously. Acute left heart failure, pneumonedema and respiratory failure were complicated. The patient died after further treatment had been refused by her family members. If the background of patients (age, gender, etc), the underlying disease, and aggregated effects of serial electrical cardioversion are neglected without delicate control of intravenous potassium supplement during the process of hypokalemia rebalance, the prognosis of patients would be very unacceptable and severe combinations, even multiple organ dysfunction and failure, could be complicated, although serum potassium concentration is rebalanced.

Keywords

Hypokalemia; Acute left Heart Failure; Respiratory Failure

Introduction

Serum potassium is the vital ion maintaining the electrical activity of cardiac and skeletal muscle cells. Hypokalemia is one of the most common, emergent and severe electrolyte imbalance [1]. Hypokalemia can lower the excitability of skeletal muscle, resulting in myasthenia of limbs and even flaccid paralysis. Hypokalemia can also cause extended action potential duration, abnormal enhanced autonomy, decreased conductivity and contractility of cardiac muscle cell [2]. Severe hypokalemia can induce malignant arrhythmia and even cardiac arrest [3]. Severe hypokalemia is defined with serum concentration of potassium ranging less than 2.5 mmol/L. There are a lot of potassium supplement method, such as taking pills, nasal feeding and intravenous. Concentration of potassium via peripheral venous is limited to 40 mmol/L with maxim rate of 60mmol/h, due to the side effect of potassium, such as complicated pain caused by spasticity of small vessels. Then solution of 5000 mL should beadministered during potassium supplement in the case of severe hypokalemia. This volume might be acceptable for young patients without underlying diseases. But it is totally unacceptable for aging patients, especially for those suffering hypertension, coronary artery diseases and other critical underlying diseases. Special and safe protocols of potassium supplement and symptomatic treatment should be considered for this group of patients with hypokalemia in order to reduce the mortality of complications and improve the prognosis.