Severe hypokalaemia in a Chinese male

Y. F. Lin, S. H. Lin, W. S. Tsai, M. R. Davids, M. L. Halperin

Research output: Contribution to journalArticle

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Abstract

A 34-year-old Chinese man developed acute, severe, generalized muscle weakness while mountain climbing. In the Emergency Department that morning, the most striking abnormalities were flaccid paralysis of both upper and lower limbs and a plasma potassium (K+) concentration (PK) of 1.7 mmol/l. To explain the basis for this constellation of findings, an imaginary consultation was sought with Professor McCance, the legendary integrative physiologist. Using both a deductive and a quantitative analysis, he illustrated that a simple story of an acute shift of K+ into cells was not sufficient to explain the patient's hypokalaemia. The clue he used to suspect a large total body deficit of K+ was a higher than expected rate of K+ excretion on the initial spot urine (higher than expected ratio of K+: creatinine in the urine). This interpretation was supported by the fact that the patient needed a large supplement of K+ to raise his PK to just under 3 mmol/l. It was only after more detailed studies based on urine chemistry that an accurate diagnosis and effective treatment could be instituted. The final question was why one of the hallmarks of the diagnosis of hyperaldosteronism (hypertension) was absent, yet hypokalaemia was so severe.

Original languageEnglish
Pages (from-to)695-704
Number of pages10
JournalQJM
Volume95
Issue number10
Publication statusPublished - Oct 1 2002
Externally publishedYes

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Hypokalemia
Urine
Hyperaldosteronism
Muscle Weakness
Paralysis
Hospital Emergency Service
Lower Extremity
Creatinine
Potassium
Referral and Consultation
Hypertension
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lin, Y. F., Lin, S. H., Tsai, W. S., Davids, M. R., & Halperin, M. L. (2002). Severe hypokalaemia in a Chinese male. QJM, 95(10), 695-704.

Severe hypokalaemia in a Chinese male. / Lin, Y. F.; Lin, S. H.; Tsai, W. S.; Davids, M. R.; Halperin, M. L.

In: QJM, Vol. 95, No. 10, 01.10.2002, p. 695-704.

Research output: Contribution to journalArticle

Lin, YF, Lin, SH, Tsai, WS, Davids, MR & Halperin, ML 2002, 'Severe hypokalaemia in a Chinese male', QJM, vol. 95, no. 10, pp. 695-704.
Lin YF, Lin SH, Tsai WS, Davids MR, Halperin ML. Severe hypokalaemia in a Chinese male. QJM. 2002 Oct 1;95(10):695-704.
Lin, Y. F. ; Lin, S. H. ; Tsai, W. S. ; Davids, M. R. ; Halperin, M. L. / Severe hypokalaemia in a Chinese male. In: QJM. 2002 ; Vol. 95, No. 10. pp. 695-704.
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