Hypokalaemia with flaccid paralysis following high-voltage electrical injury in an adolescent patient

Bird, Ruth; Naji, Simon Alexander; Vowles, Benjamin; Shaw, Ari; Martin, NA

doi:10.1177/1460408619838927

Cited by 2 publications

(6 citation statements)

References 14 publications

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“…We described a rare case of profound transient hypokalemia and sensory-motor deficits following a lightning strike, contrary to the usual hyperkalemia caused by rhabdomyolysis or tissue necrosis after such injuries [6,15]. Our literature review found three similar cases of hypokalemia following high-voltage electrical injuries [2,10,11], with one specifically involving lightning [2]. These patients showed varying degrees of electrical burns and neurological symptoms like paralysis and extremity weakness.…”

Section: Discussionmentioning

confidence: 97%

“…These patients showed varying degrees of electrical burns and neurological symptoms like paralysis and extremity weakness. The exact cause of hypokalemia remains unclear, but potential factors include significant intracellular potassium shifts and muscle damage from the electrical impact [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Our search results included articles on high-voltage electrical injuries, lightning strike injuries, hypokalemia, hyperkalemia, and other metabolic derangements. We extracted and summarized the key findings and characteristics of the identified studies and cases related to hypokalemia for inclusion in Table 1 [2,10,11]. The first previously documented case details a 17-year-old woman who was struck by lightning while walking [2].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The third report examines a 15-year-old man who came into contact with power lines [10]. In the emergency department, he was hemodynamically stable, with mild upper and severe lower extremity weakness.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The authors concluded that the high-voltage injury likely caused muscle damage, releasing potassium into the bloodstream, which was then rapidly absorbed by healthy cells via stimulated sodium-potassium pumps (Na + /K + -ATPase). They identified three potential mechanisms for this increased Na + /K + -ATPase activity: cholinergic discharge, epinephrine signaling, and CGRP signaling [10,14].…”

Section: Review Of the Literaturementioning

confidence: 99%

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The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature

Baker,

Binda,

Nozari

et al. 2024

JCM

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High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.

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