Severe hypokalemia with cardiac arrest as an unusual manifestation of alcoholism

Abstract

Introduction: Unhealthy use of alcohol can be associated with serious adverse events. Patients with alcoholism and malnutrition are at high risk for electrolyte disturbances, commonly hypokalemia. Here in we describe a case of alcohol use disorder presented with weakness and subsequently developed cardiac arrest secondary to severe hypokalemia.Case description: A 51-year-old lady presented to our emergency department because of generalized body ache and marked weakness in both lower extremities for two days duration. She had a long-term history of alcoholism, consuming two to three pints of vodka every day for about 20 years. Her last drink of alcohol was about 48 hours prior to presentation. Her examination revealed bilateral lower limb weakness of 4/5, with intact sensory system and reflexes. Biochemical analysis of the serum showed severe electrolytes disturbance, a potassium level of 2.3 mmol/L (reference 3.6−5.1 mmol/L). Electrocardiogram (ECG) showed no arrhythmias, but changes characteristic of hypokalemia with marked corrected QT segment prolongation (QTc 551ms). Aggressive supplementation of electrolytes was initiated, however, potassium level failed to increase and subsequently she had a sinus bradycardia followed by cardiac arrest. Cardiopulmonary resuscitation was initiated, return of spontaneous circulation was obtained. During the following days, potassium supplementation was continued to achieve normal plasma potassium level. She was then discharged from the hospital with recommendations for abstinence from alcohol.Conclusion: Patients with chronic alcohol-use can have serious electrolyte disturbances including hypokalemia which can have life-threatening consequences. Prolonged potassium supplementation over several days is required to achieve normal level of plasma potassium and replenish total-body potassium deficit.

Hypokalemia-Induced Arrhythmia: A Case Series and Literature Review

“…The 2000 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend that in patients with hypokalemia-induced malignant ventricular arrhythmia or cardiac arrest, an empirical intravenous injection of 2 mmol of potassium should be administered in the first one minute, followed by an intravenous infusion of 10 mmol of potassium over five to 10 minutes [ 13 ]. The maximum potassium supplement dose is as high as 480 mmol/24 h, and in patients with underlying heart block or renal insufficiency, it is up to 120 mmol/24 h [ 2 ]. In 2019, Du et al conducted an experiment in animal models that showed that the strategy of tailored rapid potassium supplementation is a safe and efficient option for reversing life-threatening arrhythmia due to severe hypokalemia.…”

“…The patient might still be experiencing depletion of intracellular potassium. Therefore, to ensure that a stable potassium level is achieved, monitoring signs and symptoms of recurrent hypokalemia, ECG, and the serum potassium level for 24 h are recommended [ 2 ].…”

“…Thus, a mild decrease in serum potassium level can be associated with significantly depleted total body potassium pool. A reduction in serum potassium level of approximately 0.3 mmol/L corresponds to a 100 mmol deficit in the total body potassium pool [ 2 ]. Potassium (K+) is the major cation in the intracellular fluid and plays a central role in maintaining cell membrane excitability.…”