Transient Hypokalemic Quadriplegia After a Lumbar Transforaminal Epidural Dexamethasone Injection: A Case Report

Sohi, Maryam Tahmasbi; Sullivan, William J.; Anderson, Dustin

doi:10.1016/j.pmrj.2017.10.003

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…This case was similar to ours regarding gender, the latency of symptom development, and patient management [17]. What distinguishes the case presented in this report from the case reported by Tahmasbi Sohi et al is the absence of thyrotoxicosis, with the hypokalemia in their case solely attributed to the direct effects of the steroids and hyperglycemia [17]. In the case reported by Tahmasbi Sohi et al, epidural steroid injection was performed with dexamethasone [17].…”

Section: Discussionsupporting

confidence: 81%

“…Although rare, hypokalemia with paralysis has been reported after epidural steroid injection [17]. Recently, Tahmasbi Sohi et al reported a case of a 30-year-old man who developed hypokalemia, hyperglycemia with quadriplegia 4 hours after intrathecal steroid injection [17]. This case was similar to ours regarding gender, the latency of symptom development, and patient management [17].…”

Section: Discussionsupporting

confidence: 74%

“…Systemic effects of steroids after epidural steroid injections are not uncommon and can have significant effects on metabolism [14–16]. Although rare, hypokalemia with paralysis has been reported after epidural steroid injection [17]. Recently, Tahmasbi Sohi et al reported a case of a 30-year-old man who developed hypokalemia, hyperglycemia with quadriplegia 4 hours after intrathecal steroid injection [17].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Tahmasbi Sohi et al reported a case of a 30-year-old man who developed hypokalemia, hyperglycemia with quadriplegia 4 hours after intrathecal steroid injection [17]. This case was similar to ours regarding gender, the latency of symptom development, and patient management [17]. What distinguishes the case presented in this report from the case reported by Tahmasbi Sohi et al is the absence of thyrotoxicosis, with the hypokalemia in their case solely attributed to the direct effects of the steroids and hyperglycemia [17].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

2018

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Patient: Male, 36Final Diagnosis: Epidural steroid induced thyrotoxic periodic paralysisSymptoms: ParalysisMedication: —Clinical Procedure: Epidural steroid injectionSpecialty: Endorinology and MetabolicObjective:Rare diseaseBackground:Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases.Case Report:A 36-year-old Asian man presented to the emergency department with sudden onset of paralysis of all his limbs following epidural steroid injection for traumatic low back pain. At presentation, he was found to have severe hypokalemia of 1.8 mEq/L. Further investigations led to the diagnosis of hyperthyroidism and Graves’ disease. In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected. He had a rapid recovery and an early discharge from hospital.Conclusions:Although several factors can lead to paralysis after an epidural steroid injection, TPP should be considered in the differential diagnosis, especially in individuals who have predisposing factors of ethnicity and gender. If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed. In the management of patients with TPP, care should be taken when correcting potassium levels.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

2018

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“…This might also be the reason for the better results we obtained in the ILESI group compared to the TFESI group. In addition, taking into consideration the easier application of ILESI from the point of the methodological view, and life-threatening complications reported for TFESI, we believe ILESI is a better therapeutic alternative in LCSS patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminarversusbilateral transforaminal approach

et al. 2020

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Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.

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Hypokalemic paralysis following intramuscular betamethasone injection: A case report and review of literature

Ebrahimi,

Taheri,

Mousavinejad

et al. 2024

Clinical Case Reports

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Key Clinical MessageAcute neuromuscular paralysis is a relatively common condition in emergency rooms (ERs). They can be caused by several reasons, including adverse drug reactions. Betamethasone is a glucocorticoid commonly used for various conditions, such as allergic conditions. One of the rare but known side effects of glucocorticoids is hypokalemia. Rare cases of hypokalemia following high‐ and low‐dose glucocorticoid injections have been reported. This study presents the history of a young, healthy male without significant past medical history who presented with an inability to stand and walk due to four‐limb paralysis (more prominent in the lower limbs) following an intramuscular injection of a 4 mg betamethasone, which was prescribed for the treatment of allergic rhinitis. The patient was stabilized with an intravascular injection of potassium chloride diluted in 1000 mL of normal saline and monitored for 24 h, ruling out any other endocrine condition. Hypokalemia and its severe form are defined as the serum level of lower than 3.5 and 2.5 mEq/Lit, respectively. One of the etiologies of drug‐induced hypokalemic paralysis is systemic glucocorticoid administration. In severe cases, it can cause quadriplegia and other neuromuscular, respiratory, and cardiac complications. Therefore, it is an urgent condition that should be managed carefully. Pregnant women who are receiving these medications are a specific group at risk of hypokalemic paralysis. There are several safer treatments for seasonal allergic rhinitis compared to systemic glucocorticoids, which should be considered by physicians. Moreover, paralysis in patients receiving these medications should be approached attentively since it might be caused by hypokalemia, which can be life threatening if not treated. It is advisable that the blood level of electrolytes, especially potassium, be checked for patients who present with paralysis or weakness after glucocorticoid injections.

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Transient Hypokalemic Quadriplegia After a Lumbar Transforaminal Epidural Dexamethasone Injection: A Case Report

Abstract: IV.

Cited by 4 publications

References 9 publications

A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

A Rare Case of Thyrotoxic Periodic Paralysis After Epidural Steroid Injection: A Case Report and Literature Review

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminarversusbilateral transforaminal approach

Hypokalemic paralysis following intramuscular betamethasone injection: A case report and review of literature

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