Fainardi Valentina, Cabassi Aderville, Carano Nicola, Rocco Rossana, Fiaccadori Enrico, Regolisti Giuseppe, Dodi Icilio, Del Rossi Carmine
University of Parma.
Acta Biomed. 2014 Aug 20;85(2):167-70.
Background Severe hypokalemia, defined as serum potassium < 2.5 mEq/L, may lead to neuromuscular, gastrointestinal, and ECG abnormalities. Neuromuscular consequences of hypokalemia include weakness, cramps, rarely paralysis, eventually progressing to rhabdomyolysis. Case presentation We report a case of a 4-year-old girl presenting carpopedal spasm and rhabdomyolysis due to severe hypokalemia associated to hypophosphatemia and hypovolemia. At one month of age she underwent an ileal resection because of a neonatal necrotizing enterocolitis, and a bowel resection at two years of age, because of sub-occlusive episodes. The child had frequent episodes of diarrhoea and was treated with oral white clay (kaolin) and a restrictive diet. Three days prior the admission to the hospital she had numerous episodes of watery diarrhoea. Laboratory tests revealed severe hypokalemia, hypophosphatemia, normal calcium levels associated with marked dehydration. An ECG demonstrated sinus bradycardia, ST-segment depression, T-wave flattening, U-wave, and long-QTc. Symmetric carpal and pedal spasms were observed. A marked rise of creatinine phosphokinase and myoglobin associated to cola colored urine was observed. Intravenous supplementation of potassium phosphate as well as adequate volume repletion led to an improvement of the clinical condition, to the disappearance of carpal and pedal spasms, to normalisation of ECG. Conclusions Careful electrolytes and volume supplementation led to the correction of potential life-threatening arrhythmias and obtained a complete recovery from carpopedal spasm and rhabdomyolysis. Dietary restriction and pharmacological preparations as kaolin have to be administered with caution to treat diarrhea in children and particularly in those who may present other pre-existing risk factors.
背景 严重低钾血症定义为血清钾＜2.5 mEq/L，可导致神经肌肉、胃肠道及心电图异常。低钾血症的神经肌肉后果包括无力、痉挛，极少出现麻痹，最终发展为横纹肌溶解。病例报告 我们报告一例4岁女孩，因严重低钾血症合并低磷血症和低血容量出现手足痉挛和横纹肌溶解。1月龄时因新生儿坏死性小肠结肠炎行回肠切除术，2岁时因亚闭塞发作行肠切除术。该患儿频繁腹泻，接受口服白陶土（高岭土）和限制性饮食治疗。入院前3天，她出现多次水样腹泻。实验室检查显示严重低钾血症、低磷血症，血钙水平正常，伴有明显脱水。心电图显示窦性心动过缓、ST段压低、T波低平、U波和QTc延长。观察到对称性手足痉挛。观察到肌酐磷酸激酶和肌红蛋白显著升高，尿液呈可乐色。静脉补充磷酸钾以及充足的容量补充使临床状况得到改善，手足痉挛消失，心电图恢复正常。结论 仔细补充电解质和容量可纠正潜在的危及生命的心律失常，使手足痉挛和横纹肌溶解完全恢复。饮食限制和白陶土等药物制剂在治疗儿童腹泻时，尤其是对那些可能存在其他既往危险因素的儿童，必须谨慎使用。
