Soriano Paolo K, Bhattarai Mukul, Vogler Carrie N, Hudali Tamer H
Department of Internal Medicine, Southern Illinois University, Springfield, IL, USA.
Department of Pharmacy Practice, Southern Illinois University School of Pharmacy, Edwardsville, IL, USA.
Am J Case Rep. 2017 Apr 26;18:454-457. doi: 10.12659/ajcr.903139.
BACKGROUND Trigger-point injection (TPI) therapy is an effective modality for symptomatic treatment of myofascial pain. Serious adverse effects are rarely observed. In this report, we present the case of a 39-year-old man who experienced severe, transient hypokalemic paralysis in the context of TPI therapy with methylprednisolone, bupivacaine, and epinephrine. He was successfully treated with electrolyte replacement in a closely monitored setting. CASE REPORT A 39-year-old man with no past medical history except for chronic left hip pain from a work-related injury received a TPI with methylprednisolone and bupivacaine. The TPI targeted the left iliopsoas tendon and was administered using ultrasound guidance. There were no immediately perceived complications, but within 12 h he presented with severe hypokalemic paralysis with a serum potassium 1.7 mmol/L. Judicious potassium repletion was initiated. Repeated tests after 6 h consistently showed normal potassium levels of 4.5 mmol/L. CONCLUSIONS Severe hypokalemic paralysis in the context of trigger-point injection is an incredibly rare occurrence and this is the first case report in English literature. A high index of clinical suspicion and a systematic approach are therefore required for prompt diagnosis and management of this obscure iatrogenic entity. Clinicians can enhance patient safety by allowing the primary pathology to guide them.
触发点注射（TPI）疗法是治疗肌筋膜疼痛症状的一种有效方式。严重不良反应很少见。在本报告中，我们呈现了一名39岁男性的病例，该患者在接受含有甲泼尼龙、布比卡因和肾上腺素的TPI治疗过程中出现了严重的、短暂性低钾性麻痹。他在密切监测的情况下通过补充电解质成功治愈。病例报告：一名39岁男性，除因工作相关损伤导致慢性左髋疼痛外无既往病史，接受了含有甲泼尼龙和布比卡因的TPI治疗。该TPI针对左髂腰肌肌腱，在超声引导下进行注射。当时未立即察觉到并发症，但在12小时内他出现了严重的低钾性麻痹，血清钾为1.7 mmol/L。开始谨慎补钾。6小时后重复检测结果持续显示正常血钾水平为4.5 mmol/L。结论：触发点注射相关的严重低钾性麻痹极为罕见，这是英文文献中的首例病例报告。因此，对于这种隐匿的医源性疾病实体，需要高度的临床怀疑指数和系统的方法来进行快速诊断和处理。临床医生可通过依据主要病理情况来指导治疗，从而提高患者安全性。
