Tran Kelvin Mh, Hinther Kelsey, Bueti Joe, Karpinski Martin, Hingwala Jay
Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Can J Kidney Health Dis. 2019 Aug 27;6:2054358119871594. doi: 10.1177/2054358119871594. eCollection 2019.
Hypokalemia is a common finding. Typically asymptomatic presentations of neuromuscular weakness emerge at levels below 2.5 mmol/L. Causes include gastrointestinal losses, renal losses, or intracellular shift, with gastrointestinal losses and diuretics accounting for the majority. Although the cause is often apparent on clinical assessment, a systematic approach incorporating urine biochemistry can aid in narrowing the differential in obscure cases.
We describe a case of a previously healthy 27-year-old man who presented with acute ascending paralysis, with an associated severe hypokalemia and metabolic acidosis. There were no apparent causes on clinical assessment.
Based on analysis of urine biochemistry, we concluded that a pathologic kaluresis was present, and given his acidemia and transient pathology, we diagnosed the patient with hypokalemic paralysis secondary to toluene toxicity.
We provided supportive care and electrolyte repletion for our patient; no specific therapies for toluene were required. Our patient was counseled regarding appropriate protective measures when handling toluene.
Complete neurologic recovery and biochemical normalization occurred within 48 hours of presentation with supportive care. He continued to use proper precautions when handling toluene, and experienced no symptom relapse, or further abnormalities on both blood and urine chemistry.
Using this case, we review an algorithmic approach incorporating urine biochemistries to aid in the workup of hypokalemia. We review toluene as a toxicologic entity and highlight its role as a cause of hypokalemia.
低钾血症是一种常见的表现。通常，当血钾水平低于2.5mmol/L时会出现无症状的神经肌肉无力表现。病因包括胃肠道丢失、肾脏丢失或细胞内转移，其中胃肠道丢失和利尿剂是主要原因。虽然病因在临床评估中通常很明显，但结合尿液生化检查的系统方法有助于在疑难病例中缩小鉴别诊断范围。
我们描述了一例先前健康的27岁男性患者，他出现急性上行性麻痹，并伴有严重低钾血症和代谢性酸中毒。临床评估未发现明显病因。
根据尿液生化分析，我们得出存在病理性尿钾增多的结论，鉴于他的酸血症和短暂性病变，我们诊断该患者为甲苯中毒继发低钾性麻痹。
我们为患者提供了支持性护理和电解质补充；无需针对甲苯的特异性治疗。我们为患者提供了关于处理甲苯时适当保护措施的咨询。
在给予支持性护理后，患者在就诊后48小时内实现了完全神经功能恢复和生化指标正常化。他在处理甲苯时继续采取适当的预防措施，未出现症状复发，血液和尿液化学检查也未发现进一步异常。
通过这个病例，我们回顾了一种结合尿液生化检查的算法方法，以帮助对低钾血症进行检查。我们回顾了甲苯作为一种毒理学实体，并强调了它作为低钾血症病因的作用。
