Coughlin Paige, Patel Goonja, Vadaketh Jessica, Pandit Ramesh
Medicine, Drexel University College of Medicine, Philadelphia, USA.
Medicine, Crozer Chester Medical Center, Upland, USA.
Cureus. 2022 Apr 4;14(4):e23817. doi: 10.7759/cureus.23817. eCollection 2022 Apr.
Levetiracetam is a Food and Drug Administration (FDA)-approved drug for partial, generalized, and myoclonic seizures. Its mechanism of action as an antiepileptic involves the release of neurotransmitters from synaptic vesicles. The common side effects of levetiracetam include sleepiness, weakness, dizziness, and infection. We present a case of levetiracetam-induced hypokalemia, which was refractory to multiple repletion attempts. A 73-year-old woman with a history of seizures, heart failure, and previous stroke was admitted to the hospital due to witnessed seizure-like activity as a result of medication non-compliance. Her serum potassium prior to the start of antiepileptic medication was 4.5 mmol/L. She was restarted on her home dose of levetiracetam 1000 mg twice daily. Twenty-four hours after starting levetiracetam, the patient was found to have hypokalemia, and the patient's potassium levels failed to correct, dropping as low as 2.0 mmol/L despite continued repletion and normalized magnesium levels. A decision was made to switch the levetiracetam to lacosamide. Thirty-six hours after this change was made, the patient's potassium level corrected to 3.3 mmol/L and then corrected to 3.9 mmol/L five days later without requiring further repletion. Based on her clinical course, a diagnosis of levetiracetam-induced refractory hypokalemia was made. She was discharged home on lacosamide as her new antiepileptic medication, along with a close follow-up with neurology. Our case highlights the importance of considering Levetiracetam as a cause of refractory hypokalemia. Cases of levetiracetam-induced hypokalemia and hypomagnesemia are rarely reported in the literature, and those that have been reported vary greatly in onset and the resolution of electrolyte derangements. Given that levetiracetam is a widely used antiepileptic medication, we suggest that in cases of refractory hypokalemia, a change in antiepileptic medication should be considered.
左乙拉西坦是一种经美国食品药品监督管理局（FDA）批准用于治疗部分性、全身性和肌阵挛性癫痫发作的药物。其作为抗癫痫药物的作用机制涉及神经递质从突触小泡的释放。左乙拉西坦的常见副作用包括嗜睡、虚弱、头晕和感染。我们报告一例左乙拉西坦诱发的低钾血症病例，多次补钾尝试均无效。一名73岁女性，有癫痫发作、心力衰竭和既往中风病史，因未遵医嘱服药出现类似癫痫发作的活动而入院。在开始使用抗癫痫药物之前，她的血清钾为4.5 mmol/L。她重新开始服用家中剂量的左乙拉西坦，每日两次，每次1000 mg。开始服用左乙拉西坦24小时后，发现患者出现低钾血症，尽管持续补钾且镁水平正常，但患者的钾水平仍未纠正，降至低至2.0 mmol/L。决定将左乙拉西坦换为拉科酰胺。更换药物36小时后，患者的钾水平纠正至3.3 mmol/L，五天后进一步纠正至3.9 mmol/L，无需进一步补钾。根据她的临床病程，诊断为左乙拉西坦诱发的难治性低钾血症。她出院时服用拉科酰胺作为新的抗癫痫药物，并由神经科密切随访。我们的病例强调了考虑左乙拉西坦作为难治性低钾血症病因的重要性。左乙拉西坦诱发低钾血症和低镁血症的病例在文献中很少报道，已报道的病例在电解质紊乱的发作和缓解方面差异很大。鉴于左乙拉西坦是一种广泛使用的抗癫痫药物，我们建议在难治性低钾血症的病例中，应考虑更换抗癫痫药物。
