Qian Kun, Cao Song, Liu Xing-Kui
Department of Anesthesiology The Affiliated Hospital of Zunyi Medical University Zunyi Guizhou China.
Department of Pain The Affiliated Hospital of Zunyi Medical University Zunyi Guizhou China.
Ibrain. 2021 Jun 28;7(2):113-118. doi: 10.1002/j.2769-2795.2021.tb00073.x. eCollection 2021 Jun.
Disorders of consciousness (DOC) are neurocognitive disorders related to sharp fluctuations of attention and consciousness, while DOC is characterized by significant interindividual differences, rapid development, and a higher lethal rate.
A 53-year-old female patient underwent general anesthesia with tracheal intubation in otoendoscopic tympanoplasty. The patient suddenly appeared moderate DOC after tracheal tube removal with K 3.6 (3.5-5.3 mmol/L). Based on the ancillary testing and routine laboratory workup, the possible causes of DOC, such as general anesthesia drugs and cardio cerebral events, were temporarily excluded. DOC was reversed by intravenous administration of KCl 1 g, with K 3.78 mmol/L. On one day after surgery, the patient occurred suddenly DOC again after intravenous guttae of 5% glucose 1000 ml, K 3.87 mmol/L, possibly because of her recurrent hypokalemic paralysis (HP) of past medical history. The patient's consciousness gradually improved after effective KCl supplementation therapy.
DOC caused by periodic paralysis (PP) has not been reported, we speculate that hypoactive DOC is closely correlated with normokalemic periodic paralysis (NormoPP) in this case.
意识障碍（DOC）是与注意力和意识急剧波动相关的神经认知障碍，而DOC具有个体差异大、发展迅速和致死率较高的特点。
一名53岁女性患者在耳内镜下鼓膜成形术时接受气管插管全身麻醉。拔除气管导管后患者血钾为3.6（3.5 - 5.3毫摩尔/升），突然出现中度DOC。基于辅助检查和常规实验室检查，暂时排除了DOC的可能原因，如全身麻醉药物和心脑血管事件。静脉注射1克氯化钾后血钾升至3.78毫摩尔/升，DOC得到逆转。术后一天，患者静脉滴注1000毫升5%葡萄糖后血钾为3.87毫摩尔/升，再次突然出现DOC，可能是由于其既往有复发性低钾性麻痹（HP）病史。有效补充氯化钾治疗后患者意识逐渐改善。
周期性瘫痪（PP）导致的DOC尚未见报道，我们推测本例中反应迟钝的DOC与正常血钾性周期性瘫痪（NormoPP）密切相关。
