Severe hypokalemia mimicking Guillain-Barré Syndrome in 42-years-old Ethiopian patient: case report

Abstract

Acute neuromuscular paralysis is one of the common neurological emergencies, of which Guillain Barre Syndrome (GBS) remains the most common cause. This syndrome presents with acute ascending muscle weakness and loss of deep tendon reflexes (DTR), often preceded by distal paresthesia and back pain. However, a severe hypokalemia may have a similar presentation and put the treating physician in dilemma.

We report a 42-year-old previously healthy man, who presented with acute areflexic ascending quadriparesis associated with impending respiratory failure. This followed a one day history of frequent diarrhea, vomiting and low grade fever. A provisional diagnosis of GBS was given by the treating physician and the patient was intubated for ventilatory support. A few hours later the serum potassium and magnesium were reported to be very low, so the patient was given parenteral potassium chloride (KCl), later supplemented with magnesium. Following KCl infusion, the patient’s neurologic and respiratory conditions improved dramatically and he was extubated .Despite continued KCL infusion; however, the patient suddenly sustained cardiac arrest and expired, which is attributable to multiple electrolyte disturbance especially low potassium and low magnesium, it’s important to bear in mind that in 5% of the cases GBS is associated with autonomic dysfunction.

Even though severe hypokalemia related muscle weakness reported rarely, it is a potentially treatable and correctable cause of neuromuscular weakness. Therefore treating physician should have this in mind whenever faced with such acute areflexic ascending weakness associated with hypokalemia, especially in resource limited setup like Ethiopia, where it’s difficult to have comprehensive emergency work up for such patients to differentiate possible causes of acute generalized weakness.

Keywords: Cardiac arrest, Guillain-Barre syndrome, Hypokalemia, Hypomagnesemia