Table 1 – Emergency Department Workup1

Test Category Results

Vital signs

• BP 162/92 mmHg

• HR 94 BPM

• RR 22 CPM

• Temp 97.9° F (36.6° C)

• SAO2 95%

Affect/demeanor

• Calm/conversational

Respiration

• Mild respiratory distress, shallow

Cardiovascular, pulmonary, gastrointestinal examinations

• Unremarkable

Neurologic examination

• Intact cerebral/cognitive function

• GCS15

• Normal pupillary light reflex

• No nystagmus

Physical findings

• Severe paresis of upper extremities

• 1/5 bilateral motor strength

• Nearly choreiform movement

• Sensory perception and deep-tendon reflexes normal in all extremities

Serum labs

• Na 140 (136–145meq/L)

• K 1.7 (3.5–4.5 meq/L)

• Cl 110 (98–107 meq/L)

• HCO3 20 (22–29 mmol/L)

• Glucose 210 (70–105 mg/dL)

• BUN 20 (8–26 mg/dL)

• S. Crea 1.03 (0.72–1.25 mg/dL)

• Mag 2.1 (1.6–2.6 mg/dL)

• Anion gap 10 (8–16)

• eGFR 106

• TSH 0.61 (0.34–5.6 uIU/mL)

• Venous blood gas

     o pH 7.31 (7.35–7.45)

     o pCO2 38 (15–45 mmhg)

     o HCO3 19 (18–26 mmol/L)

Urine labs

• Osmolality 637 (300–1000 mosmkg)

• pH 6.0 (5.0–7.0)

• Na 131 mmol/L

• K 12 mmol/L

• Cl 176 mmol/L

• U. Crea 66.3 mg/dL

• U.K/U. Crea ratio 0.18 meq/mmol

Electrocardiogram (ECG)

• Sinus arrhythmia

• Flat T-waves

• Small U-waves

• Normal QT interval

Soriano PK, et al. Am J Case Rep. 2017 Apr 26; 18: 454-457

Table 2 – Proposed Mechanisms for the Patient’s Hypokalemic Paralysis1

• Exaggerated response to the epinephrine component of the TPI

• Increased stress of the procedure leading to epinephrine release, which may be negatively correlated with serum potassium, causing post-traumatic hypokalemia

• Adverse drug reaction to methylprednisolone or epinephrine

Soriano PK, et al. Am J Case Rep. 2017 Apr 26; 18: 454-457.