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Kidney Week

Abstract: FR-PO582

Loquat Induced Severe Hyperkalemia Presenting as Secondary Hyperkalemic Paralysis and Cardiac Conduction Abnormalities

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rashid, Raja Muhammad, CPSP, Islamabad, Pakistan
  • Nabi, Zahid, KRL Hospital, Islamabad, Pakistan
Introduction

Severe hyperkalemia is attributed to 3-5% deaths and a quarter of emergency dialysis sessions in ESRD patients. It generally manifests as cardiac abnormalities and rarely as secondary hyperkalemic paralysis. Missed dialysis sessions and dietary indiscretions to known potassium rich food are common causes. Loquat (Nispero, Eriobotrya japonica) is an often overlooked fruit for having moderate to high potassium content (266mg/100gram) that caused life threatening hyperkalemia in our patient.

Case Description

27 year old male with ESRD secondary to diabetic nephropathy on thrice weekly maintenance hemodialysis for past 1.5 years presented in ER with restlessness, feeling of unease and weakness in limbs and inability to walk. There was no history of current or preceding fever and any such episode in the past. Examination revealed an alert yet restless individual, afebrile with pulse of 62 bpm and blood pressure of 90/60mmhg, flaccid paraparesis, hypotonia and diminished reflexes. His immediate EKG is shown in Fig. 1. Calcium gluconate was infused, transcelluar shifting measures were instituted and dialysis session of 4 hours was carried out within 30 minutes of presentation with constant cardiac monitoring. EKG changes necessitated repetition of calcium gluconate, thrice over an hour, changing serum calcium from 8.8 mg/dl pre-dialysis to 9.4mg/dl afterwards. Non hemolized and repeated samples confirmed pre dialysis serum potassium of 9.6mmol/L and post dialysis concentration of 5.2mmol/L. His symptoms improved after 80 mins of dialytic therapy. Patient was not on Beta blockers, ACE inhibitors or NSAIDs. The family and patient denied taking any unusual substance except for repeated large servings of loquat since his last dialysis session.

Discussion

Context specific and dietary education curtailing multicultural cuisines can prevent potassium catastrophes. In the ER, secondary hyperkalemic paralysis should be considered in differentials of acute paralysis. IV Calcium for myocardial stability is to be repeated judiciously unless pressing EKG changes vanish. Unambiguous EKG changes in pertinent clinical setting are sufficient in dialysis population to warrant urgent hemodialysis administration.