Cisplatin-induced hypokalemic paralysis.
BACKGROUND
Profound hypokalemic conditions resulting from cisplatin therapy have been known to produce hypokalemic paralysis in rare cases. We describe such a case of cisplatin-induced hypokalemic paralysis.


METHODS
A 15-year-old Persian girl with ovarian dysgerminoma presented with severe generalized weakness and paraplegia 1 week after the fourth course of cisplatin-based chemotherapy. On physical examination, there was symmetric flaccid paralysis and areflexia in all of the extremities and particularly in the lower limbs. Her serum potassium concentration was 1.7 mmol/L. Metastatic disease was excluded by a comprehensive systemic evaluation. Complete clinical and paraclinical recovery was achieved after short-term administration of potassium supplement.


CONCLUSIONS
Adverse drug reactions are common with cisplatin, but the drug is only rarely associated with hypokalemic paralysis. Based on the Naranjo causality algorithm, an objective assessment revealed cisplatin to be a probable cause of hypokalemic paralysis in this case. This adverse drug event--whether isolated or secondary to hypomagnesemia--may be deceptive, leading to a fatal mistake in the oncology setting, and should therefore be precisely differentiated from cancer-related complications.


CONCLUSIONS
This case suggests that cisplatin should be added to the list of agents causing hypokalemic paralysis. Regular serum electrolyte measurement, the early detection of cation deficiency, and appropriate replacement of cations are all recommended.
Mohammadianpanah
Mohammad
M
Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Iran. mohpanah@sums.ac.ir
Omidvari
Shapour
S
Mosalaei
Ahmad
A
Ahmadloo
Niloofar
N
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D002945:Cisplatin / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004407:Dysgerminoma / Q000188:drug therapy; D005260:Female; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy; D011188:Potassium / Q000008:administration & dosage
D000970:Antineoplastic Agents; D002945:Cisplatin; D011188:Potassium