Betamethasone-induced hypokalemic periodic paralysis in pregnancy.
BACKGROUND
Acute hypokalemic periodic paralysis may be induced by betamethasone injections during pregnancy.


METHODS
A healthy 23-year-old gravid woman at 32 weeks of gestation with preterm premature rupture of membranes received two doses of 12-mg intramuscular betamethasone 24 hours apart to accelerate fetal lung maturation. She developed significant proximal muscle weakness within 16 hours after the initial dose. Her serum potassium was 1.6 mEq/L. Oral and parenteral potassium replacement restored her neuromuscular function over several days. She delivered by repeat cesarean at 34 weeks of gestation without complications for her or the neonate.


CONCLUSIONS
Hypokalemic periodic paralysis, a rare cause of weakness, may be induced by betamethasone injections during pregnancy and is reversible with low-risk interventions.
From the Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; and St. Vincent Health System, Erie, Pennsylvania and the Department of Social Medicine at the University of North Carolina School of Medicine in Chapel Hill, North Carolina.
Corey M
CM
Teagarden
Carla W
CW
Picardo
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000175:diagnosis; D020514:Hypokalemic Periodic Paralysis / Q000139:chemically induced* / Q000175:diagnosis; D007231:Infant, Newborn; D018908:Muscle Weakness / Q000139:chemically induced; D011188:Potassium / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000175:diagnosis; D011256:Pregnancy Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D001623:Betamethasone; D011188:Potassium
Stedwell R, Allen KM, Binder LS. Hypokalemic paralysis: a review of the etiologies, pathophysiology, presentation and therapy. Am J Emerg Med 1992;10:143–8.
Sax TW, Rosenbaum RB. Neuromuscular disorders in pregnancy. Muscle Nerve 2006;34:559–71.
Arzel-Hezode M, McGoey S, Sternberg D, Vicart S, Eymard B, Fontaine B. Glucocorticoids may trigger attacks in several types of periodic paralysis. Neuromuscular Disord 2009;19:217–9.
Appel CC, Myles TD. Caffeine-induced Hypokalemic Paralysis in Pregnancy. Obstet Gynecol 2001;97:805–7.
Damallie KK, Drake JG, Block WA. Hypokalemic periodic paralysis in pregnancy after 1-hour glucose screen. Obstet Gynecol 2000;95:1037.
Richey SD, Wendel GD. Thyrotoxic hypokalemia periodic paralysis following second-trimester prostaglandin-induced abortion. Obstet Gynecol 1993;82:696–8.
Viscomi CM, Ptacek LJ, Dudley D. Anesthetic management of familial hypokalemic periodic paralysis during parturition. Anesth Analg 1999;88:1081–2.
Rajabally YA, El Lahawi M. Hypokalemic periodic paralysis associated with malignant hyperthermia. Muscle Nerve 2002;25:453–5.
Gills MA, DuBe JE, Young WW. Hypokalemic, metabolic alkalosis induced by high-dose ampicillin sodium. Am J Hosp Pharm 1977;34:528–31.