title: Acute hypokalemic periodic paralysis possibly precipitated by albuterol.
abstract: OBJECTIVE
  An episode of acute hypokalemic paralysis associated with the use of inhaled albuterol is described.
  
  
  CONCLUSIONS
  A 34-year-old woman admitted to the emergency department reported the development of pain and diffuse paralysis of the extremities and torso shortly after using an albuterol inhaler. At age 18, she had been diagnosed with hyokalemic periodic paralysis (HPP), a disorder of muscle membrane excitability caused by serum potassium depletion that can lead to life-threatening neuromuscular and cardiovascular complications. After a 15-year period of episodically recurring HPP symptoms despite long-term acetazolamide use, she was switched to spironolactone therapy and had experienced no HPP exacerbations for about 1 year. On her arrival in the emergency department, the patient's serum potassium concentration was 1.8 meq/L and she was mildly tachycardic (heart rate of 125 beats/min). After careful supplementation to gradually increase the serum potassium concentration to 5.4 meq/L, the patient slowly regained movement and strength in her extremities. Application of the adverse drug reaction probability scale of Naranjo et al. to this case yielded a score of 3, indicating that albuterol was possibly the cause of the patient's HPP exacerbation. Beta-2-adrenergic agonists and several other medications can affect serum potassium levels; although the potential risks posed by the use of such drugs in patients with a history of HPP are unclear, cautious use in the context of known HPP is advised.
  
  
  CONCLUSIONS
  A patient previously diagnosed with HPP experienced an exacerbation of HPP possibly induced by inhaled albuterol treatment.
authors.affiliation: Critical Care, St. Vincent's Medical Center, Jacksonville, FL, USA. calvin.tucker@jaxhealth.com
authors.forename: Calvin
authors.initials: C
authors.lastname: Tucker
authors.forename: Lyn
authors.initials: L
authors.lastname: Villanueva
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000208:Acute Disease; D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects*; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000139:chemically induced* / Q000188:drug therapy; D009330:Nebulizers and Vaporizers; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D011188:Potassium / Q000097:blood; D013610:Tachycardia / Q000139:chemically induced
chemical_list: D000318:Adrenergic beta-Agonists; D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide; D000420:Albuterol; D011188:Potassium