title: Lazy lips: hyperkalemia and acute tetraparesis-a case report from an urban emergency department.
abstract: A 58-year-old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II-XII intact, muscle strength of the lower extremities was 4/5, and a minimal sensory loss of the left hemisphere was found. In addition, the patient complained about lazy lips. During ongoing examinations, the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient's neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Braun
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: David S
authors.initials: DS
authors.lastname: Srivastava
authors.affiliation: Department of Surgery, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Bianca Maria
authors.initials: BM
authors.lastname: Engelhardt
authors.affiliation: Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Baumgartner Höhe 1, 1140 Vienna, Austria.
authors.forename: Gregor
authors.identifier: 0000-0001-5551-8227
authors.initials: G
authors.lastname: Lindner
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos