title: [A woman with pareses of the arms and legs].
abstract: BACKGROUND
  Hypokalemic pareses are caused by low extracellular potassium levels which reduce the resting membrane potential of muscle cells and make them less excitable. It may be caused by an intracellular shift of potassium, renal potassium loss, reduced potassium intake or increased gastrointestinal loss.
  
  
  METHODS
  A woman in her 60s presented with rapid-onset tetraparesis and hyporeflexia starting the day before admission. The patient history revealed several months of low food intake, increased alcohol consumption and diarrhoea. Laboratory tests showed severe hypokalemia (1.5 mmol/l) and hypomagnesemia (0.38 mmol/l), and ECG showed atrial fibrillation. She was admitted to the medical intensive care unit and treated with intravenous normal saline with added potassium and magnesium, with good effect on her symptoms. Urine tests showed high potassium-creatinine ratio (4.22 mmol/mmol creatinine) and increased fractional excretion of magnesium (18.6%). Abdominal CT scan revealed colonic wall thickening, and colonic biopsies showed mild inflammation. Faecal calprotectin was moderately elevated (294 mg/kg).
  
  
  CONCLUSIONS
  The patient had hypokalemic pareses for which there were several contributing factors. The renal causes were augmented excretion of magnesium and potassium, probably due to increased alcohol consumption. The extrarenal causes were increased gastrointestinal loss, with ulcerative colitis being the presumed explanation, and reduced food intake.
authors.affiliation: Nevrologisk avdeling Haukeland universitetssykehus.
authors.forename: Sander Johan
authors.initials: SJ
authors.lastname: Aarli
authors.affiliation: Gastroenterologisk seksjon Medisinsk avdeling Haukeland universitetssykehus.
authors.forename: Tarek Ramzi Elia
authors.initials: TR
authors.lastname: Mazzawi
authors.affiliation: Nevrologisk avdeling Haukeland universitetssykehus.
authors.forename: Geir Olve
authors.initials: GO
authors.lastname: Skeie
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011782:Quadriplegia / Q000209:etiology*