Methylprednisolone
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Hypokalaemic paralysis: case report A 42-year-old man developed hypokalaemic paralysis following a single dose of methylprednisolone for Graves’ ophthalmopathy. The man, who had recently been diagnosed with Graves’ ophthalmopathy and thyrotoxicosis, started treatment with thiamazole [methimazole] and atenolol. He was admitted 2 days later for IV glucocorticoid pulse therapy with methylprednisolone, 1g in 500mL of normal sodium chloride over 3 hours. Twelve hours later, he developed progressive flaccid paralysis and diminished tendon reflexes in his lower limbs. Laboratory analysis revealed serum potassium and creatine kinase levels of 2.6 mEq/L and 495 IU/L, respectively. At this time, his plasma glucose level was 196 mg/dL. The man made a full recovery following correction of his hypokalaemia with IV potassium administration. One month later, when the man was considered euthyroid, he was readmitted for a second dose of IV glucocorticoids. His serum potassium level was 4.96 mmol/L. The same dose of methylprednisolone (1g) was administered, which he tolerated well without any weakness. His serum potassium level remained normal 12 hours after steroid administration. Author comment: "It is plausible that glucocorticoid administration in the thyrotoxic phase triggered the development of [thyrotoxic hypokalaemic periodic paralysis] in this case." Tigas S, et al. Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves’ thyrotoxicosis and ophthalmopathy. 803068392 Hormones 10: 313-316, No. 4, Oct-Dec 2011 - Greece
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Reactions 24 Mar 2012 No. 1394
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