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26 April 2017 : Case report  USA

A Case of Trigger-Point Injection-Induced Hypokalemic Paralysis

Unknown etiology, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Educational Purpose (only if useful for a systematic review or synthesis)

Paolo K. Soriano1ABCDEFG, Mukul Bhattarai1ABCDFG, Carrie N. Vogler2CDF, Tamer H. Hudali1ABCDEFG*

DOI: 10.12659/AJCR.903139

Am J Case Rep 2017; 18:454-457

Abstract

BACKGROUND: Trigger-point injection (TPI) therapy is an effective modality for symptomatic treatment of myofascial pain. Serious adverse effects are rarely observed. In this report, we present the case of a 39-year-old man who experienced severe, transient hypokalemic paralysis in the context of TPI therapy with methylprednisolone, bupivacaine, and epinephrine. He was successfully treated with electrolyte replacement in a closely monitored setting.

CASE REPORT: A 39-year-old man with no past medical history except for chronic left hip pain from a work-related injury received a TPI with methylprednisolone and bupivacaine. The TPI targeted the left iliopsoas tendon and was administered using ultrasound guidance. There were no immediately perceived complications, but within 12 h he presented with severe hypokalemic paralysis with a serum potassium 1.7 mmol/L. Judicious potassium repletion was initiated. Repeated tests after 6 h consistently showed normal potassium levels of 4.5 mmol/L.

CONCLUSIONS: Severe hypokalemic paralysis in the context of trigger-point injection is an incredibly rare occurrence and this is the first case report in English literature. A high index of clinical suspicion and a systematic approach are therefore required for prompt diagnosis and management of this obscure iatrogenic entity. Clinicians can enhance patient safety by allowing the primary pathology to guide them.

Keywords: Hypokalemia, Hypokalemic Periodic Paralysis, trigger points

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923