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Clinical syndrome of potassium intoxication

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      Abstract

      Potassium intoxication in man results in widespread impairment of neuromuscular function. Potassium produces a characteristic sequence of electrocardiographic changes, impaired contraction of the heart recognizable by auscultation, and final arrest of the heart in diastole. Flaccid paralysis may also be present, involving the extremities and to a lesser degree the trunk but sparing the cranial nerves for the most part.
      Two cases with elevation of serum potassium manifesting this clinical syndrome are described. Following administration of sodium chloride, both paralysis and electrocardiographic changes reverted toward normal.
      The genesis of potassium intoxication, the typical sequence of electrocardiographic changes, the nature of the paralysis and the therapeutic approach are discussed.
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      References

        • Ringer Sidney
        A further contribution regarding the influence of the deficient constituents of the blood on the concentration of the heart.
        J. Physiol. 1883; 4: 29-42
        • Kuhlmann D.
        • Ragan C.
        • Ferrebee J.W.
        • Atchley D.W.
        • Loeb R.F.
        Toxic effects of desoxycorticosterone esters in dogs.
        Science. 1939; 90: 496-497
        • Finch C.A.
        • Marchand J.F.
        Cardiac arrest by the action of potassium.
        Am. J. M. Sc. 1943; 206: 507-520
        • Marchand J.F.
        • Finch C.A.
        Fatal spontaneous potassium intoxication in patients with uremia.
        Arch. Int. Med. 1944; 73: 384-390
        • Dameshek W.
        • Singer K.
        Familial nonhemolytic jaundice; constitutional hepatic dysfunction with indirect van den Bergh reaction.
        Arch. Int. Med. 1941; 67: 259-285
        • Comfort M.W.
        Constitutional hepatic dysfunction.
        M. Clin. North America. 1945; 29: 282-289
        • Curry J.J.
        • Greenwalt T.J.
        • Russell J.T.
        Familial nonhemolytic jaundice. Report of a case with liver biopsy.
        New England J. Med. 1942; 226: 909-912
        • Mogena H.G.
        The clinical significance of hyperbilirubinemia.
        Lancet. 1929; 1: 1187-1189
        • Junkman K.
        Perorale Cholecystographie mit Biliselectan.
        Klin. Wchnschr. 1941; 20: 125-128
        • Modell W.
        Pharmacology of β (3,5 di-iodo-4-hydroxyphenyl) α phenyl propionic acid.
        J. Lab. & Clin. Med. 1942; 27: 1376-1384
        • Muntioeyler E.
        • Mellors R.C.
        • Mantz F.R.
        • Magnum G.H.
        Electrolyte and water equilibria in the dog. 2. Electrolyte and water exchange between skeletal muscle and blood in adrenal insufficiency.
        J. Biol. Chem. 1940; 134: 367-387
        • Thorn G.W.
        • Koepf G.F.
        • Clinton Jr., M.
        Renal failure simulating adrenocortical insufficiency.
        New England J. Med. 1944; 226: 76-85
        • Fenn W.O.
        The role of potassium in physiological processes.
        Physiol. Rev. 1940; 20: 377-415
        • Keith N.M.
        • King H.E.
        • Osterberg A.E.
        Serum concentration and renal clearance of potassium in severe renal insufficiency in man.
        Arch. Int. Med. 1943; 71 (1943): 675-701
        • Winkler A.W.
        • Hoff H.E.
        • Smith P.K.
        The toxicity of orally administered potassium salts in renal insufficiency.
        J. Clin. Investigation. 1941; 20: 119-126
        • Atchley D.W.
        • Loeb R.F.
        • Benedict E.M.
        • Palmer W.W.
        Physical and chemical studies of human blood serum. II. A study of twenty-nine cases of nephritis.
        Arch. Int. Med. 1923; 31: 611-615
        • Greene C.H.
        • Wakefield E.G.
        • Power M.H.
        • Keith N.M.
        The electrolyte distribution and the acid-base equilibrium in the serum in cases of nephritis and nephritic acidosis.
        Biochem. J. 1932; 262: 1377-1382
        • Keith N.M.
        • Burchell H.B.
        • Baggenstoss A.H.
        Electrocardiographic changes in uremia associated with a high concentration of serum potassium.
        Am. Heart J. 1944; 27: 817-844
        • Rabinowitch I.M.
        On the relative proportions of sodium, potassium, calcium and magnesium in blood plasma in renal disease.
        J. Biol. Chem. 1924–1925; 62: 667-673
        • Addis T.
        • Lew W.
        Diet and death in acute uremia.
        J. Clin. Investigation. 1939; 18: 773
        • Manery J.F.
        • Solandt D.Y.
        Studies in experimental traumatic shock with particular reference to plasma potassium changes.
        Am. J. Physiol. 1943; 138: 499-511
        • Bywaters E.G.L.
        Ischemic muscle necrosis, crushing injury, traumatic edema, crush syndrome, traumatic anuria, compression syndrome; type of injury seen in air raid casualties following burial beneath debris.
        J. A. M. A. 1944; 124: 1103-1109
      1. Roos, A., Weisiger, J. E. and Moritz, A. R. To be published.

        • Mullin F.J.
        • Demmis J.
        • Calvin D.B.
        Blood potassium in tetany and asphyxia of dogs.
        Am. J. Physiol. 1938; 124: 192-201
        • Loeb R.F.
        Adrenal insufficiency.
        Bull. New York Acad. Med. 1940; 16: 347-367
        • Hastings A.B.
        • Compere E.L.
        Effect of bilateral suprarenalectorny on certain constituents of the blood of dogs.
        in: Proc. Soc. Biol. & Med.28. 1930–1931: 376-378
        • Winkler A.W.
        • Hoff H.E.
        • Smith P.K.
        Electrocardiographic changes and concentration of potassium in serum following intravenous injection of potassium chloride.
        Am. J. Physiol. 1938; 24: 478-483
      2. Hecht, H. Personal communication.

        • Chamberlin F.L.
        • Scudder J.
        • Zwemer R.L.
        Electrocardiographic changes associated with experimental alterations in blood potassium in cats.
        Am. Heart J. 1939; 18: 458-470
        • Nahum L.H.
        • Hoff H.E
        Observation on potassium fibrillation.
        J. Pharm. & Exper. Therap. 1939; 65: 322-331
        • McLean F.C.
        • Bay E.B.
        • Hastings A.B.
        Electrical changes in the isolated heart of the rabbit following changes in the potassium content of the perfusing fluid.
        Am. J. Physiol. 1933; 105: 72-73
        • Thomson W.A.R.
        The effect of potassium on the heart in man.
        Brit. Heart J. 1939; 1: 269-282
        • Sharpey-Shafer E.P.
        Potassium effects on t wave inversion in myocardial infarction and preponderance of a ventricle.
        Brit. Heart Jr. 1943; 5: 80-84
        • Keith N.M.
        • Osterberg A.E.
        • Burchell H.B.
        Some effects of potassium salts in man.
        in: Proc. Staff Meet., Mayo Clin.17. 1942: 49-52
        • Thomson W.A.R.
        Potassium and the t wave of the electrocardiogram.
        Lancet. 1939; 1: 808-811
        • Arden Felix
        Experimental observations upon thirst and on potassium overdosage.
        Australian J. Exper. Biol. & M. Sc. 1934; 12: 121-122
        • Landry O.
        Note sur la paralysie ascendante aigue.
        Gaz. heb. d. méd. et d. chir. 1859; 6: 412
        • Stockman R.
        Lathyrism.
        J. Phar. & Exper. Therap. 1929; 37: 43-53
        • Sampson B.F.
        Strange Durban epidemic of 1937.
        South African M. J. 1942; 16: 1-9
        • Ferrebee J.W.
        • Gerity M.K.
        • Atchley D.W.
        • Loeb R.F.
        Behavior of electrolytes in familial periodic paralysis.
        Arch. Neurol. & Psychiat. 1940; 44: 830-840
      3. Thorn, G. W. and Firor, W. M. Desoxycorticosterone acetate therapy in Addison's disease. J. A. M. A., 114: 2517–2525.

        • Thorn G.W.
        • Clinton Jr., M.
        Metabolic changes in a patient with Addison's disease following the onset of diabetes mellitus.
        J. Clin. Endocrinol. 1943; 3: 335-344
        • Brown M.R.
        • Currens J.H.
        • Marchand J.F.
        Muscular paralysis and electrocardiographic abnormalities resulting from potassium loss in chronic nephritis.
        J. A. M. A. 1944; 124: 545-549
        • Amberg S.
        • Helmholz H.F.
        The detoxifying action of sodium salt on potassium salt in the guinea pig.
        J. Pharm. & Exper. Therap. 1919; 12: 19-35
        • Rosenthal S.M.
        Experimental chemotherapy of burns and shock. 4. Production of traumatic shock in mice. 5. Therapy with mouse serum and sodium salts.
        Public Health Rep. 1943; 58: 1429-1436
        • Hechter O.
        • Bergman H.C.
        • Prenzmetal M.
        Comparison of the therapeutic effectiveness of serum and sodium chloride in scald shock.
        Am. Heart J. 1945; 29: 484-492
        • McCance R.A.
        Medical problems in mineral metabolism.
        Lancet. 1936; 1: 823-830
        • McCance R.A.
        Experimental sodium chloride deficiency in man.
        in: Proc. Roy. Soc. London, S. B.119. 1936: 245-268