High-dose glucocorticoids can precipitate severe hypokalemia and life-threatening ventricular fibrillation in patients with unrecognized thyrotoxic periodic paralysis.
High-dose glucocorticoids may trigger life-threatening VF in unrecognized thyrotoxic periodic paralysis; this case leaves open the need for prospective confirmation.
We report a 25-year-old Japanese man with ventricular fibrillation associated with severe hypokalemia. He developed arm and leg paralysis. He had received 2 g of methylprednisolone because thoracic epidural hematoma had been suspected in another hospital. His serum potassium was 0.8 mEq/l on arrival at our hospital. Half an hour after arrival ventricular fibrillation occurred. Treatment with electric defibrillation 8 times was successful. Afterward Graves' disease was diagnosed, therefore, his clinical symptom was diagnosed as thyrotoxic periodic paralysis. We considered that the unusual condition of hyperthyroid-related hypokalemia worsened by steroid therapy induced the ventricular fibrillation.
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Miyashita et al. (2006) studied this question.
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