{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:29:44Z","timestamp":1756463384955,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,6,21]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>A male patient in his late 30s with a history of Lynch syndrome and colorectal cancer relapse, which recently started chemotherapy, was admitted to the emergency department with acute lower limb weakness that had progressed to all limbs and resulted in complete flaccid paresis with general areflexia. Blood tests showed severe hyperkalaemia, severe acute kidney injury and hyperuricaemia. Ultrasound showed bilateral hydronephrosis due to pelvic mass obstruction. Hyperkalaemia correction measurements were started as well as rasburicase with the assumption of tumour lysis syndrome and postrenal kidney injury. The patient showed a favourable clinical response with complete return of limb movement in the following hours and progressive recovery of renal function in the following days. This case highlights the need for prompt diagnosis and correction of severe hyperkalaemia, and its multiple possible causes, as it can lead to acute flaccid paralysis and a fatal outcome.<\/jats:p>","DOI":"10.1136\/bcr-2023-255608","type":"journal-article","created":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T14:09:05Z","timestamp":1688393345000},"page":"e255608","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Acute flaccid paralysis due to multifactorial hyperkalaemia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5367","authenticated-orcid":false,"given":"Ricardo Ambr\u00f3sio","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1805-6099","authenticated-orcid":false,"given":"Telma","family":"Alves","sequence":"additional","affiliation":[{"name":"Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2856-0889","authenticated-orcid":false,"given":"Christine Joannie","family":"Canizes Paiva","sequence":"additional","affiliation":[{"name":"Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Rocha","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,30]]},"reference":[{"key":"2025082710440171000_16.6.e255608.1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1055\/s-0040-1705123","article-title":"Acute flaccid myelitis: a clinical review","volume":"40","author":"Murphy","year":"2020","journal-title":"Semin Neurol"},{"key":"2025082710440171000_16.6.e255608.2","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/NRL.0b013e3181b120b8","article-title":"Acute quadriplegia from hyperkalemia","volume":"16","author":"Panichpisal","year":"2010","journal-title":"The Neurologist"},{"key":"2025082710440171000_16.6.e255608.3","doi-asserted-by":"crossref","unstructured":"Mushiyakh Y , Dangaria H , Qavi S , et al . Treatment and pathogenesis of acute hyperkalemia. J Community Hosp Intern Med Perspect 2011;1. doi:10.3402\/jchimp.v1i4.7372","DOI":"10.3402\/jchimp.v1i4.7372"},{"key":"2025082710440171000_16.6.e255608.4","first-page":"S10","article-title":"Expert panel recommendations for the identification and management of hyperkalemia and role of patiromer in patients with chronic kidney disease and heart failure","volume":"23","author":"Rafique","year":"2017","journal-title":"J Manag Care Spec Pharm"},{"key":"2025082710440171000_16.6.e255608.5","article-title":"Acute ascending flaccid paralysis secondary to multiple trigger factor induced hyperkalemia","volume":"2018","author":"Hemachandra","year":"2018","journal-title":"Case Rep Neurol Med"},{"key":"2025082710440171000_16.6.e255608.6","doi-asserted-by":"publisher","DOI":"10.1007\/BF00254706"},{"key":"2025082710440171000_16.6.e255608.7","article-title":"Hyperkalemia-induced acute flaccid paralysis: a case report","volume":"38","author":"D\u2019Ercole","year":"2021","journal-title":"G Ital Nefrol"},{"key":"2025082710440171000_16.6.e255608.8","unstructured":"Sekhon DS , Vaqar S , Paralysis GV . Hyperkalemic periodic. In: StatPearls. Treasure Island: StatPearls Publishing, 2022."},{"key":"2025082710440171000_16.6.e255608.9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.5492\/wjccm.v4.i2.130","article-title":"Tumor lysis syndrome: a clinical review","volume":"4","author":"Mirrakhimov","year":"2015","journal-title":"World J Crit Care Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-255608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:44:07Z","timestamp":1756316647000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-255608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":9,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,30]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bcr-2023-255608"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-255608","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}