{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T07:49:20Z","timestamp":1676188160585},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Hypokalemia has been rarely attributed to tizanidine, although the precise mechanism is unclear. Severe hypokalemia is a well-established cause of abnormalities involving cardiac conduction. Given this agent\u2019s well-known cardiac arrhythmogenic potential, awareness of potential concomitant electrolyte abnormalities is important.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>Electrolyte disorders, including hypokalemia, are rare complications of the antispasmodic medicine tizanidine when taken in doses as outlined by the manufacturer\u2019s prescribing instructions. Although cases of severe hypokalemia have also been described in the literature in association with this agent, such reports are few. We report a Caucasian case of an intentional overdose involving a very large ingestion of tizanidine. In addition to the characteristic  abnormalities on the electrocardiogram, our patient developed electrolyte derangements as well as self-limited acute kidney injury. These biochemical abnormalities included profound hypokalemia that was refractory to aggressive replacement over the ensuing several days, before eventually dissipating. A thorough assessment of the etiology of this hypokalemia was consistent with a defect in renal potassium handling.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In our patient with intentional tizanidine overdose, severe and refractory hypokalemia appears to have been due to a transient potassium wasting nephropathy.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-02811-8","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T11:58:07Z","timestamp":1620043087000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Potassium wasting nephropathy in the setting of tizanidine overdose: a case report"],"prefix":"10.1186","volume":"15","author":[{"given":"Michael J.","family":"Brucculeri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"issue":"3","key":"2811_CR1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.2165\/00003495-199753030-00007","volume":"53","author":"AJ Wagstaff","year":"1997","unstructured":"Wagstaff AJ, Bryson HM. Tizanidine. A review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs. 1997;53(3):435\u201352.","journal-title":"Drugs"},{"issue":"1","key":"2811_CR2","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/j.1774-9987.2005.00206.x","volume":"9","author":"Y Kitabata","year":"2005","unstructured":"Kitabata Y, Orita H, Kamimura M, Shiizaki K, Narukawa N, Abe T, et al. Symptomatic bradycardia probably due to tizanidine hydrochloride in a chronic hemodialysis patient. Ther Apher Dial. 2005;9(1):74\u20137.","journal-title":"Ther Apher Dial"},{"issue":"4","key":"2811_CR3","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1016\/j.jemermed.2014.10.005","volume":"48","author":"J Cortes","year":"2015","unstructured":"Cortes J, Hall B, Redden D. Profound symptomatic bradycardia requiring transvenous pacing after a single dose of tizanidine. J Emerg Med. 2015;48(4):458\u201360.","journal-title":"J Emerg Med."},{"key":"2811_CR4","unstructured":"Acorda Therapeutics Inc. Zanaflex (tizanidine) [package insert]. U.S. Food and Drug Administration. Revised July 2006. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2006\/020397s021,021447s002lbl.pdf. Accessed 7 Mar 2020."},{"issue":"4","key":"2811_CR5","first-page":"A60","volume":"59","author":"G Nakhoul","year":"2012","unstructured":"Nakhoul G, Toukhy A, Simon J. Tizanidine: a cause of hypokalemia. Am J Kid Dis. 2012;59(4):A60.","journal-title":"Am J Kid Dis"},{"issue":"1","key":"2811_CR6","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/24734306.2018.1522027","volume":"2","author":"R Souza","year":"2018","unstructured":"Souza R, Jauregui J, Valento M. Mixed propranolol and tizanidine overdose treated with intravenous lipid emulsion. Toxicol Commun. 2018;2(1):71\u20134.","journal-title":"Toxicol Commun"},{"issue":"14","key":"2811_CR7","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1001\/archinte.164.14.1561","volume":"164","author":"SH Lin","year":"2004","unstructured":"Lin SH, Lin YF, Chen DT, Chu P, Hsu CW, Halperin ML. Laboratory tests to determine the cause of hypokalemia and paralysis. Arch Intern Med. 2004;164(14):1561.","journal-title":"Arch Intern Med."},{"issue":"7","key":"2811_CR8","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/j.amjmed.2017.01.023","volume":"130","author":"KL Wu","year":"2017","unstructured":"Wu KL, Cheng CJ, Sung CC, Tseng MH, Hsu YJ, Yang SS, et al.. Identification of the causes for chronic hypokalemia: importance of urinary sodium and chloride excretion. Am J Med. 2017;130(7):846.","journal-title":"Am J Med"},{"issue":"4","key":"2811_CR9","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/S0272-6386(12)80076-X","volume":"15","author":"JH Ethier","year":"1990","unstructured":"Ethier JH, Kamel KS, Magner PO, Lemann J, Halperin ML. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. Am J Kidney Dis. 1990;15(4):309\u201315.","journal-title":"Am J Kidney Dis"},{"issue":"10","key":"2811_CR10","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1681\/ASN.2007070792","volume":"18","author":"CL Huang","year":"2007","unstructured":"Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. JASN. 2007;18(10):2649\u201352.","journal-title":"JASN"},{"issue":"9","key":"2811_CR11","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1172\/JCI102803","volume":"32","author":"BI Heller","year":"1953","unstructured":"Heller BI, Hammarsten JF, Stutzman FL. Concerning the effects of magnesium sulfate on renal function, electrolyte excretion, and clearance of magnesium. J Clin Invest. 1953;32(9):858\u201361.","journal-title":"J Clin Invest"},{"key":"2811_CR12","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","volume":"30","author":"CA Naranjo","year":"1981","unstructured":"Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239\u201345.","journal-title":"Clin Pharmacol Ther"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02811-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-021-02811-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02811-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T03:39:07Z","timestamp":1626838747000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-02811-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2811"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-02811-8","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,1]]},"assertion":[{"value":"5 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None, the authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"250"}}