BACKGROUND
Hypokalemia (serum
potassium level below 3.5 mmol/L) is present in approximately 11% of patients admitted to emergency departments.
Hypokalemia can be a manifestation of many underlying causes and if untreated can be fatal. A careful approach to work-up and management is required in hypokalemic patients. CASE REPORT Here we report a 26-year-old previously healthy male patient who was admitted to the Emergency Department with rapidly progressing
paresis of the lower and upper extremities. Initial laboratory results revealed severe
hypokalemia of 2.1 mmol/l, which aggravated to 1.6 mmol/l before receiving treatment with intravenous
potassium chloride supplementation. In addition, the patient developed
rhabdomyolysis secondary to prolonged
paralysis and immobilization induced by
hypokalemia. Following this treatment, the patient's symptoms eased rapidly, and his
potassium concentration was normalized. The patient admitted to smoking cannabis the day before admission. In this case report, we systematically elaborate and exclude the causes of
hypokalemia in this otherwise healthy young adult, including medication, gastrointestinal symptoms, licorice consumption, and genetical testing. Cannabis has been associated with
hypokalemia, proposedly through activation of the
cannabinoid receptor 1 (CB1)-mediated activation of
G protein-coupled inwardly rectifying
potassium (GIRK) channels. CONCLUSIONS This case report emphasizes that
hypokalemia can cause
paralysis and cannabis should be included in the diagnostic mindset.