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July 1966

Fatal Hyperkalemic Paralysis Associated With Spironalactone: Observation on a Patient With Severe Renal Disease and Refractory Edema

Author Affiliations

From the Isotopic Department and Metabolic Unit and the Department of Medicine, János Hospital, XII, Diósárok ut 1, Budapest.

Arch Neurol. 1966;15(1):74-77. doi:10.1001/archneur.1966.00470130078008

FLACCID quadriplegia associated with hyperkalemia was described by Finch and Marchand1 in 1943 in two patients with renal insufficiency. Since then, a number of cases have been described in patients with renal insufficiency accompanied by oliguria, anuria, and "salt-losing" nephritis2-8; in Addison's disease4,5,9-12; and in patients with a peculiar familial disease accompanied by hyperkalemia (hyperkalemic familial periodic paralysis).3,4,13 In the case reported here the hyperkalemic state accompanied by irreversible flaccid muscular paralysis developed in a patient suffering from diabetic nephropathy who had been treated with spironolactone because of refractory edema.

This case is reported in order to call attention to the danger of spironolactone treatment in patients with chronic renal diseases, and because no similar case could be found in the literature.

Report of a Case  The patient, a 43-year-old man, was admitted on Feb 1, 1964. He had been suffering from juvenile diabetes mellitus since

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