Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review
The widespread use of glucocorticoids in clinical practice may occasionally be complicated by hypokalemic paralysis. Previously, only a few cases of glucocorticoid-induced hypokalemic paralysis in healthy adults had been reported. Intriguingly, cases of B12-induced hypokalemia have previously been r...
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Elsevier
2025-01-01
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| author | Keivan Sahebi Hassan Foroozand Mohammad Bahmei Raziee Taghizadeh Samane Zare Soroor Inaloo |
| author_facet | Keivan Sahebi Hassan Foroozand Mohammad Bahmei Raziee Taghizadeh Samane Zare Soroor Inaloo |
| author_sort | Keivan Sahebi |
| collection | DOAJ |
| description | The widespread use of glucocorticoids in clinical practice may occasionally be complicated by hypokalemic paralysis. Previously, only a few cases of glucocorticoid-induced hypokalemic paralysis in healthy adults had been reported. Intriguingly, cases of B12-induced hypokalemia have previously been reported in patients with pernicious anemia. Recently, we experienced a case of hypokalemic paralysis in an adolescent following intramuscular injections of dexamethasone and vitamin B12. Upon exclusion of other causes, a presumptive diagnosis of glucocorticoid-induced hypokalemic paralysis, with a possible but uncertain contribution from B12 supplementation, was made for the patient. After potassium replacement therapy, the patient fully recovered and was discharged after five days. Although glucocorticoids are known to cause hypokalemia through mechanisms such as enhanced transcellular shift or renal excretion, the potential role of vitamin B12 in worsening this effect remains unclear. It is hypothesized that B12 supplementation under certain conditions could influence electrolyte balance and potentially amplify the hypokalemic effects of glucocorticoids. However, this hypothesis is based on a few cases, and further pathophysiological and clinical studies are needed to clarify whether B12 supplementation exacerbates hypokalemia induced by glucocorticoids or if the observation is coincidental or context-specific. Meanwhile, clinicians should be cautious when prescribing glucocorticoids, particularly in combination with B12 supplements. This includes ensuring that both are administered only when clinically indicated, monitoring vital signs and serum potassium levels in at-risk patients, and considering alternatives when appropriate. |
| format | Article |
| id | doaj-art-868cf621f61b445cb83627f65a4843f3 |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| spelling | doaj-art-868cf621f61b445cb83627f65a4843f32025-02-02T05:27:57ZengElsevierHeliyon2405-84402025-01-01112e41675Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature reviewKeivan Sahebi0Hassan Foroozand1Mohammad Bahmei2Raziee Taghizadeh3Samane Zare4Soroor Inaloo5Student Research Committee, School of Medicine, Shiraz University of Medicine, Shiraz, IranStudent Research Committee, School of Medicine, Shiraz University of Medicine, Shiraz, Iran; Corresponding author. Student Research Committee, School of Medicine, Shiraz University of Medicine, Shiraz, Iran.Student Research Committee, School of Medicine, Shiraz University of Medicine, Shiraz, IranPediatric Neurology Department, Nemazee Hospital, Shiraz, IranPediatric Neurology Department, Nemazee Hospital, Shiraz, IranPediatric Neurology Department, Nemazee Hospital, Shiraz, Iran; Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Corresponding author. Pediatric Neurology Department, Nemazee Hospital, Shiraz, Iran.The widespread use of glucocorticoids in clinical practice may occasionally be complicated by hypokalemic paralysis. Previously, only a few cases of glucocorticoid-induced hypokalemic paralysis in healthy adults had been reported. Intriguingly, cases of B12-induced hypokalemia have previously been reported in patients with pernicious anemia. Recently, we experienced a case of hypokalemic paralysis in an adolescent following intramuscular injections of dexamethasone and vitamin B12. Upon exclusion of other causes, a presumptive diagnosis of glucocorticoid-induced hypokalemic paralysis, with a possible but uncertain contribution from B12 supplementation, was made for the patient. After potassium replacement therapy, the patient fully recovered and was discharged after five days. Although glucocorticoids are known to cause hypokalemia through mechanisms such as enhanced transcellular shift or renal excretion, the potential role of vitamin B12 in worsening this effect remains unclear. It is hypothesized that B12 supplementation under certain conditions could influence electrolyte balance and potentially amplify the hypokalemic effects of glucocorticoids. However, this hypothesis is based on a few cases, and further pathophysiological and clinical studies are needed to clarify whether B12 supplementation exacerbates hypokalemia induced by glucocorticoids or if the observation is coincidental or context-specific. Meanwhile, clinicians should be cautious when prescribing glucocorticoids, particularly in combination with B12 supplements. This includes ensuring that both are administered only when clinically indicated, monitoring vital signs and serum potassium levels in at-risk patients, and considering alternatives when appropriate.http://www.sciencedirect.com/science/article/pii/S2405844025000556HypokalemiaParalysisDexamethasoneVitamin B12Case reportGlucocorticoid-induced hypokalemia |
| spellingShingle | Keivan Sahebi Hassan Foroozand Mohammad Bahmei Raziee Taghizadeh Samane Zare Soroor Inaloo Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review Heliyon Hypokalemia Paralysis Dexamethasone Vitamin B12 Case report Glucocorticoid-induced hypokalemia |
| title | Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review |
| title_full | Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review |
| title_fullStr | Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review |
| title_full_unstemmed | Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review |
| title_short | Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review |
| title_sort | hypokalemic paralysis in an adolescent following dexamethasone and b12 injection a case report and literature review |
| topic | Hypokalemia Paralysis Dexamethasone Vitamin B12 Case report Glucocorticoid-induced hypokalemia |
| url | http://www.sciencedirect.com/science/article/pii/S2405844025000556 |
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