Severe post-dialysis hypokalaemia leading to quadriparesis

A 36-year-old male developed acute renal failure and severe metabolic acidosis following acute severe gastroenteritis. Two hours following haemodialysis he developed generalized muscle weakness, which progressed to quadriplegia over the next 4 hours. Electrocardiography (ECG) revealed classic signs of hypokalaemia. Serum potassium (K+) levels were 0.98 mmol/L. He was immediately started on intravenous (i/v) and oral potassium supplementation. He gradually improved and his ECG changes also reverted as potassium levels normalized. Postdialysis hypokalaemia can be a serious complication in patients who are already in total body potassium deficit. Dialysis fluid potassium levels should be kept higher in such patients.