In this case report we describe a 55 year-old woman admitted to our emergency department first with the impression of seizure. Eventually, it was realized that she had suffered from brain hypo-perfusion secondary to
hypokalemia induced
arrhythmia. Her
arrhythmia was managed by unsynchronized biphasic
shock in acute phase and also
potassium replacement. She was then admitted to the CCU (Coronary Care Unit) where she received further care for medical management and
drug dose adjustment and was discharged 4 days later.
CONCLUSIONS:
Syncope from
arrhythmia most commonly results from
ventricular tachycardia, which accounts for 11% of all cases of
syncope. Torsades de point is a unique type of
ventricular tachycardia, characterized by QRS complexes of changing amplitude proceeded by prolonged QT intervals and almost often followed by
loss of consciousness and also seizure like movements. Prolonged QT interval which is an important provocative factor for torsades de point commonly results from interactions between
drug therapy,
myocardial ischemia, and
electrolyte disturbances such as
hypokalemia or hypomagnesaemia. Changes in the extracellular
potassium level have predominant and profound influences on the function of the cardiovascular system that may provoke fatal demonstrations such as QT prolongation, ventricular
arrhythmia and even
cardiac arrest.
Electrolyte assessment is particularly important in certain patient populations, such as the elderly in whom a variety of pathological states or conditions like
dehydration or
renal failure are more common. Early identification and correction of these disturbances are necessary to control either
seizures or seizure-like movements and prevent permanent brain damage, as
anticonvulsants alone are generally ineffective.