Hypokalemic paralysis in an adolescent following dexamethasone and B12 injection: A case report and literature review
Open accessAbstract
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.
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Corticosteroids enhance Na+/K+-ATPase activity both directly and indirectly by altering glucose metabolism.
“Corticosteroids enhance Na+/K+-ATPase activity both directly and indirectly by altering glucose metabolism.”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [38]
The Introduction and Discussion say glucocorticoids may activate Na+/K+-ATPase and that glucocorticoid-induced hyperglycemia can lead to hyperinsulinemia and a shift of potassium into cells. They do not say corticosteroids directly activate the pump or that the glucose-mediated pathway increases pump activity; the Introduction instead describes pump activation as possibly indirect. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCorticosteroids stimulate hepatic gluconeogenesis and may upregulate insulin secretion, thereby further promoting intracellular potassium uptake.
“Sahebi et al. [38] and Mebane et al. [42] reported that corticosteroids stimulate hepatic gluconeogenesis and may upregulate insulin secretion, thereby further promoting intracellular potassium uptake.”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [38]
The Introduction and Discussion (pages not provided) say glucocorticoid-induced hyperglycemia can lead to compensatory hyperinsulinemia, which shifts potassium into cells. They do not attribute the hyperglycemia to stimulation of hepatic gluconeogenesis, so that specific mechanism is unsupported by this source. (LLM, conf=0.88)
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Cites
Functional and clinical significance of skeletal muscle architecture
Lieber, R. L., & n, J. F. (2000) · Muscle & Nerve · doi:10.1002/1097-4598(200011)23:11 · Cited by 1,249 · see citing works
Tardy, A.-L., Pouteau, E., Marquez, D., Yilmaz, C., & Scholey, A. (2020) · Nutrients · doi:10.3390/nu12010228 · Cited by 541 · see citing works
Glucocorticoid-induced hyperglycemia
Clore, J. N., & Thurby-Hay, L. (2009) · Endocrine Practice · doi:10.4158/ep08331.rar · Cited by 508 · see citing works
Clinical Pharmacology of Corticosteroids
Williams, D. M. (2018) · Respiratory Care · doi:10.4187/respcare.06314 · Cited by 460 · see citing works
Hypokalemia: a clinical update
Kardalas, E., Paschou, S. Α., Anagnostis, P. G., Muscogiuri, G., Siasos, G., & Vryonidou, A. (2018) · Endocrine Connections · doi:10.1530/ec-18-0109 · Cited by 364 · see citing works
Molecular Mechanisms of Glucocorticoid-Induced Insulin Resistance
Beaupere, C., Liboz, A., Fève, B., Blondeau, B., & Guillemain, G. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22020623 · Cited by 271 · see citing works
Pathophysiology and management of hypokalemia: a clinical perspective
Unwin, R. J., Luft, F. C., & Shirley, D. G. (2011) · Nature Reviews Nephrology · doi:10.1038/nrneph.2010.175 · Cited by 215 · see citing works
Voltage sensor charge loss accounts for most cases of hypokalemic periodic paralysis
Matthews, E., Labrum, R., Sweeney, M. G., Sud, R., Haworth, A., Chinnery, P. F., Meola, G., Schorge, S., Kullmann, D. M., Davis, M. B., et al. (2009) · Neurology · doi:10.1212/01.wnl.0000342387.65477.46 · Cited by 201 · see citing works
Voltage-sensor mutations in channelopathies of skeletal muscle
Cannon, S. C. (2010) · The Journal of Physiology · doi:10.1113/jphysiol.2010.186874 · Cited by 116 · see citing works
Extracellular Potassium Homeostasis: Insights from Hypokalemic Periodic Paralysis
Cheng, C.-J., Kuo, E., & Huang, C.-L. (2013) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2013.04.004 · Cited by 107 · see citing works
Pharmacologic Characteristics of Corticosteroids
Samuel, S., Nguyen, T., & Choi, H. A. (2017) · Journal of Neurocritical Care · doi:10.18700/jnc.170035 · Cited by 90 · see citing works
Cushing's syndrome, glucocorticoids and the kidney.
Smets, P., Meyer, E., Maddens, B., & Daminet, S. (2010) · General and Comparative Endocrinology · doi:10.1016/j.ygcen.2010.07.004 · Cited by 81 · see citing works
Etiology and symptoms of severe hypokalemia in emergency department patients
Marti, G., Schwarz, C., Leichtle, A. B., Fiedler, M., Arampatzis, S., Exadaktylos, A. K., & Lindner, G. (2013) · European Journal of Emergency Medicine · doi:10.1097/mej.0b013e3283643801 · Cited by 69 · see citing works
Bazerbachi, F., Haffar, S., Szarka, L. A., Wang, Z., Prokop, L. J., Murad, M. H., & Camilleri, M. (2017) · Neurogastroenterology & Motility · doi:10.1111/nmo.13120 · Cited by 39 · see citing works
Glucocorticoids may trigger attacks in several types of periodic paralysis
Arzel-Hézode, M., McGoey, S. T., Sternberg, D., Vicart, S., Eymard, B., & Fontaine, B. (2009) · Neuromuscular Disorders · doi:10.1016/j.nmd.2008.12.008 · Cited by 34 · see citing works
Miyashita, Y., Monden, T., Yamamoto, K., Matsumura, M., Kawagoe, N., Iwata, C., Banba, N., Hattori, Y., & Kasai, K. (2006) · Internal Medicine · doi:10.2169/internalmedicine.45.1495 · Cited by 29 · see citing works
Barium poisoning: an uncommon cause of severe hypokalemia
McNeill, I. R., & Isoardi, K. (2019) · Toxicology Communications · doi:10.1080/24734306.2019.1691340 · Cited by 27 · see citing works
Huynh, T. P., Barwe, S. P., Lee, S. J., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122442 · Cited by 22 · see citing works
De Quervain thyroiditis in the course of H1N1 influenza infection.
Michas, G., Alevetsovitis, G., Andrikou, I., et al. (2014) · PubMed · Cited by 20 · see citing works
Impaired skeletal health and neuromuscular function among amphetamine users in clinical treatment
Mosti, M. P., Flemmen, G., Hoff, J., Stunes, A. K., Syversen, U., & Wang, E.-L. (2015) · Osteoporosis International · doi:10.1007/s00198-015-3371-z · Cited by 19 · see citing works
Steroid-induced hypokalemic periodic paralysis: a case report and literature review
Tai, H.-T., Lee, P., & Ou, S. (2023) · BMC Nephrology · doi:10.1186/s12882-023-03131-3 · Cited by 17 · see citing works
HYPOKALÆMIA IN MEGALOBLASTIC ANÆMIAS
Lawson, D. H., Parker, J. L. W., Murray, R. M., et al. (1970) · The Lancet · doi:10.1016/s0140-6736(70)90168-6 · Cited by 16 · see citing works
Grams, M. E., Hoenig, M. P., & Hoorn, E. J. (2021) · JAMA · doi:10.1001/jama.2020.17672 · Cited by 15 · see citing works
Affram, K. O., Reddy, T. L., & Osei, K. M. (2018) · American Journal of Case Reports · doi:10.12659/ajcr.911270 · Cited by 13 · see citing works
Tenofovir induced Fanconi syndrome: A rare cause of hypokalemic paralysis
Venkatesan, E., Pranesh, M. B., Gnanashanmugam, G., et al. (2014) · Indian Journal of Nephrology · doi:10.4103/0971-4065.127898 · Cited by 12 · see citing works
Xie, G., YAN, H. H., & Lu, Z. (2010) · Experimental Eye Research · doi:10.1016/j.exer.2010.07.005 · Cited by 8 · see citing works
Hypokalemic Periodic Paralysis that Presented with Hemiparesis after Dexamethasone Injection
Çetin, Ö. E., & Özlü, C. (2016) · Turkish Journal Of Neurology · doi:10.4274/tnd.21605 · Cited by 7 · see citing works
Sohi, M. T., Sullivan, W. J., & Anderson, D. (2017) · PM&R · doi:10.1016/j.pmrj.2017.10.003 · Cited by 7 · see citing works
A Rare Presentation of Severe Organophosphate Poisoning: A Case Report and Review of Literature
Ibrahim, A. E., Ghantarchyan, H., Le, T., et al. (2022) · Cureus · doi:10.7759/cureus.31497 · Cited by 7 · see citing works
Tenofovir-Induced Fanconi Syndrome Presenting as Hypokalemic Periodic Paralysis
Bhogal, S. S. (2016) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000000490 · Cited by 6 · see citing works
Low-dose glucocorticoid can lead to hypokalemic paralysis
Ryu, S., Yu, T. Y., Kim, H.-Y., & Cho, C. G. (2019) · Endocrine · doi:10.1007/s12020-019-02133-2 · Cited by 6 · see citing works
Shin, Y., Kim, Y.-L., Kim, K. Y., et al. (2021) · Medicina · doi:10.3390/medicina58010052 · Cited by 6 · see citing works
Wanas, A. M., Giacuzzo, C., Ghazi-Nouri, S., & Tan, L. T. (2025) · Orbit · doi:10.1080/01676830.2023.2296553 · Cited by 6 · see citing works
Ebrahimi, P., Taheri, H., Mousavinejad, S. A., & Nazari, P. (2024) · Clinical Case Reports · doi:10.1002/ccr3.8923 · Cited by 5 · see citing works
Thyrotoxic Periodic Paralysis Induced by Dexamethasone
Lee, E. J., Kim, T. K., Kwon, M. J., Lee, S. H., & Park, J. H. (2012) · Endocrinology and Metabolism · doi:10.3803/enm.2012.27.4.299 · Cited by 4 · see citing works
Amanati, A., Vali, M., Fatemian, H., Maleki, Z., Foroozand, H., Sahebi, K., Rahmanian, M. R., & Meybodi, M. J. E. (2022) · Archives of Pediatric Infectious Diseases · doi:10.5812/pedinfect-119701 · Cited by 4 · see citing works
Self-citationDexamethasone induced severe paralysis hypokalemia: A case report
Pinzon, R. T., & Fadjarsugeng, N. (2023) · Romanian Journal of Neurology · doi:10.37897/rjn.2023.4.15 · Cited by 3 · see citing works
Chen, B., Counts, C. J., Maresca, P., Greller, H. A., & Heller, M. J. (2024) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2024.09.021 · Cited by 3 · see citing works
Thyroid Function Test Abnormalities in Children and Adolescents with COVID-19: A Case-Control Study
Afshar, Z., Sahebi, K., Foroozand, H., Yazdani, N., Hamzavi, S. S., Moravej, H., Ilkhanipoor, H., & Amirhakim, A. (2023) · Archives of Pediatric Infectious Diseases · doi:10.5812/apid-136044 · Cited by 2 · see citing works
Self-citationDON'T METH WITH DRUGS: A RARE PRESENTATION OF METHAMPHETAMINE-INDUCED HYPOKALEMIC PERIODIC PARALYSIS
NAVEED, H., Shyamkumar, S., Ike, C., et al. (2023) · CHEST Journal · doi:10.1016/j.chest.2023.07.1483 · Cited by 1 · see citing works
SPINAL AND NEUROMUSCULAR COMPLICATIONS OF SUBSTANCE ABUSE
Weimer, L. H. (2004) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/01.con.0000293609.99710.4d · Cited by 1 · see citing works
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Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms
Qing, G., Zakaria, W. N. A., Rom, F. Z. M., Nik, W. N. F. H. W., Zulkeflee, H. A., & Rahim, S. N. A. (2025) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2554 · Cited by 5 · see citing works
“Sahebi et al. [38] and Mebane et al. [42] reported that corticosteroids stimulate hepatic gluconeogenesis and may upregulate insulin secretion, thereby further promoting intracellular potassium uptake.”
Influential
- Authors
- Sahebi, K., Foroozand, H., Bahmei, M., Taghizadeh, R., Zare, S., & Inaloo, S.
- Affiliations
- Shiraz University (IR)
- Corresponding author
- Foroozand, Hassan
- Inaloo, Soroor
- Venue
- Heliyon
- Publisher
- Elsevier BV
- Published
- 2025-01
- Volume
- 11
- Issue
- 2
- Pages
- e41675
- ISSN
- 2405-8440 (ISSN-L)
- PMC
- PMC11782966
- OpenAlex
- W4406205298
- Cited by
- 2
- References
- 41
- Citations by year
- 2026: 1 · 2025: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Heliyon (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Keywords
- hypokalemic paralysis, dexamethasone, vitamin B12 supplementation, potassium replacement therapy, adolescents, drug-induced hypokalemia, electrolyte imbalance, glucocorticoid adverse effects
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