背景:由于与COVID相关的工作流失导致财务和粮食不安全,一名28岁的妇女开始了一种饮食,每天只吃一杯拉面,持续22个月,导致27公斤的体重减轻。拉面热量低,缺乏关键营养素,包括钾,氯化物,和维生素B12。
方法:患者就诊于急诊科,她左手腕和手的虚弱和感觉异常恶化。检查显示,除了恶病质的外观外,没有其他异常。实验室发现明显的低钾血症,低氯血症,乳酸性酸中毒,混合代谢性碱中毒与呼吸性酸中毒,和低水平的锌和铜。心电图显示QT间期延长。在神经科和精神病学会诊后,病人因营养不良而未能茁壮成长,周围神经病变,低钾血症,和酸碱紊乱.大脑的MRI并不明显。其他营养缺乏的研究,自身免疫性疾病,性传播感染并不明显。患者接受了食物和维生素补充剂,被监测为再喂养综合征,并有了显著的恢复。
结论:中风后,脊髓损伤,多发性硬化症,排除了最常见的局灶性单神经病变,临床重点转向营养缺乏,其中最显著的是低钾血症。先前的研究表明,严重的低钾血症会导致虚弱。它还表明,长期饮食摄入不足是低钾血症的常见原因。这个案子,单侧上肢部分瘫痪,可能会增加已知的低钾血症的临床表现。我们回顾了低钾血症和低氯血症在酸碱动力学中的作用。钴胺素的病因和临床表现,硫胺素,吡哆醇,和铜缺乏,随着铅的毒性,也讨论了。在营养不良和低钾血症的情况下,诊断单一神经病的清晰度可以通过补充之前的尿钾水平来帮助。神经成像,包括颈椎,和后续的肌电图。
Due to a COVID-related job loss resulting in financial and food insecurity, a 28-year-old woman initiated a diet consisting solely of one cup of ramen noodles daily for twenty-two months, leading to 27 kg of weight loss. Ramen noodles are low in calories and lack key nutrients, including potassium, chloride, and vitamin B12.
The patient presented to the emergency department with acute, worsening weakness and paresthesias in her left wrist and hand. Exam revealed no other abnormalities aside from a cachectic appearance. Labs revealed marked hypokalemia, hypochloremia, lactic acidosis, a mixed metabolic alkalosis with respiratory acidosis, and low levels of zinc and copper. An EKG revealed a prolonged QT interval. After a neurology and psychiatry consult, the patient was admitted for failure to thrive with malnutrition, peripheral neuropathy, hypokalemia, and an acid-base disorder. An MRI of the brain was unremarkable. Studies of other nutritional deficiencies, autoimmune conditions, and sexually transmitted infections were unremarkable. The patient received food and vitamin supplementation, was monitored for re-feeding syndrome, and had a significant recovery.
After stroke, spinal injury, multiple sclerosis, and the most common focal mononeuropathies were ruled out, the clinical focus turned to nutritional deficiencies, the most significant of which was hypokalemia. Prior research has shown that severe hypokalemia can lead to weakness. It has also shown that chronically insufficient dietary intake is a common cause of hypokalemia. This
case, with its partial paralysis of a unilateral upper extremity, may add to the known clinical manifestations of hypokalemia. We review the role of hypokalemia and hypochloremia in acid-base dynamics. Etiologies and clinical manifestations of cobalamin, thiamine,
pyridoxine, and copper deficiencies, along with lead toxicity, are also discussed. Diagnostic clarity of mononeuropathies in the context of malnutrition and hypokalemia can be aided by urine potassium levels prior to repletion, neuroimaging that includes the cervical spine, and follow-up electromyography.