Interesting Case of extremity weakness
41 y.o. female PMHx familial hypokalemic periodic paralysis p/w weakness.
- Mechanical fall from bed after a night of binge drinking.
- Awoke with RUE, RLE weakness
- Notes hx weakness in past secondary to hypokalemia but never this severe
BP 120/77 | Pulse 91 | Temp 98.8 °F (37.1 °C) (Oral) | Resp 15 | SpO2 93%
- Distal R-sided extremities cold to touch
- Pulses intact
- 2/5 strength in RUE/RLE
- CVA, ICH, hypokalemic periodic paralysis, peripheral nerve palsy, cervical neck/sacral injury, rhabdomyolysis
- Stroke alert → imaging unrevealing for acute abnormality
- Labs results: hyperkalemia (8.4), elevated Cr (1.52), CK 63,780, 3+ blood on UA
- Re-examined patient → improving RUE strength but remains weak RLE with significant pain in the right hip and thigh
- R gluteal compartment: firm and tender → compartment pressure 34 mmhg
- Level 1 OR for gluteal compartment syndrome
Take Home Points
- ALWAYS fully examine the patient!
- Compartment syndrome
- Causes: fractures AND soft tissue injuries
- Soft tissue injuries: crush, exertional, prolonged immobilization, tissue infection, seizures, burns
- Complicated by rhabdo, renal failure
- 6P’s: pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
- Compartment pressures indicating fasciotomy
- Absolute > 30 mmHG
- Delta pressure < 30 mmHG
For a refresher on direct measurement of compartment pressures - click here!