Secondary hyperkalemic paralysis and acute kidney injury due to rhabdomyolysis caused by sea-snake envenomation

Abstract

Sea-snakes are a common occupational hazard to fishermen in Asian coastal waters.Sea snake venom contains both myotoxins and neurotoxins. Hyperkalemia is a rare cause of acute flaccid paralysis. Myotoxicity result in rhabdomyolysis due to muscle necrosis, acute kidney injury(AKI) and hyperkalemia sometimes resulting in flaccid paralysis. We report here a 50 year old fisherman who presented with muscle pain, AKI,hyperkalemia and quadriparesis with respiratory paralysis. History revealed sea snake bite on his right hand. His serum creatine kinase and lactate dehydrogenase enzymes were elevated several fold.Urine myoglobin was positive. He was treated with hemodialysis and other supportive measures. He required total of 7 hemodialysis sessions and was discharged with serum creatinine of 2mg/dl on day 25.His muscle paralysis was attributed to hyperkalemia as he recovered dramatically with hemodialysis support.