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Post-Stroke Hemispatial Neglect — SCE Neurology MCQ

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HardNeurorehabilitationPost-Stroke Hemispatial NeglectSCE Neurology

A 22-year-old presents with a first severe attack of flaccid tetraparesis after a carbohydrate-heavy meal. Potassium is 2.1 mmol/L with U waves; acid-base status is normal and thyrotoxicosis is excluded. What is the safest acute replacement strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Monitored intravenous potassium with serial electrolytes

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

B is correct: severe paralysis with potassium below 2.5 mmol/L and ECG changes justifies cautious intravenous potassium, with continuous ECG and serial serum monitoring during and for hours after correction. In genetic hypokalaemic periodic paralysis potassium is shifted intracellularly rather than lost from the body, so aggressive replacement can cause rebound hyperkalaemia as the attack resolves. Bicarbonate worsens intracellular potassium shift. Observation alone is unsafe with tetraparesis and ECG abnormalities.

Reference: Skeletal muscle channelopathies: a guide to diagnosis and management: https://pn.bmj.com/content/21/3/196