BRIEF COMMUNICATION An Unusual Clinical Sign Mydriasis Associated with Hyperkalemia and Metabolic Acidosis

MUSCLE PARESIS OR PARALYSIS is infrequently associated with hyperkalemia (1-3). Th i s relat ionship was noted in the case presented here and was part icularly interest ing because of associated mydriasis. T r e a t m e n t of the hyper-kalemia resulted in a p r o m p t remission of all muscle signs, including the mydriasis. C A S E R E P O R T A 15-year-old white boy was admitted to a hos-pital because of uremia secondary to right uretero-pelvic obstruction and congenital absence of the left kidney. There was no family history of renal or muscle disease. A right nephrostomy was per-formed, but the patient's clinical condition con-tinued to deteriorate, and the blood urea nitrogen rose from 30 to 190 mg/100 ml. The patient was transferred to The New York Hospital for consideration of hemodialysis with the artificial kidney. On admission, deep respira-tions were evident, and the patient complained of muscle weakness and paresthesias. Within 15 min after the patient was moved from the transport stretcher to a bed, paresis had progressed to flaccid paralysis of almost all the skeletal muscles. Respira-tions became shallow, but cyanosis was not present. Both pupils were markedly dilated and did not respond to a light stimulus. Blood pressure was 100/50 mm Hg; pulse, 104/min; and temperature, 37 C. Blood studies revealed a plasma potassium o