A case of successful resuscitation from hypokalemic cardiac arrest using rapid intravenous potassium

A 31-year-old male with no prior comorbidities presented with rapid-onset quadriparesis following one week of non-bloody diarrhea. Initial evaluation revealed severe hypokalemia (1.41 mmol/L) and an electrocardiogram (ECG) demonstrating signs of cardiotoxicity (irregular rhythm, diffuse ST depression, prominent U waves, and prolonged QT interval). The patient subsequently experienced cardiac arrest due to polymorphic ventricular tachycardia (VT). VT was refractory to an initial 200 J DC shock but terminated following the rapid intravenous administration of a 40 mEq potassium chloride (KCl) bolus over 5 min. The patient achieved Return of Spontaneous Circulation (ROSC). Subsequent laboratory workup, including a low urine potassium concentration (10.20 mmol/L), confirmed the etiology was massive extra-renal (gastrointestinal) potassium loss. The patient made a full recovery, highlighting the critical role of prompt, aggressive potassium replacement in severe hypokalemic cardiotoxicity.