IMH Case Of the Week – Surviving against all odds with Hyperkalemia of 9mmol/L - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

IMH Case Of the Week – Surviving against all odds with Hyperkalemia of 9mmol/L

 01 Mar 2024

Dr. Ahmad Mjallal

Specialist Nephrologist

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In the realm of medicine, miracles often materialize in the most unexpected circumstances, challenging our understanding and redefining the boundaries of possibility. The case of a 31-year-old previously healthy male, stands as a testament to the remarkable resilience of the human body and the transformative power of medical intervention.

Clinical Presentation:

Patient arrived at our hospital amidst a dire medical crisis, with symptoms of progressive weakness in his upper and lower limbs so severe that he required assistance from friends for mobility. The initial evaluation revealed a startling Potassium level of 9 mmol/L, paired with a normally functioning heart as indicated by a seemingly paradoxical ECG showing only peaked T waves. Additionally, patient displayed slightly low sodium, borderline blood sugar and blood pressure, and moderate metabolic acidosis. Amidst these concerning findings, the silver lining emerged in the form of normal kidney function, offering a glimmer of hope amidst the chaos.

Diagnostic Workup:

Driven by a sense of urgency, our medical team, led by Dr. Nagwa, our esteemed Endocrinologist, and Dr. Saad, our dedicated Critical Medicine Specialist, embarked on an exhaustive diagnostic journey. Immediate intervention commenced with urgent Hemodialysis aimed at swiftly correcting the perilously elevated potassium levels and safeguarding against potential cardiac complications. Simultaneously, a thorough investigation into hormonal disturbances was initiated, recognizing their potential significance in patient’s clinical presentation.

Key Finding:

In the ensuing days, amidst meticulous testing and analysis, a crucial discovery emerged – Patient exhibited persistently low cortisol levels, even following ACTH stimulation. This pivotal finding led to the diagnosis of Primary Adrenal Insufficiency, more commonly known as Addison’s disease. This adrenal gland dysfunction, characterized by inadequate cortisol production, explained the constellation of symptoms and laboratory abnormalities observed in our patient.

Treatment and Outcome:

With a definitive diagnosis in hand, Dr. Ahmad and team wasted no time in implementing appropriate treatment measures. Patient responded remarkably well to therapy, experiencing a rapid reversal of symptoms and normalization of laboratory parameters. Within a mere four days of hospitalization, he emerged from the grips of illness, once again “walking” on his own two feet. Remarkably, his diagnosis necessitated only two oral medications – steroids to replace deficient cortisol production and sodium bicarbonate to address metabolic acidosis.


This case serves as a poignant reminder of the profound impact of timely intervention, collaborative teamwork, and the resilience of the human spirit. Amidst the chaos of severe illness, miracles still find a way to manifest, illuminating the path towards healing and restoration. Let us remain steadfast in our commitment to advancing medical knowledge and fostering compassionate care, ensuring that every patient has the opportunity to defy the odds and reclaim their health and vitality.

Dr. Ahmad Mjallal
Specialist Nephrologist