Indian Journal of Anaesthesia  
About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions
Home | Login  | Users Online: 2355  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size    




 
 Table of Contents    
LETTERS TO EDITOR
Year : 2019  |  Volume : 63  |  Issue : 6  |  Page : 498-499  

Acute onset quadriparesis following oesophagectomy due to isolated hypophosphataemia


Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Date of Web Publication11-Jun-2019

Correspondence Address:
Dr. Abhijit S Nair
Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad - 500 034, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_22_19

Rights and Permissions

How to cite this article:
Naik VM, Saifuddin MS, Nair AS, Rayani BK. Acute onset quadriparesis following oesophagectomy due to isolated hypophosphataemia. Indian J Anaesth 2019;63:498-9

How to cite this URL:
Naik VM, Saifuddin MS, Nair AS, Rayani BK. Acute onset quadriparesis following oesophagectomy due to isolated hypophosphataemia. Indian J Anaesth [serial online] 2019 [cited 2019 Jun 19];63:498-9. Available from: http://www.ijaweb.org/text.asp?2019/63/6/498/259938



Sir,

A 65-year-old male weighing 50 kg with carcinoma oesophagus received neo-adjuvant chemotherapy (carboplatin and paclitaxel) and radiation and subsequently underwent transhiatal oesophagectomy under general anaesthesia after an elaborate preoperative workup which was unremarkable. His past medical and surgical history was unremarkable. All preoperative laboratory investigations including electrolytes were within normal limits. At the end of surgery, the patient was shifted to the surgical intensive care unit and the trachea was extubated uneventfully after 2 h. On postoperative day (POD) 2, high flow oxygen therapy was initiated via nasal cannula as he developed bibasal atelectasis, had poor incentive spirometry efforts and had a PaO2/FiO2 ratio of 175. On POD3, he developed sudden onset atrial fibrillation (AF) with fast ventricular rate which was managed with IV amiodarone. About 24 h after new onset AF, patient developed acute onset flaccid quadriparesis which raised a suspicion of thromboembolic phenomenon. This was ruled out on echocardiography (right heart function and chambers were normal with normal biventricular function) and a normal computed tomography scan of brain. Meanwhile, sample for serum electrolytes (sodium, potassium, chloride, calcium, magnesium and phosphate) was sent. Serum phosphate was 1.7 mg/dl (normal range 2.5–4.5 mg/dl), which was very low. Correction with intravenous injection Potphos™ (93 mg/ml of phosphorus and 170 mg/ml of potassium chloride) available as 15 ml vial (manufactured by Neon Laboratories Ltd.) was started. Values of other electrolytes were within normal limits. The acute onset quadriparesis recovered in 45 min of starting phosphorus correction. The patient was thereafter treated with IV Potphos™ 1 vial/day for 3 days and was later on advised to use Addphos™ sachet (available as 3.2 g sachet, manufactured by Steadfast Medishield Pvt. Ltd.), which contains 1.936 g of sodium acid phosphate, for 2 weeks. He was transferred to ward on POD 8. Serum phosphorus level measured prior to discharge was 3.5 mg/dl which was considered within normal range.

There could be numerous causes of hypophosphataemia in post-oesophagectomy patients. Prolonged use of antacids, poor nutritional status, re-feeding syndrome, acute respiratory alkalosis, and bronchodilator use can all contribute to hypophosphatemia in the early postoperative period.[1] Severe hypophosphataemia has been demonstrated as a rare cause of early postoperative weakness.[2] It is a documented complication after hepatic surgery with multifactorial cause including increased excretion in urine due to phosphatonins.[3] To the best of our knowledge, similar acute onset symptoms of hypophosphataemia have not been described after oesophagectomy. We suggest monitoring phosphate levels in the early postoperative period for oesophagectomy patients. As suggested by Ianov et al.,[4] phosphorus correction should be done slowly at the rate of 10–45 mmol in 6–8 h (10 mmol = 1395 mg phosphorus which is present in 15 ml of potassium phosphate infusion).

Consent was taken from the patient for publication in a medical journal for academic purpose without disclosing the name.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Imel EA, Econs MJ. Approach to the hypophosphatemic patient. J Clin Endocrinol Metab 2012;97:696-706.  Back to cited text no. 1
    
2.
Sprung J, Weingarten TN. Severe hypophosphatemia: a rare cause of postoperative muscle weakness. J Clin Anesth 2014;26:584-5.  Back to cited text no. 2
    
3.
Datta HK, Malik M, Neely RD. Hepatic surgery-related hypophosphatemia. Clin Chim Acta 2007;380:13-23.  Back to cited text no. 3
    
4.
Ianov I, Wilkerson DL. Hypophosphatemia and acute postoperative respiratory distress. J Ark Med Soc 2010;106:265-6.  Back to cited text no. 4
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed106    
    Printed0    
    Emailed0    
    PDF Downloaded33    
    Comments [Add]    

Recommend this journal