Toluene Toxicity: A Case Report of Transdermal Exposure Causing Hypokalemic Paralysis

Toluene Toxicity: A Case Report of Transdermal Exposure Causing Hypokalemic Paralysis

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Rationale: Hypokalemia is a common finding.Typically asymptomatic presentations of neuromuscular weakness emerge at welding sweater levels below 2.5 mmol/L.Causes include gastrointestinal losses, renal losses, or intracellular shift, with gastrointestinal losses and diuretics accounting for the majority.Although the cause is often apparent on clinical assessment, a systematic approach incorporating urine biochemistry can aid in narrowing the differential in obscure cases.

Presentation: We describe a case of a previously healthy 27-year-old man who presented with acute ascending paralysis, with an associated severe hypokalemia and metabolic acidosis.There were no apparent causes on clinical assessment.Diagnosis: Based on analysis of urine biochemistry, we concluded that a pathologic kaluresis was present, and given his acidemia and transient pathology, we diagnosed the patient with hypokalemic paralysis secondary to toluene toxicity.Interventions: We provided supportive care and electrolyte repletion for our patient; no specific therapies for toluene were required.Our patient was counseled regarding appropriate protective measures when handling toluene.

Outcomes: Complete neurologic recovery and biochemical normalization occurred within 48 hours of presentation with supportive care.He continued to use proper precautions when handling toluene, 12n/1200 wella and experienced no symptom relapse, or further abnormalities on both blood and urine chemistry.Lessons learned: Using this case, we review an algorithmic approach incorporating urine biochemistries to aid in the workup of hypokalemia.We review toluene as a toxicologic entity and highlight its role as a cause of hypokalemia.