Recurrent Severe Hypokalemia Presenting With Acute Generalized Weakness and Persistent Creatinine Elevation: A Case Report

Abstract

Recurrent severe hypokalemia may cause profound neuromuscular weakness and requires systematic evaluation to identify the underlying mechanism. We report a 45-year-old man with repeated episodes of severe hypokalemia from 2024 to 2026, presenting with acute generalized weakness and inability to walk. Serum potassium was 1.8 mmol/L during the index admission and had previously reached 1.6 mmol/L; a later recurrence showed 1.55 mmol/L. Serum creatinine remained persistently elevated at approximately 1.6–1.8 mg/dL, while abdominal ultrasonography showed no structural renal abnormality. Potassium replacement produced partial biochemical improvement, but recurrence occurred five months later. The available data were insufficient to establish whether renal loss, gastrointestinal loss, intracellular redistribution, medication exposure, or heavy cigarette smoking was responsible. This case emphasizes that correction of serum potassium alone is insufficient in recurrent hypokalemia and that longitudinal etiological evaluation, renal monitoring, and assessment of modifiable risk factors are essential to prevent further episodes and associated clinical complications.