Hypokalaemia induced paralytic ileus

Mythili1*, Sofiya2

1Nursing In charge, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

2Clinical Instructor, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

*Correspondence

Introduction

A 54-year-old male came to the emergency department with complaints of decreased responsiveness associated with reduced food intake for the past three days and constipation for three days. He also had a history of chills and rigors, along with decreased urine output for the past three days. He is a known case of hypertension and irritable bowel syndrome with a possible history of compensated liver disease. He is also a chronic alcoholic and smoker.

Definition

Hypokalaemia induced paralytic ileus is a condition in which low potassium levels in the blood lead to temporary paralysis of the intestinal muscles. It is a type of functional intestinal obstruction caused by decreased gastro intestinal motility due to hypokalaemia.

On Examination

General Condition: Drowsy, Arrousable, Afebrile

Vital sign

Temp98.60f
Heart Rate98bpm
Blood Pressure80/40mmof Hg
Respiratory Rate22bpm
Spo296% with 2 Lit Oxygen

Neuromuscular System

GCSE4v5m6: 15/15
Pupils2mm Equally Reacted to Light

Gastrointestinal System

InspectionAbdomen distended, reduced bowel movements
PalpationMild tenderness present
PercussionGastric distension present
AuscultationBowel sounds absent

Signs and Symptoms

  • Abdominal distension
  • Constipation or inability to pass stool and gas
  • Nausea and vomiting
  • Decreased or absent bowel sounds
  • Generalized weakness
  • Diffuse abdominal comfort

Pathophysiology

Muscle Membrane Hyperpolarization: Potassium plays a critical role in maintaining cell membrane potential. A reduction in extracellular potassium increases the ratio of intracellular-to-extracellular potassium, which hyperpolarizes the smooth muscle cell membrane.

Impaired Action Potential Generation: Hyperpolarization makes it harder for the smooth muscle cells to reach the threshold for contraction, slowing or stopping muscle contraction in the gut.

Enteric Neural Dysfunction: Hypokalaemia interferes with the Neural Conduction within the Enteric Nervous System (ENS), which is responsible for coordinating GI motility patterns.

Accumulated Effects: Paralytic Ileus often arises from a combination of these factors, especially when aggravated by postoperative trauma, sepsis, or medication, leading to significant bowel distension.

Medical Management

  • Rifagut 150mg
  • Meropenem 1g
  • Pan 40mg
  • Duphalac 15ml
  • Looz Enema
  • Vit- K 10mg
  • Thiamine 200mg
  • Potassium Correction 60meq In 100ml Ns Over 4 Hours (25meq/Hr)
  • Ionotropic Supports

Nursing Management

  • Continuous Neurological Assessment (GCS Monitoring).
  • Maintenance of airway and oxygen therapy.
  • Proper positioning and use of nimbus bed to prevent pressure sores.
  • RT feed administration and tolerance monitoring.
  • Catheter care and intake-output charting.
  • Mouth care and back care to maintain hygiene.
  • Strict infection control practices.
  • Emotional support to family and coordination for discharge planning

Nursing interventions

  • Airway management: maintain o₂ therapy, monitor saturation.
  • Nutrition: administer RT feeds as per schedule.
  • Skin care: two-hourly repositioning and pressure area care.
  • Elimination: catheter care and documentation.
  • Neurological observation: monitor level of consciousness and limb movement.
  • Medication administration: as prescribed (Antibiotics, Anti-hypertensive, etc.).

Outcomes

  • Persistent shock requiring high dose of inotropes
  • Refractory hypokalaemia
  • Organ failure present
  • Low GCS
  • Airway protection

Patient satisfaction and feedback

Family expressed satisfaction with the multidisciplinary team’s efforts and care during hospital stay. They were counselled about prognosis and post-discharge plan.

Evaluation

The care plan was effectively implemented with timely nursing interventions, infection prevention, and supportive therapy. Electrolytes maintained with correction support. Inotropes supports provided.

Conclusion

He presented to the hospital with complaints of drowsiness reduced oral intake, reduced urine output for 3 days. In view of hemodynamic instability, he was shifted to ICU. He was initiated on vasopressors. Baseline investigations revealed altered renal, liver function. 2d echo showed normal cardiac function. Cultures were sent and initiated on antibiotics medical gastroenterologist opinion was obtained and advice followed. He had worsening hemodynamic instability and drop in sensorium. He was intubated in view of airway protection. On reassessment he had severe left ventricular dysfunction with elevated biomarkers. Cardiology opinion was obtained and advice followed his vasopressor requirement gradually worsened and poor prognosis was explained in detail to attendants. He developed sudden bradycardia followed by cardiac arrest, despite adequate resuscitation measures he could not be revived and in being declared dead at 12.38hrs on 16.02.2026

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment