HPI 

41 y.o. female PMHx familial hypokalemic periodic paralysis p/w weakness. 

• Mechanical fall from bed after a night of binge drinking. 
• Awoke with RUE, RLE weakness
• Notes hx weakness in past secondary to hypokalemia but never this severe

Physical Exam

BP 120/77  | Pulse 91 | Temp 98.8 °F (37.1 °C) (Oral)  | Resp 15 | SpO2 93%

• Distal R-sided extremities cold to touch
• Pulses intact 
• 2/5 strength in RUE/RLE

DDX

• CVA, ICH, hypokalemic periodic paralysis, peripheral nerve palsy, cervical neck/sacral injury, rhabdomyolysis

Management

• Stroke alert → imaging unrevealing for acute abnormality
• Labs results: hyperkalemia (8.4), elevated Cr (1.52), CK 63,780, 3+ blood on UA
• Re-examined patient → improving RUE strength but remains weak RLE with significant pain in the right hip and thigh
• R gluteal compartment: firm and tender → compartment pressure 34 mmhg
• Level 1 OR for gluteal compartment syndrome

Take Home Points

• ALWAYS fully examine the patient!
• Compartment syndrome
• Causes: fractures AND soft tissue injuries
• Soft tissue injuries: crush, exertional, prolonged immobilization, tissue infection, seizures, burns
• Complicated by rhabdo, renal failure
• 6P’s: pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia 
• Compartment pressures indicating fasciotomy
• Absolute > 30 mmHG
• Delta pressure < 30 mmHG

For a refresher on direct measurement of compartment pressures - click here!