Refractory ventricular tachycardia storm associated with severe hypokalemia in Fanconi syndrome

Rodriguez, Alex P.; Badiye, Amit; Lambrakos, Litsa K.; Ghodsizad, Ali; Myerburg, Robert J.; Goldberger, Jeffrey J.

Initial laboratory data demonstrated profound metabolic disarray including hypokalemia to 2.5 mmol/L, bicarbonate 13 mmol/L, hyperchloremia 122 mmol/L, blood urea nitrogen 31 mg/dL, and creatinine at 3.77 mg/dL. Magnesium was normal (2.5 mg/dL) and calcium was borderline lownormal (8.5 mg/dL). Toxicology and coagulation panels were unremarkable. Thyroid studies revealed a low T3 and thyroid-stimulating hormone, but normal free T4. Cardiac biomarkers remained negative despite cardiopulmonary resuscitation and defibrillation shocks. Bedside echocardiography demonstrated a preserved ejection fraction (EF) and no wall motion abnormalities, pericardial effusion, or evidence of structural heart disease. Chest radiograph did not reveal any obvious acute cardiopulmonary process.