In Reply. —Sadjadi is correct in stating that diarrhea from any cause may produce hypokalemia. The uniqueness of the reported case is the association of Yersinia-induced diarrhea, severe hypokalemia, rhabdomyolysis, and flaccid quadriparesis.
Besides the diarrhea-induced hypokalemia, no other explanation was apparent for the patient's rhabdomyolysis and quadriparesis. There was no evidence of an acid-base disorder, the serum calcium and magnesium concentrations were both normal, and there are no known neurotoxins associated with Yersinia enterocolitica. Rose1 notes that hypokalemia of simi(Continued on p 686.) (Continued from p 683.) lar magnitude may produce quite different amounts of muscle weakness in different individuals. He states that hypokalemia-induced muscle paralysis is more likely to occur in the setting of an intracellular potassium shift rather than through chronic potassium loss. However, an intracellular shift cannot be invoked in this case. While rhabdomyolysis and quadriparesis both occur more commonly with a serum potassium