Life-Threatening Laryngeal Oedema Secondary to Electrolytes Imbalance: Implications for an Otolaryngologist

Introduction: Electrolytes are essential for normal functioning of every system in the body and their imbalance can have serious consequences. Some of the well known complications include cardiac arrhythmias, neuromuscular instability, myopathy, cerebral oedema, and osmotic demyelination which can prove fatal. However, less commonly known complication arising from electrolyte imbalance is stridor associated with vocal cord paralysis and / or laryngeal oedema. Known risk factors for electrolytes imbalance include old age, diabetes mellitus, diuretics, pure water hydration and gastrointestinal tract losses.

Aims: To raise awareness among Otolaryngologists about the importance of electrolyte imbalance that could potentially compromise the airway.

Methods: Two case reports with literature review.

Results: A 60 year old Caucasian female developed proximal muscle weakness associated with a 2 weeks history of diarrhoea. She was found to have hypokalaemia of 1.7 and other electrolytes were deranged as well. She continued to deteriorate and required intubation and ventilation because of respiratory muscles involvement. She failed extubation trial and was noted to have severe endolaryngeal oedema. She required surgical tracheostomy. As the electrolytes were corrected, her muscular weakness and laryngeal oedema improved and she made full recovery.

A 63 year old Caucasian male presented with stridor and confusion with a preceding 1 week history of sore throat and dysphagia. On examination he had severe laryngeal oedema that required emergency debulking and subsequently he was kept intubated and ventilated. He was found to have hyponatraemia of 112 that was gradually replaced with improvement in his laryngeal swelling.

Conclusions: Stridor and laryngeal oedema can be the presenting features of deranged electrolytes. Such patients should be looked after in a multidisciplinary team setting involving the Endocrinologists, Intensivists and Otolaryngologists.