Hypokalemic Periodic Paralysis With Reversible Electrophysiological Abnormalities: A Case Report

Shoaib Bhatti, Tahniyat Huq, Syed Mohammad Mazhar Uddin, Aatera Haq, Syed Faheem Ali Kazmi, Uzair Yaqoob, Haider Shah

Abstract


Hypokalemic periodic paralysis (HPP) is a reasonably rare condition, presenting complains being those associated with acute systemic weakness and hypokalemia. Majority of the cases are characterized as familial or primary, whereas sporadic cases are associated with various other conditions such as barium poisoning, hyperthyroidism, renal disorders, endocrinopathies and gastrointestinal potassium losses. We report a unique case in a 5-year-old female child following gastrointestinal losses (vomiting and diarrhea). According to the patient’s mother, for the past 2 days, she was lethargic, unable to walk and hold the neck. She underwent pyelolithotomy for recurrent kidney stones 5 years back. Her neurologic examination revealed diminished bulk overall, decreased tone, power and reflexes in lower limbs with down-going plantars. Labs (except potassium) and electrocardiography were normal. Nerve conduction studies (NCS) favored the diagnosis of Guillain-Barre syndrome. Intravenous immunoglobulin and potassium replacement was started. After a week, patient’s condition had a remarkable improvement. We did a repeat NCS which came out to be normal. Potassium serum values were normal too. We turned back to the other differential diagnosis of HPP. Our case report highlights several important factors. Firstly, it states that the NCS can be deceptive in patients with flaccid paralysis, especially when we are not suspecting hypokalemia. It further explains the importance of suspecting a diagnosis of HPP in a patient presenting with features of Guillain-Barre syndrome following an NCS.




J Med Cases. 2018;9(6):177-178
doi: https://doi.org/10.14740/jmc3058w

Keywords


Hypokalemia; GBS; Nerve conduction studies; Hypokalemic periodic paralysis

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