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Sara S, Tv D, Dg G, Elumalai B, Javid M. A Rare Case of Hypokalemic Periodic Paralysis With Acute Urinary Retention: Diagnosis and Management. Cureus 2024; 16:e52839. [PMID: 38406120 PMCID: PMC10884782 DOI: 10.7759/cureus.52839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Hypokalemic periodic paralysis (hypoPP) is a rare channelopathy caused by mutations in skeletal muscle ion channels that usually occurs in young individuals and adolescents. The etiology can be attributed to various factors, such as idiopathic or secondary causes. It is characterized by episodes of sudden flaccid muscle weakness. Timely detection may mitigate the risk of severe complications. Secondary causes of hypoPP, such as hyperthyroidism, should be ruled out, as this could lead to thyrotoxic periodic paralysis. We report the case of a 19-year-old boy who presented to the ED with severe weakness in both the upper and lower extremities. The weakness rapidly progressed to his trunk and was accompanied by acute urinary retention. The physical examination was significant for bilateral upper and lower extremity weakness. Subsequent laboratory investigations revealed markedly low serum potassium levels. The patient's symptoms resolved after the replacement of potassium, and he was discharged without neurological deficits. Although rarely accompanied by acute urinary retention, hypoPP must be differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly. The rarity of hypoPP, a condition seldom encountered in clinical practice, and the added rarity of its coexistence with acute urinary retention further underscore the uniqueness of this case report.
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Affiliation(s)
- S Sara
- Internal Medicine, Public Health Centre, Chennai, IND
| | - Dhigvijay Tv
- General Surgery, Sri Saraswathi Hospital and Surgical Center, Krishnagiri, IND
| | - Gokulesh Dg
- Internal Medicine, Madras Medical College, Chennai, IND
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Shankar M, Nayaka M, Aralapuram K, Gurusiddaiah SC. Wilson's Disease Presents as Recurrent Hypokalemic Muscle Paralysis. Indian J Nephrol 2023; 33:292-295. [PMID: 37781558 PMCID: PMC10503580 DOI: 10.4103/ijn.ijn_143_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 11/23/2022] Open
Abstract
A 21-year-old euthyroid gentleman born to nonconsanguineous parents was diagnosed with bipolar affective disorder. He presented 4 years later with hypokalemic quadriparesis. On evaluation, he was found to have features of both proximal and distal renal tubular acidosis. Ophthalmologic examination by slit lamp confirmed the presence of the Kayser-Fleischer ring. The diagnosis of Wilson's disease was established with serum ceruloplasmin levels and 24-h urinary copper levels.Here is a rare clinical presentation of Wilson's disease in the form of hypokalemic muscle paralysis due to proximal renal tubular acidosis with distal tubule involvement. The diagnosis was delayed due to the initial presentation with psychiatric symptoms.
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Affiliation(s)
- Mythri Shankar
- Assistant Professor, Department of Nephrology, Institute of Nephro-Urology, Bengaluru, Karnataka, India
| | - Monica Nayaka
- Senior Resident, Department of Nephrology, Institute of Nephro-Urology, Bengaluru, Karnataka, India
| | - Kishan Aralapuram
- Associate Professor, Department of Nephrology, Institute of Nephro-Urology, Bengaluru, Karnataka, India
| | - Sreedhara C. Gurusiddaiah
- Head of the Department, Department of Nephrology, Institute of Nephro-Urology, Bengaluru, Karnataka, India
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Vivek A, Sengar P, Chaurasia RN, Pathak A, Kumar A, Singh VK. Hyperkalemic Periodic Paralysis in Twenty-Two Family Members Over Four Generations: A Rare Case Report. Ann Indian Acad Neurol 2023; 26:595-597. [PMID: 37970276 PMCID: PMC10645229 DOI: 10.4103/aian.aian_425_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Ankur Vivek
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pratishtha Sengar
- Department of Pathology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anand Kumar
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Luís T, Linhares MI, Silva SR, Rodrigues F. Novel CACNA1S mutation in hypokalaemic periodic paralysis. BMJ Case Rep 2022; 15:e245952. [PMID: 35039355 PMCID: PMC8768461 DOI: 10.1136/bcr-2021-245952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/03/2022] Open
Abstract
A 15-year-old girl was admitted to emergency department with an acute flaccid tetraparesis with no other symptoms. A history of recurrent similar episodes with spontaneous recovery was reported and no family history was known. Laboratory tests revealed severe hypokalaemia and hypokaluria. Symptoms resolution occurred after potassium replacement. The diagnosis of hypokalaemic periodic paralysis (HPP) was confirmed by genetic testing, which revealed a not previously described mutation in CACNA1S gene (c.3715C>G p.Arg1239Gly). HPP is a rare neuromuscular disorder that causes episodic attacks of flaccid paralysis with concomitant hypokalaemia. Primary forms of the disease are skeletal muscle ion channelopathies. HPP occurs due to a problem in potassium distribution rather than a total body potassium deficiency. Therefore potassium replacement should be carefully performed because of the risk of rebound hyperkalaemia. Knowing this rare entity is important in order to avoid diagnostic delays and so that proper treatment can be initiated to reduce morbidity and mortality.
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Affiliation(s)
- Telma Luís
- Department of Pediatrics, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Maria Inês Linhares
- Centro Hospitalar e Universitario de Coimbra EPE Hospital Pediatrico de Coimbra, Coimbra, Portugal
| | - Sónia Regina Silva
- Department of Pediatrics, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Filipa Rodrigues
- Department of Pediatrics, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
- Child Development Unit-Neuropediatrics, Department of Pediatrics, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
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Abdelmasih R, Abdelmaseih R, Hasan M, Nasser H. A Case of Hypokalemic Periodic Paralysis in a Young Athlete. Cureus 2021; 13:e15236. [PMID: 34188982 PMCID: PMC8232928 DOI: 10.7759/cureus.15236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypokalemic periodic paralysis (HPP) is one of the group muscle disorders that can cause sudden onset paresis or paralysis. It is a quite rare, yet, potentially life-threatening condition that, if appropriately and promptly diagnosed and treated, can be completely reversed. Other forms of periodic paralysis include thyrotoxic periodic paralysis, hyperkalemic periodic paralysis, and Anderson syndrome. We are presenting a case of a young male who presented to the emergency department (ED) with sudden paralysis to shed light on such a diagnosis and on other differential diagnoses.
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Affiliation(s)
- Randa Abdelmasih
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Ramy Abdelmaseih
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Mustajab Hasan
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Hesham Nasser
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
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Modi HN, Shreshtha U, Lakhani O. Hypokalemic Paraparesis Progressing to Quadriparesis in a Case of Intradural Spinal Tumor. J Orthop Case Rep 2020; 10:47-51. [PMID: 34169016 PMCID: PMC8046447 DOI: 10.13107/jocr.2020.v10.i09.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction This study aims to present a case of spinal intradural tumor with paraparesis referred for surgery, which later progressed to quadriparesis and subsequently found to have hypokalemia due to primary hyperaldosteronism causing a clinical dilemma. Case Report A 46-year-old male was referred for surgery from peripheral center with a diagnosis of an intradural tumor at L1. The patient presented to us with paraparesis, which progressed to quadriparesis. On evaluation, the patient was found to have low serum potassium levels of 1.6 mmol/L with hypertension. The plasma aldosterone-renin was elevated which was suggestive of primary hyperaldosteronism. Further, investigations in the form of CT abdomen suggested the presence of a right adrenal adenoma. The patient was diagnosed with hypokalemia-induced quadriparesis and treated conservatively with potassium supplementation and later spironolactone. The patient recovered completely in 72 h and was able to walk independently before discharge. Conclusion Spinal tumor may not always be the cause for patient's paraparesis; non-spinal factors such as hypokalemia should be kept in mind. The presence of intradural spinal tumor with hypokalemia may cause decision dilemma regarding treatment and interdisciplinary approach is recommended to facilitate the treatment.
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Affiliation(s)
- Hitesh N Modi
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Ahmedabad. Gujarat. India
| | - Utsab Shreshtha
- Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Ahmedabad. Gujarat. India
| | - Om Lakhani
- Department of Endocrinology, Zydus Hospitals and Healthcare Research Private Limited, Ahmedabad. Gujarat. India
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Liu JK, Sim SS, Hsieh FC, Wu YH. Intravenous potassium solution boluses save a life from hypokalemic cardiac arrest. Am J Emerg Med 2019; 38:162.e1-162.e2. [PMID: 31422859 DOI: 10.1016/j.ajem.2019.158393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jen-Kuei Liu
- Residency Program in Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shyh-Shyong Sim
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fu-Chien Hsieh
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
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Paralysie périodique thyrotoxique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Thyrotoxic hypokalemic periodic paralysis is characterized by acute attacks of muscle paralysis, hypokalemia, and thyrotoxicosis. It is a medical emergency, as fatal and life-threatening ventricular arrhythmia associated with hypokalemia has been reported. A 24-year-old man presented with severe lower extremity weakness, which progressed to his trunk and arms. He denied any associated symptoms and had no history of a similar episode or predisposing condition. The physical examination was significant for bilateral extremity weakness, more severe in the lower as compared to the upper extremities. The rest of the neurologic exam was normal. A small, smooth, nontender goiter was palpated. Laboratory data was significant for a potassium level of 2.0 mEq/L. Final lab data revealed a thyroid panel consistent with hyperthyroidism. Once the patient's potassium level normalized after repletion, he recovered his strength and was able to walk again. He was diagnosed with thyrotoxic hypokalemic periodic paralysis, a potentially lethal complication of hyperthyroidism. Because it is reversible with treatment of hyperthyroidism, it is imperative that this condition be considered, recognized and managed appropriately.
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Affiliation(s)
- Heba Haddad
- Internal Medicine Resident, Olive View-UCLA Medical Center , Sylmar, CA , USA
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Ranjan A, Debata PK. A case of periodic hypokalemic paralysis in a patient with celiac disease. J Clin Diagn Res 2014; 8:PD03-4. [PMID: 25121038 DOI: 10.7860/jcdr/2014/8372.4483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/18/2014] [Indexed: 11/24/2022]
Abstract
A 4-year-old male child presented with recurrent episodes of diarrhoea for 6-months, each episode associated with weakness of all four limbs and documented hypokalemia who on examination had some pallor, short stature, flaccid quadriparesis with absent DTR. The patient responded clinically and biochemically to potassium supplement. TTG and Intestinal biopsy confirmed celiac disease. Patient was put on gluten free diet and patient is doing well with no recurrence. We present a case of Recurrent hypokalemic paralysis with previously unsuspected celiac disease who was not in celiac crisis.
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Affiliation(s)
- Amitabh Ranjan
- Senior Resident, Deprtment of Paediatrics, Safdarjung Hospital and VMMC , New Delhi, India
| | - Pradeep K Debata
- Specialist, Department of Paediatrics, Safdarjung Hospital and VMMC , New Delhi, India
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Turcotte J, White D, Tilney PVR. Hypokalemic periodic paralysis: two cases of profound weakness. Air Med J 2013; 32:181-189. [PMID: 23816210 DOI: 10.1016/j.amj.2013.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 06/02/2023]
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Abstract
Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. Clinical assessment should aim to distinguish proximal myopathy from other conditions that can present similarly, identify patients who need prompt attention, like those with cardiac, respiratory or pharyngeal muscle involvement, and determine underlying cause of myopathy. Initial evaluation should include simple tests, like creatine kinase, thyroid function and (25)OH vitamin D levels, but further evaluation including neurophysiological studies, muscle imaging and muscle biopsy should be considered for patients in whom no toxic, metabolic or endocrine cause is found, and in those with clinical features suggestive of inflammatory or hereditary myopathy. Additionally, screening for malignancy and testing for anti-Jo1 antibody is indicated for selected patients with IIM. Management depends on underlying cause, and includes measures, such as removal of offending agent, correction of endocrine or metabolic problem, corticosteroids and immunosuppressive therapy for IIM, and physical therapy, rehabilitation and genetic counselling for muscular dystrophies.
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Affiliation(s)
- Ernest Suresh
- Department of Medicine, Alexandra Hospital, Singapore, Singapore.
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Sinha U, Sengupta N, Sinharay K, Sahana PK. Recurrent hypokalemic paralysis: An atypical presentation of hypothyroidism. Indian J Endocrinol Metab 2013; 17:174-176. [PMID: 23776877 PMCID: PMC3659891 DOI: 10.4103/2230-8210.107880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypothyroidism presenting as recurrent hypokalemic paralysis is rare in the literature. This transient and episodic neurological condition is commonly associated with thyrotoxicosis. We report a case of young female admitted with recurrent paralytic attacks since last 1 year. She had no symptom of hypothyroidism. She had weakness of all four limbs, delayed relaxation of ankle jerks, and normal higher mental function. There was no enlargement of thyroid. Serum potassium level ranged from 1.6 to 3.2 meq/L during attack with high serum creatine phosphokinase level. Electromyography was normal. The patient was diagnosed having chronic thyroiditis with high thyroid-stimulating hormone and thyroid-related antibodies. Follow up shows satisfactory result with thyroxine replacement. It is an extremely rare and unusual presentation of hypothyroidism, probably the fourth reported case of hypothyroidism with hypokalemic paralysis, to the best of our knowledge.
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Affiliation(s)
- Uma Sinha
- Department of Medicine, Nilratan Sircar Medical College, Kolkata, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, India
| | - Keshab Sinharay
- Department of Medicine, Nilratan Sircar Medical College, Kolkata, India
| | - Pranab K. Sahana
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, India
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Abstract
Hypokalemia is one of the most frequent electrolytic disturbances encountered in clinical practice. It usually presents with symmetrical generalized muscle weakness and, on occasions, with arrhythmias. There are scarce reports of cases presenting with asymmetric or focal weakness in the literature and no systematic reviews on the subject. Therefore, our aim is to describe 2 cases of hypokalemic paralysis that presented as monoparesis and to review the literature on focal hypokalemic paralysis. Hypokalemic paralysis is usually reversible. However, it can be fatal if the diagnosis and treatment are delayed. It is important to take into account this presentation because failure to recognize it could lead to misdiagnosis, delaying the adequate treatment.
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Yanagawa Y, Suzuki C, Imamura T. Recovery of paralysis in association with an improvement of hypomagnesemia due to alcoholism. Am J Emerg Med 2011; 29:242.e1-2. [PMID: 20825899 DOI: 10.1016/j.ajem.2010.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 02/27/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology andCritical Care Medicine , National Defense Medical College Tokorozawa, Saitama, Japan.
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