Rapidly Resolving Weakness Related to Hypokalemia in Patients Infected With Dengue Virus

Abstract

Dengue-associated acute hypokalemic paralysis is an underrecognized entity having favorable outcome. It should be suspected in patients presenting as acute pure motor quadriparesis after febrile illness in dengue endemic areas.

Neurological Manifestations of Dengue Infection

“…The severity of weakness may not correlate with potassium levels in Maurya's report (Maurya et al, 2016 ). Hypokalemia does not always lead to paralysis.…”

“…Until 2012, neurological complications of dengue virus infection were classified into three categories based on pathogenesis as proposed by Murthy, Marzia and colleages: (1) metabolic disturbance, e.g., encephalopathy; (2) viral invasion, including encephalitis, meningitis, myositis, and myelitis; (3) autoimmune reactions, including acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis, myelitis, encephalopathy, and Guillain-Barré syndrome (Murthy, 2010 ; Puccioni-Sohler et al, 2012 ). In recent years, Solbrig et al reported neurological involvements of the CNS and eyes, associated peripheral nervous system (PNS) syndromes, and convalescent or post-dengue immune-mediated syndromes (Solbrig and Perng, 2015 ; Maurya et al, 2016 ).…”

“…Dengue-associated hypokalemic paralysis was reported by several authors, but most studies were based on isolated case reports and short series (Esack et al, 1999 ; Santos et al, 2004 ; Kalita et al, 2005 ; Jha and Ansari, 2010 ; Roy et al, 2011 ; Jain et al, 2014 ; Maurya et al, 2016 ). Maurya and colleagues assessed 12 dengue patients with hypokalemic paralysis, who had complete and rapid recovery after potassium supplementation (Maurya et al, 2016 ).…”

“…Hypokalemic paralysis differs from dengue myositis and idiopathic hypokalemic paralysis according to clinical, biochemical features, and consequences (Maurya et al, 2016 ). It represents a systemic complication of dengue fever (Murthy, 2010 ; Jain et al, 2014 ).…”

“…The pathogenesis of hypokalemic paralysis in dengue remains obscure. A probable explanation for hypokalemia in dengue is serum potassium redistribution in cells and transient kidney tubular dysfunction increasing urinary potassium elimination (Jha and Ansari, 2010 ; Jain et al, 2015 ; Maurya et al, 2016 ). In addition, infection-related stress may lead to catecholamine or insulin release, which results in an intracellular shift of potassium (Jha and Ansari, 2010 ; Hira et al, 2012 ).…”