Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

Abstract

Background:Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis.Materials and Methods:We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability.Results:In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn's syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover.Conclusion:In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.

Idiopathic hypokalemic periodic paralysis: A series of cases clustered in a part of Eastern India

“…We had found hard work or heavy physical labor to be the commonest precipitating factor (Figure 3). Garg et al 13 had observed rest after exercise and rich meal to be the precipitating factors, corroborating our findings (Figure 3). No definite precipitating factor was found in eleven cases as well, suggesting the difficulty of predicting the attacks and formulate a preventive strategy.…”

“…In our study, the IHOPP cases did not have family history of similar weakness. We had found higher male affection (4.3:1) than Kayal et al 8 ( 2.73:1) but lower than Garg et al 13 (8.6:1). The age at first attack in our study was 4-50 years, median 23.5 years, whereas, Kayal et al 8 had found 15-92 years, mean 36.7 years and Garg et al 13 had found 16-47 years, mean 27.6 years.…”

“…We had found higher male affection (4.3:1) than Kayal et al 8 ( 2.73:1) but lower than Garg et al 13 (8.6:1). The age at first attack in our study was 4-50 years, median 23.5 years, whereas, Kayal et al 8 had found 15-92 years, mean 36.7 years and Garg et al 13 had found 16-47 years, mean 27.6 years. 44.65% cases had presented during their first attack in the study done by Kayal et al 8 .…”

“…No definite precipitating factor was found in eleven cases as well, suggesting the difficulty of predicting the attacks and formulate a preventive strategy. Kayal et al 8 found 68% and Garg et al 13 found 62% cases to have raised CPK. In comparison to one case of raised CPK in our study.…”

“…Thyrotoxic hypokalemic paralysis is common in the Asian population whereas familial periodic paralysis is common in Caucasians. [5][6][7] In India, until recently and excepting few, [8][9][10][11][12][13] no large case series have been reported.…”