Familial hypokalemic periodic paralysis in pregnancy: A case report

Abstract

Familial hypokalemic periodic paralysis (f-hypoPP) is a rare neuromuscular disorder causing intermittent muscle paralysis. Pregnancy can exacerbate f-hypoPP, yet obstetric management is not well documented. We present a case of a nulliparous woman with f-hypoPP, outlining a complete prenatal care plan generalizable to other women with known f-hypoPP. To our knowledge, this is the first obstetric f-hypoPP case to prioritize intrapartum oral potassium over intravenous potassium, as well as to outline the importance of multidisciplinary care. The patient had a spontaneous vaginal delivery at term with an uneventful postpartum period. Muscle weakness and episodes of relative hypokalemia in the second trimester and during labor were effectively treated with oral potassium supplementation. Care was provided by a multidisciplinary team, and caution was taken to avoid known triggers of paralytic episodes.

A Successful Obstetric Outcome in a Woman With Familial Hypokalemic Periodic Paralysis: Challenges in Management

“…Proper monitoring of the cardiac status and serum potassium level (four to six hourly) during therapy is mandatory for dose titration. Intravenous administration of potassium through media such as normal saline, ringer lactate, or mannitol can be used rather than dextrose-containing fluids as it triggers an attack [2,9]. The choice of continuing oral potassium in the antenatal or postnatal period should be individualized.…”

“…The well-known complications of hypokalaemia are life-threatening, such as cardiac arrhythmias and respiratory muscle paralysis, and in severe cases, rhabdomyolysis has also been reported [1]. Pregnancy is known to cause worsening of familial hypokalemia periodic paralysis, but there are no guidelines or protocols for managing a pregnant woman with this condition [2]. Although most cases are genetically inherited, women are rarely affected due to the incomplete penetrance of the genes [3].…”

Unusual Clinical Presentation of Periodic Paralysis: Case Report and Literature Review

“…The effect of hypokalemia symptoms depends on the severity and acuity of the change in the potassium level. [5]…”