Hypokalemic paralysis and crohn’s disease (cd): report of two cases

Abstract

Background: Hypokalemic Paralysis (HP) is a rare condition that can be acquired or due to an inherited channelopathy. Objective: To describe the clinical, electrodiagnostic and neurological findings of two patients from a cohort of Brazilian Inflammatory Bowel Disease (IBD) patients who presented with hypokalemic paralysis. Methods: Patients underwent neurological evaluation, including detailed neurological exam and electrodiagnostic testing. The study was approved by the local IRB. Results: Patient 1: A 18 year-old man with a 2-year history of CD presented with acute generalized muscle weakness, dysarthria and limb paresthesias. Initial tests revealed hypokalemia (2.8 mEq/L), hypocalcaemia and hypomagnesaemia. Hypokalemic paralysis was diagnosed. Replacement of electrolytes was performed, with full recovery of muscle strength. Exams showed normal urinary electrolytes and preserved renal function. Patient had had major weight loss in the prior months and important generalized muscle atrophy. EMG revealed generalized axonal sensorimotor neuropathy. Patient 2: A 30 year-old female with 10 years of CD presented with acute generalized paralysis and hyporreflexia. Initial evaluation showed hypokalemia (1.5 mEq/L), hypocalcaemia and hyponatremia. After electrolytes replacement, the paralysis was reversed. Further investigation showed normal urinary electrolytes and preserved renal function. She subsequently had seizure episodes, several bouts of CD relapse, associated with fistulae as well as additional episodes of weakness also associated with lower limbs paresis and edema. Clinical improvement happened after the stabilization of the CD relapse. EMG revealed right peroneal neuropathy at the fibular head. Conclusions: HP may be present in patients with CD, secondary to fecal/diarrheal potassium loss and bowel inflammation.