Abstract
Hypokalemic Periodic Paralysis is one form of Periodic Paralysis, a rare group of disorders that can cause of sudden onset weakness. A case of a 29 year old male is presented here. The patient presented with sudden onset paralysis of his extremities. Laboratory evaluation revealed a markedly low potassium level. The patient's paralysis resolved upon repletion of his low potassium and he was discharged with no neurologic deficits. An association with thyroid disease is well established and further workup revealed Grave's disease in this patient. Although rare, Periodic Paralysis must differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly.
Highlights
A 29 year-old Hispanic male with no significant past medical history presented to the emergency room with sudden onset paralysis
The patient was diagnosed with Hypokalemic Periodic Paralysis associated with Grave's Disease and was started on methimazole for control of his underlying hyperthyroidism and a beta-blocker for control of blood pressure and tachycardia
Acetazolamide may prevent the paralytic episodes and antiarrhythmics or betablockers may prevent ventricular ectopy, but there is little data available. This patient presented with sudden onset paralysis and markedly abnormal potassium, Thyroid stimulating hormone (TSH), T3 and T4 levels but no significant symptoms of hyperthyroidism
Summary
A 29 year-old Hispanic male with no significant past medical history presented to the emergency room with sudden onset paralysis. The patient had been healthy and denied any recent diarrhea, chest pain, shortness of breath, or weight change He did report several episodes of waking from sleep with a "racing heart." He did not take any medications and denied use of alcohol or drugs, or significant changes in diet or activity levels. Neurologic exam revealed flaccid paralysis of all extremities which involved the proximal and distal muscles and included the hips and shoulders. Two hours after initiation of intravenous potassium replacement, the patient's neurologic symptoms had completely resolved His blood pressure remained elevated at 174/86, repeat electrocardiogram revealed a normal sinus rhythm and rate. He was discharged home with an appointment to follow up with an endocrinologist
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