Secondary hypokalemic non-periodic paralysis in a case of intractable hyperemesis gravidarum – A maternal near miss

Abstract

Hyperemesis Gravidarum is a debilitating early pregnancy complication causing Hypokalemia and associated morbidity if timely recognition and intervention is not initiated. A rare sequelae of intractable hyperemesis is Non periodic Hypokalemic paralysis. A 26 years old primigravida at 13 weeks 6 days of gestation was admitted with hyperemesis gravidarum preceded by nausea and vomiting of 10 days duration. Her sonography showed a single live fetus of corresponding maturity. She was treated with intravenous fluid therapy and parenteral antiemetics. As her hyperemesis continued despite all medications, she was started on steroid therapy, she however developed hypokalaemic paralysis with serum potassium of < 2.3mmEq/L and ECG changes of prolonged QT interval with u waves. Timely detection and potassium supplementation prevented adverse maternal outcome and patient recovered totally within 48 hrs of potassium infusion initiation. Hypokalemia remains a morbid sequelae of hyperemesis gravidarum which can be missed in the early stages as patient may remain asymptomatic. It thus becomes essential to serially monitor such patients with daily serum electrolytes especially when on corticosteroid therapy for intractable Hyperemesis to prevent any maternal near miss condition.