title: Clinical and biochemical spectrum of hypokalemic paralysis in North: East India.
abstract: BACKGROUND
  Acute hypokalemic paralysis, characterized by acute flaccid paralysis is primarily a calcium channelopathy, but secondary causes like renal tubular acidosis (RTA), thyrotoxic periodic paralysis (TPP), primary hyperaldosteronism, Gitelman's syndrome are also frequent.
  
  
  OBJECTIVE
  To study the etiology, varied presentations, and outcome after therapy of patients with hypokalemic paralysis.
  
  
  METHODS
  All patients who presented with acute flaccid paralysis with hypokalemia from October 2009 to September 2011 were included in the study. A detailed physical examination and laboratory tests including serum electrolytes, serum creatine phosphokinase (CPK), urine analysis, arterial blood gas analysis, thyroid hormones estimation, and electrocardiogram were carried out. Patients were further investigated for any secondary causes and treated with potassium supplementation.
  
  
  RESULTS
  The study included 56 patients aged 15-92 years (mean 36.76 ± 13.72), including 15 female patients. Twenty-four patients had hypokalemic paralysis due to secondary cause, which included 4 with distal RTA, 4 with Gitelman syndrome, 3 with TPP, 2 each with hypothyroidism, gastroenteritis, and Liddle's syndrome, 1 primary hyperaldosteronism, 3 with alcoholism, and 1 with dengue fever. Two female patients were antinuclear antibody-positive. Eleven patient had atypical presentation (neck muscle weakness in 4, bladder involvement in 3, 1 each with finger drop and foot drop, tetany in 1, and calf hypertrophy in 1), and 2 patient had respiratory paralysis. Five patients had positive family history of similar illness. All patients improved dramatically with potassium supplementation.
  
  
  CONCLUSIONS
  A high percentage (42.9%) of secondary cause for hypokalemic paralysis warrants that the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis.
authors: Department of Neurology, Gauhati Medical College, Guwahati, Assam, India.
authors: Ashok K
authors: AK
authors: Kayal
authors: Munindra
authors: M
authors: Goswami
authors: Marami
authors: M
authors: Das
authors: Rahul
authors: R
authors: Jain
keywords: Hypokalemia; paralysis; secondary causes
references: QJM. 2001 Mar;94(3):133-9
references: 11259688
references: Postgrad Med J. 1999 Apr;75(882):193-7
references: 10715756
references: Clin Nephrol. 1992 Apr;37(4):189-91
references: 1582057
references: Postgrad Med J. 2010 Dec;86(1022):692-5
references: 20935343
references: Natl Med J India. 2006 Sep-Oct;19(5):246-9
references: 17203677
references: J Assoc Physicians India. 2009 May;57:419-20
references: 19637407
references: Yonsei Med J. 2000 Apr;41(2):276-80
references: 10817031
references: Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2007 Jun;21(2):123-5
references: 17653311
references: Am J Emerg Med. 1992 Mar;10(2):143-8
references: 1586409
references: Rinsho Shinkeigaku. 1990 Jan;30(1):100-2
references: 2331814
references: Folia Psychiatr Neurol Jpn. 1976;30(4):505-15
references: 1021545
references: Trans Assoc Am Physicians. 1966;79:221-35
references: 5929460
references: Kidney Int. 1981 Sep;20(3):389-96
references: 6795380
references: Neurol India. 2010 Jul-Aug;58(4):592-4
references: 20739798
references: J Neurol Neurosurg Psychiatry. 1964 Feb;27:5-9
references: 14123927
references: Ann Indian Acad Neurol. 2011 Oct;14(4):272-8
references: 22346016
references: Intern Med J. 2007 May;37(5):303-7
references: 17504277
references: Q J Med. 1986 Nov;61(235):1021-37
references: 3659246
references: N Engl J Med. 1999 Apr 15;340(15):1177-87
references: 10202170
references: J Intern Med. 1993 Jun;233(6):463-6
references: 8501417
references: J Clin Endocrinol Metab. 1996 Nov;81(11):4038-41
references: 8923857