Case Presentation: Introduction: Hypokalemic periodic paralysis (HOKPP) is characterized by transient episodes of muscle weakness and inability of muscle movement associated with hypokalemia. The paralysis typically affects the arms and legs, though the diaphragm and the tongue may also be affected.Case Description: A 50-year-old female with tobacco use and significant alcohol consumption presented with progressive upper and lower limb weakness, numbness, and paresthesias that worsened over the past 2-3 months. She also reported fever, sweats, and unintentional 40-lb weight loss over the past 3 months. The patient denied use of diuretics and laxatives. Labs revealed serum potassium 1.9 mmol/L (3.5 – 5.2), phosphorous 2.2 mg/dL (2.5 – 4.5), bicarb 43 mmol/L (21-30), and a venous blood gas of 7.61/50/25/50, which is consistent with metabolic alkalosis. EKG demonstrated U waves and ST depressions significant for severe hypokalemia. She was admitted for severe hypokalemia and was given oral and IV potassium. Vitamin D was 16.0 ng/mL (30-100), which is suggestive of hypovitaminosis D. TSH and cortisol were normal, thus ruling out thyrotoxicosis and Cushing’s, respectively. Serum aldosterone and renin levels were normal, thus ruling out adrenal involvement. The Transtubular K+ Gradient was calculated to be 4, indicating a renal tubular wasting of potassium. In addition to renal potassium wasting, the cellular shift of potassium in the setting of chronic malnutrition and prolonged alcohol use exacerbated the severe hypokalemia. The patient’s potassium was repleted, and she was discharged from the hospital with close outpatient follow up.
Discussion: Discussion: Hypokalemic periodic paralysis (HOKPP) is characterized by transient episodes of muscle weakness in the setting of hypokalemia. HOKPP has a prevalence of 1 in 100,000. HOKPP manifests itself as a sudden onset of weakness ranging from mild transient weakness of the arms and legs to paralysis of the diaphragm and accessory muscles, resulting in lethal respiratory failure. HOKPP can be triggered by a stressor, such as a viral illness or by specific medications, such as insulin, beta-agonists, or steroids.
Conclusions: Conclusion: Hypokalemic periodic paralysis (HOKPP) is important to rule out when evaluating a patient with abrupt onset of paralysis or weakness, especially those patients with no history or risk factors of other pertinent disease, such as stroke. The failure to diagnose and properly treat HOKPP can be fatal. The rapid repletion of potassium can treat symptoms completely. It is also vital to stress that the underlying cause of hypokalemia must be addressed to prevent the recurrence of HOKPP.