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B.E.
32, female
Married with four children
Roman Catholic
from Laguna
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The patient is a diagnosed case of
hypokalemic periodic paralysis since 1997 c/o
private MD. The patient is non-hypertensive
and non-diabetic.
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Generalized body weakness
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12 yrs PTC, the patient started to have
sudden onset of generalized body weakness
described as “nawawalan ng lakas ang buong
katawan”, (-)seizures, (-)fever, (-)headache,
(-) vomiting, (-) loss of consciousness, (-)
DOB. Consulted a private MD and was
diagnosed to have HPP. Patient was
maintained on Kalium BID.
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Since being diagnosed with HPP, the patient has
been having intermittent bouts of generalized body
weakness, usually upon waking up, lasting for 1-2
days. The patient has been hospitalized 2x for IV
infusion of K.
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2 weeks PTC, the patient had another
episode of generalized body weakness now
lasting for 3-4 days with note of increase
frequency of attacks (weekly). Patient self
medicated with Kalium tablets with
resolution of symptom after 4 days.
Persistence of intermittent episodes of HPP
prompted consult
Gen: (-)weight loss, (-)fever, (-) chills, (-)pallor
CNS: (-)headache, (-)seizures, (-)vomiting
HEENT: (-)blurring of vision, (-)difficulty of swallowing
Respiratory: (-)cough/colds, (-)chest pain, (-)orthopnea,
(-)paroxysmal nocturnal dyspnea, (-)hemoptysis
CVS: (-)chest pain, (-)palpitations, (-)easy fatigability
GIT: (-)vomiting, (-)constipation, (-)hematochezia,
(-) melena, (-) abdominal pain
GUT: (-) dysuria, (-) hematuria, (-) urgency, (-)frequency
MSS: (-)limitation of movement, (-)pain on exertion
Hema: (-)easy bruising, (-)bleeding tendencies
Endo: (-) polyuria, (-)polydipsia, (-)polyphagia
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(-) DM, HPN, asthma, seizures
(-) previous surgeries
(-) known allergies to food and drugs
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(-) similar illnesses
(+) DM - father
(-) HPN , goiter, kidney disease, liver disease
58
37
59
35
32
6
4
DM
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HS graduate, previously worked as a
saleslady, currently unemployed
Patient’s husband is a jeepney driver, nonpromiscious
Lives with husband and 2 children
Non-smoker, non-alcoholic beverage drinker
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Menarche at 12 yo
Regular menstrual cycle lasting for 4-5days
consuming 2-3 pads per day ,
(-) dysmenorrhea
G2P2(2002) all via SVD c/o midwife with no
note fetomaternal complications
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Alert, awake, coherent, ambulatory, not in
cardiorespiratory distress
BP: 110/ 80 HR 88 RR 20 Temp 36.8
HEENT: Anicteric sclera, pink conjunctivae,
(-) cervical lymphadenopathy,
(-) tonsillopharyngeal congestion, (-) anterior
neck mass, (-) neck vein engorgement
CHEST: Equal chest expansion, clear breath
sounds, (-) rales, (-) rhonchi, (-) wheezes
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HEART: Adynamic precordium, distinct heart
sounds, normal rate regular rhythm, (-)
murmurs
ABDOMEN: Flabby, normoactive bowel
sounds, soft, non-tender, (-) distended
abdominal veins, liver edge palpated 7 cm
MCL, spleen not palpated
EXT: Pink nailbeds, full and equal pulses, CRT
< 2 sec, (-) edema, (-)cyanosis, (-)clubbing
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Neuro Examinations:
CN I – intact
CN II- pupils 3mm EBRTL
CN III, IV, VI – EOMS full and intact, brisk corneals
CN V – can smile
CN VII – no facial asymmetry
CN VIII – intact
CN IX, X – uvula midline, good gag
CN XI – good shoulder shrug
CN XII – tongue midline
MMTs: 5/5 on all extremities
Sensory: 100% on all extremities
Reflexes: ++
(-) dysdiadochokinesia, dysmetria
(-) nystagmus, ataxia
(-) clonus, babinksi
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Hypokalemic Periodic Paralysis
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Diagnostics:
Serum K
> other tests that should have been ordered:
ECG, blood chemistry, CBC, urinalysis,
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Therapeutics:
Kalium durules TID
Advised to increase intake of K-rich food
such as banana and watermelon
TCB once with results
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Are there any meds that can prevent the
recurrence of the weakness?
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Among adults with hypokalemic periodic
paralysis, is acetazolamide effective in
preventing episodes of weakness?
P: adult patients with HPP
I: acetazolamide
O: prevention of HPP
M: RCT
Thank You!