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Devouring his favorite #sweets used to leave a young man #paralyzed
1. 33-year old Ravi loved jalebi with rabdi, but there was a problem. Whenever he used to have jalebi-rabdi to his heart's content, his legs & arms would become weak, making him bed bound for several hours.
1. 33-year old Ravi loved jalebi with rabdi, but there was a problem. Whenever he used to have jalebi-rabdi to his heart's content, his legs & arms would become weak, making him bed bound for several hours.
2. In past 6 months, Ravi faced this problem 3 times. On first two occasions, it was during marriage function, so he passed them off as food poisoning.
A week back, he faced the same problem after having Rabdi-Jalebi hygienically prepared at home. He wanted to exclude a disease.
A week back, he faced the same problem after having Rabdi-Jalebi hygienically prepared at home. He wanted to exclude a disease.
3.After listening to Ravi, I suspected a medical problem and asked him to return to hospital a few hours after having rabdi-jalebi (after informed consent).
On exam, he had developed weakness of legs & arms. He was unable to get up from squatting position. He couldn't raise arms.
On exam, he had developed weakness of legs & arms. He was unable to get up from squatting position. He couldn't raise arms.
4. His speech and swallowing were normal. He had no muscle pain. He had no numbness and had normal bladder control. I asked for a blood test. Serum potassium was reported as 2.8 mEq/L (normal value 3.5-5 mEq/L).
#MedTwitter #neurotwitter
#MedTwitter #neurotwitter
5. Clinical diagnosis at this stage was- hypokalemic periodic paralysis (HPP). He was treated with potassium supplements, with which he completely recovered.
However, the job was only half done. We still needed to find out the cause of HPP.
However, the job was only half done. We still needed to find out the cause of HPP.
6. Examination had also revealed a high pulse rate (110/minute), prominent eyeballs (bulging eyes with a staring look) and a swelling in front of neck (goitre). The diagnosis was obvious now.
I ordered for thyroid profile, which showed high T3 and T4 levels with low TSH.
I ordered for thyroid profile, which showed high T3 and T4 levels with low TSH.
7. A final diagnosis of hyperthyroidism with hypokalemic periodic paralysis was made.
Endocrinology opinion was taken for management of hyperthyroidism.
He responded well to treatment.
He could now enjoy his rabdi-jalebi without the fear of getting paralyzed.
Endocrinology opinion was taken for management of hyperthyroidism.
He responded well to treatment.
He could now enjoy his rabdi-jalebi without the fear of getting paralyzed.
8. Having foods rich in carbohydrate (starchy foods) can reduce potassium levels in people prone to it (such as in hypokalemic periodic paralysis). This is due to insulin surge post-meal, resulting in increased potassium uptake in cells, thus decreasing serum potassium levels.
9. Take home message
*Suspect hypokalemic periodic paralysis (HPP), when weakness is triggered by carbohydrate-rich meal, exercise, or stress.
*Hyperthyroidism is among common causes of HPP.
*Early diagnosis & prompt treatment can prevent disability and reduce anxiety & costs.
*Suspect hypokalemic periodic paralysis (HPP), when weakness is triggered by carbohydrate-rich meal, exercise, or stress.
*Hyperthyroidism is among common causes of HPP.
*Early diagnosis & prompt treatment can prevent disability and reduce anxiety & costs.
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