B.E. 32, femaleMarried with four childrenRoman Catholic from Laguna

The patient is a diagnosed case of hypokalemic periodic paralysis since 1997 c/o private MD. The patient is non-hypertensive and non-diabetic.

Generalized body weakness

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.

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.

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, (-)pallorCNS: (-)headache, (-)seizures, (-)vomiting HEENT: (-)blurring of vision, (-)difficulty of swallowingRespiratory: (-)cough/colds, (-)chest pain, (-)orthopnea, (-)paroxysmal nocturnal dyspnea, (-)hemoptysisCVS: (-)chest pain, (-)palpitations, (-)easy fatigabilityGIT: (-)vomiting, (-)constipation, (-)hematochezia, (-) melena, (-) abdominal painGUT: (-) dysuria, (-) hematuria, (-) urgency, (-)frequency MSS: (-)limitation of movement, (-)pain on exertionHema: (-)easy bruising, (-)bleeding tendenciesEndo: (-) polyuria, (-)polydipsia, (-)polyphagia

(-) DM, HPN, asthma, seizures (-) previous surgeries (-) known allergies to food and drugs

(-) similar illnesses (+) DM - father (-) HPN , goiter, kidney disease, liver

disease

DM

3235

46

37

5958

HS graduate, previously worked as a saleslady, currently unemployed

Patient’s husband is a jeepney driver, non-promiscious

Lives with husband and 2 children Non-smoker, non-alcoholic beverage

drinker

Menarche at 12 yo Regular menstrual cycle lasting for

4-5days consuming 2-3 pads per day ,

(-) dysmenorrheaG2P2(2002) all via SVD c/o midwife

with no note fetomaternal complications

Alert, awake, coherent, ambulatory, not in cardiorespiratory distress

BP: 110/ 80 HR 88 RR 20 Temp 36.8HEENT: Anicteric sclera, pink conjunctivae,

(-) cervical lymphadenopathy, (-) tonsillopharyngeal congestion, (-) anterior neck mass, (-) neck vein engorgement

CHEST: Equal chest expansion, clear breath sounds, (-) rales, (-) rhonchi, (-) wheezes

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

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

Hypokalemic Periodic Paralysis

Diagnostics: Serum K

> other tests that should have been ordered: ECG, blood chemistry, CBC, urinalysis,

Therapeutics:Kalium durules TID

Advised to increase intake of K-rich food such as banana and watermelon

TCB once with results

Are there any meds that can prevent the recurrence of the weakness?

Among adults with hypokalemic periodic paralysis, is acetazolamide effective in preventing episodes of weakness?

P: adult patients with HPP I: acetazolamideO: prevention of HPPM: RCT

Thank You!