HYPOKALEMIC PERIODIC PARALYSIS

 A 62 year old male presented with weakness in both lower limbs extending upto thigh unable to lift and walk.

He is the eldest of 5 sons and owns  4 acres of land ,grows rice and owns and drives a tractor to plough the field.
He is an alcoholic since 30 years , daily intake (90-180 ml whisky) and denies smoking
5 years ago ,On an occasion, he was made to drink herbal medication in order to make him quit drinking .He developed fever the same night with chills and was taken to hospital and he even recollects that his voice was getting low and starting from paralysis of lower limbs in an ascending manner and was referred to Kims,Nkp.He stayed for 3 days and was discharged on potassium supplementation.
6-10 days later he developed paralysis of lower limbs and was again brought to Kims ,Nkp, and was corrected and was symptom free for one month 

He developed paralysis for third time later ,after 1-2 months ,he was taken to Gandhi hospital for the same and he recovered and was symptom free for 4 years .

He discontinued the medication from 2 yrs and presented to our hospital 


Personal history 
Patient takes mixed diet ,has normal appetite,with regular bowel and bladder movements

On general physical examination
Patient is c/c/c
Moderately built and well nourished
No pallor , cyanosis, clubbing , lymphadenopathy.
Vitals- 
PR- 90 bpm
BP- 110/80 mm hg
Rr- 20 cpm
Spo2 - 98% at  ra

Systemic examination
Cvs- s1,s2 +
RS- BAE+
P/a - soft ,non tender, bs+
Cns- nad


                           RL         LL 
Tone-   UL          N.          N
             LL          N.           N
Power UL         +4         +4
             LL        + 3         +3
             
Reflexes
        B               -        -
        T                -       -
        S.                -      -
        K.                 +1      +1
        A.                -.          -
        Plantar - flexor      Flexor



Provisional diagnosis
? HYPOKALEMIC PERIODIC PARALYSIS 

PLAN OF TREATMENT

1. Inj. Kcl  2 amp in 500ml Ns over 4.5 hours
 2. Inj. Thiamine  1 amp in 100 ml NS  iv tid
3. Syp. Potachlor 10 ml po TID 
4. Inj.pan 40 mg iv OD bbf
5. IVF 1 NS , 1RL @ 100 ml/hr
6. Tab.dolo 650 mg po sos
25/10/21

SOAP NOTES DAY 3
AMC bed 2

S:
C/O muscle aches
Weakness improved

O:
Patient is conscious coherent and cooperative
Temp: 98.6 F
BP: 110/80 mmHg
RR:18CPM
PR:80BPM
CVS: S1,S2 heard
RS: NVBS+,no crepts
P/A: soft ,non tender
GRBS:110 mg/dl
I/O :2600/2100
SPO2:98%

A:
? HYPOKALEMIC PERIODIC PARALYSIS 

P:
1)inj thiamine 1 amp in 100 ml NS iv Tid
2)inj.kcl 2 amp in 500 ml NS iv over 4-5 hrs
3)inj.pantop 40 mg IV OD BBF
4)Tab.Dolo 650 mg po sos
5)syp.potchlor 15 ml po Tid
6) continuous ECG monitoring
26/10/21

SOAP NOTES DAY 4
AMC bed 2

S:
C/O Tingling in the hands and feet, weakness improved

O:
Patient is conscious coherent and cooperative
Temp: 98.6 F
BP: 110/80 mmHg
RR:18CPM
PR:80BPM
CVS: S1,S2 heard
RS: NVBS+,no crepts
P/A: soft ,non tender
GRBS:110 mg/dl
I/O :2600/2100
SPO2:98%

A:
? HYPOKALEMIC PERIODIC PARALYSIS 

P:
1)inj thiamine 1 amp in 100 ml NS iv Tid
2)inj.kcl 2 amp in 500 ml NS iv over 4-5 hrs
3)inj.pantop 40 mg IV OD BBF
4)Tab.Dolo 650 mg po sos
5)syp.potchlor 15 ml po Tid
6) continuous ECG monitoring

27/10/21

SOAP NOTES DAY 5
AMC bed 2

S:
No present complaints

O:
Patient is conscious coherent and cooperative
Temp: 98.6 F
BP: 110/80 mmHg
RR:18CPM
PR:80BPM
CVS: S1,S2 heard
RS: NVBS+,no crepts
P/A: soft ,non tender
GRBS:110 mg/dl
I/O :2600/2100
SPO2:98%

A:
? HYPOKALEMIC PERIODIC PARALYSIS 

P:
1)inj thiamine 1 amp in 100 ml NS iv Tid
2)inj.kcl 2 amp in 500 ml NS iv over 4-5 hrs
3)syp.potchlor 15 ml po Tid

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