62 yr old male patient with Periodic Hypokalemic Paralysis

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

CHIEF COMPLAINT:

A 62 yr old male patient came to the opd with the weakness in both lower limbs extending upto the thigh.Unable to lift and walk.

HISTORY OF PRESENT ILLNESS:

The patient was apparently asymptomatic one week back .

On that day from evening he gradually developed weakness in lower limbs and lost his sensation around 1 am in the night.

He also noticed slurring of speech, dizziness.

On the next day morning he couldn't able to wake up and walk from the bed.

PAST HISTORY:

Patient had similar complaints about 3 times in the past .

He had a first attack in 2018 where both upper and lower limbs were weakened along with slurring of speech which continued for two days and then resolved on medication administered by physician of Gandhi hospital.

He had a similar episode in 2019 but there was no slurring of speech.

PERSONAL HISTORY:

He is not a k/c/o of hypertension, diabetes mellitus,bronchial asthma and coronary artery disease.

Appetite-normal.

Sleep-adequate.

Diet-mixed.

Regular bowel and bladder movements.

He is an alcoholic since 30 yrs with a consumption of 90ml/day.

FAMILY HISTORY:

There are no similar complaints in any of the family members.

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative and we'll oriented to time ,place and person.

There is no pallor, pedal edema,icterus,clubbing and cyanosis.

Vitals-Temp: Afebrile

            BP:120/70mmHg

            PR:82beats/min

            RR:27cpm

SYSTEMIC EXAMINATION:

Cvs:-

S1 and S2 heard.

No murmurs.

Respiratory:-

Bilateral airway +ve.

Normal vesicular breathe sounds heard.  

Per Abdomen:-

Trunkal obesity is present.

Tenderness is present.

Liver and spleen are non-palpable.

CNS:-   

Power:    UL         LL     

          R.   5/5.       5/5

          L.    5/5.       5/5


Tone:      UL.        LL

        R.     N.           N

        L.     N.           N

Reflexes:    B   T   S   K   A   P

             R:-   -     -    -    -    -    Decreased


             L:-  -     -    -    -    -    Decreased






INVESTIGATIONS:

















PROVISIONAL DIAGNOSIS:-

Periodic Hypokalemic Paralysis.


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










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