CLINICAL AND AETIOLOGICAL SPECTRUM OF HYPOKALEMIC FLACCID PARALYSIS IN TERTIARY CARE HOSPITAL

Main Article Content

Muhammad Abid
Hamza Shoaib
Asrar Haider
Safi Ullah Khan
Tazeen Nazar
Taleah Tahir

Keywords

Hypokalemic flaccid paralysis, Clinical spectrum, etiological spectrum

Abstract

Background and Aim: Hypokalemic flaccid paralysis refers to sudden muscle weakness caused by low levels of potassium in the body. This weakness affects respiratory and pharyngeal muscles and reaches its peak severity within a matter of days to weeks. The current study investigated the clinical and etiological spectrum of hypokalemic flaccid paralysis.


Patients and Methods:  This cross-sectional study was conducted on 136 hypokalemic flaccid paralysis patients in the Department of Medicine and Nephrology, Jinnah Hospital, Lahore from January 2022 to December 2022. Patient’s clinical presentation includes symptoms such as weakness, fever, difficulty in breathing, cough, heart beat variation, and vomiting etc. Improvement in clinical symptoms, complete improvement, and mortality rate were different outcomes measured.


Results: The overall mean age was 12.46±3.82 years with an age range 1 year to 20 years. There were 86 (63.2%) male and 50 (36.8%) females. Guillain bare syndrome was the most prevalent disease 52 (38.2%) followed by viral myositis 37 (27.2%) at presentation. The incidence of various symptoms such as weakness, fever, headache, vomiting, and difficulty in breathing was 100% (n=136), 44.1% (n=60), 42.6% (n=58), 17.6% (n=24), and 13.2% (n=18) respectively.  Following the treatment, 90 cases (66.2%) showed some improvement, whereas 24 patients (17.6%) did not experience any improvement. About 16 (11.8%) cases developed residual neurological disability whereas the mortality rate was 2.9% (n=4) during follow-up.


Conclusion: The present study found that Guillain bare syndrome was the most prevalent disease followed by viral myositis. Treatment can improve acute flaccid paralysis in over 60% of patients.


 


 

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References

1. Bhagat SK, Sidhant S, Bhatta M, Ghimire A, Shah B. Clinical profile, functional outcome, and mortality of guillain-barre syndrome: A five-year tertiary care experience from Nepal. Neurol Res Int 2019; 2019(1): 3867946. https://doi: 10.1155/2019/3867946.
2. Li X, Xiao J, Ding Y, Xu J, Li C, He Y, et al. Clinical and electrophysiological features of post-traumatic Guillain-Barré syndrome. BMC Neurol 2017; 17(1): 142.
https://doi.org/10.1186%2Fs12883-017-0919-x.
3. Ali S, Zia ur Rehman M, Sultan T. Spectrum of acute flaccid paralysis in children. Pak J Neurol Sci 2016; 11(4): 8-11.
4. Aliabadi N, Messacar K, Pastula DM, Robinson CC, Leshem E, Sejvar JJ, et al. Enterovirus D68 infection in children with acute flaccid myelitis, Colorado, USA, 2014. Emerg Infect Dis 2016; 22(8): 1387-1394. https://doi.org/10.3201%2Feid2208.151949.
5. Nelson GR, Bonkowsky JL, Doll E, Green M, Hedlund GL, Moore KR, et al. Recognition and Management of Acute Flaccid Myelitis in Children. Pediatr Neurol 2016; 55(1): 17-21.https://doi: 10.1016/j.pediatrneurol.2015.10.007.
6. Sejvar JJ, Lopez AS, Cortese MM, Leshem E, Pastula DM. Acute flaccid myelitis in the United States, August–December 2014: results of nationwide surveillance. Clin Infect Dis 2016; 63(6):737-745. https://doi.org/10.1093%2Fcid%2Fciw 372.
7. Chong PF, Kira R, Mori H, Okumura A. Clinical features of acute flaccid myelitis temporally associ-ated with an enterovirus d68 outbreak: results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015. Clin Infect Dis 2018; 66(5): 653-664. https://doi.org/10. 1093%2Fcid%2Fcix860.
8. Wang Q, Zhao Z, Shen H, Bing Q, Li N, Hu J. The clinical and genetic heterogeneity analysis of fve families with primary periodic paralysis. Channels Austin Tex. 2021;15(1):20–30.
9. Farooque U, Cheema AY, Kumar R, Saini G, Kataria S. Primary periodic paralyses: a review of etiologies and their pathogeneses. Cureus.2020;12(8): e10112.
10. Sardar Z, Waheed KAF, Javed MA, Akhtar F, Bokhari SRA. Clinical and etiological spectrum of hypokalemic periodic paralysis in a tertiary care hospital in Pakistan. Cureus. 2019;11(1): e3921.
11. Patra S, Chakraborty PP, Biswas SN, Barman H. Etiological search and epidemiological profle in patients presenting with hypokalemic paresis:an observational study. Indian J Endocrinol Metab. 2018;22(3):397–404.
12. Mohapatra BN, Lenka SK, Acharya M, Majhi C, Oram G, Tudu KM. Clinical and aetiological spectrum of hypokalemic faccid paralysis in Western Odisha. J Assoc Physicians India. 2016;64(5):52–8.
13. Garg RK, Malhotra HS, Verma R, Sharma P, Singh MK. Etiological spectrum of hypokalemic paralysis: a retrospective analysis of 29 patients. Ann Indian Acad Neurol. 2013;16(3):365–70.
14. Messacar K, Schreiner TL, Van Haren K et al.. Acute flaccid myelitis: a clinical review of US cases 2012–2015. Ann Neurol 2016; 80:326–38.
15. Mori S, Endo M, Uchida Y et al.. Six cases of enterovirus D68 infection including acute flaccid paralysis (in Japanese). J Jpn Pediatr Soc 2016; 120:1495–501.
16. Kimura K, Fukushima T, Katada N et al.. Adult case of acute flaccid paralysis with enterovirus D68 detected in the CSF. Neurol Clin Prac 2016. doi:10.1212/CPJ.311.
17. Gunde R, Jayashankar CA, Bhat N, Bhat V, Kodapala S. Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report. Cureus. 2023 Sep 26;15(9).
18. Gupta M, Daid S. Etiology and Outcomes of Acute Flaccid Paralysis in Adults: A Study in Tertiary Care Center. medRxiv. 2020 May 29:2020-05.
19. Kunju M, Eapen M. ACUTE FLACCID PARALYSIS BEYOND POLIO-A CASE BASED APPROACH. Indian Journal of Practical Pediatrics. 2020;22(1):12.
20. Chukwuedozie VC, Garg T, Chaudhry HA, Shawl SH, Mishra P, Adaralegbe NJ, Khan A, CHUKWUEDOZIE VC. Late-Onset Hypokalemic Periodic Paralysis in an Adult Female With Type 2 Renal Tubular Acidosis: A Case Report. Cureus. 2022 Aug 5;14(8).
21. Ahmed SF, Prathyusha M, Kumar KK, Ara OT. A Study of Clinical and Etiological Spectrum of Hypokalemic Flaccid Paralysis. European Journal of Molecular & Clinical Medicine (EJMCM).;9(03):2022.
22. Paz-Ibarra JL, Sáenz-Bustamante SM, Ildefonso-Najarro SP, Portillo-Flores K, Quispe-Flores MA, Plasencia-Dueñas EA, Concepción-Zavaleta MJ. Clinical-epidemiological profile of patients with thyrotoxic periodic paralysis in two peruvian hospitals. Revista Medica del Instituto Mexicano del Seguro Social. 2022 Jul 4;60(4):379-87.
23. Yuan JH, Higuchi Y, Hashiguchi A, Ando M, Yoshimura A, Nakamura T, Hiramatsu Y, Sakiyama Y, Takashima H. Gene panel analysis of 119 index patients with suspected periodic paralysis in Japan. Frontiers in Neurology. 2023 Jan 26;14:1078195.
24. Radhakrishan S, Sundari M, Dev A, Arun K. A Case Series Of Periodic Approach To Hypokalemic Periodic Paralysis-The Paralysis By The Potassium. Journal of Pharmaceutical Negative Results. 2022 Nov 13:1640-5.