35 year old male with periferal neuropathy under evaluation,Hypokalemic periodic paralysis(secondary to diuretics use) overcorrected to hyperkalemia, pedal edema and SOB under evaluation(resolved),chronic alcoholic

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Here is a case i have seen:

A 35 year old male presented to the opd

C/o pedal edema since 1 month(resolved)

 c/o weakness of bilateral limbs since 6 days

Pt was apparently asymptomatic 1 month ago then he developed bilateral pedal edema upto ankles pitting type and used medication for 4 days(diuretics) 

No h/o SOB, chest pain, palpitations,abdominal distension, yellowish discoloration of eyes, fever, cold, cough, decreased urine output 

C/o weakness of all 4 limbs since 6 days diagnosed with hypokalemic periodic paralysis out side (on 14/10/2020 k+:2.9 with syp potchlor on 15/10/2020 k+:3.3)

No h/o  convulsions,trauma,urinary incontinence, syncopal attacks, loss of consciousness. 

Weakness of all four limbs developed simultaneously ,symmetrical involvement. 

Pt is able to comb hair

Pt has difficulty in mixing food, holding objects,writing

Pt is not able to get up from squatting position

Pt has difficulty in climbing stairs 

Able to hold chappal 

Pt is not able to get up from bed

Pt is able to roll on bed

H/o tingling sensation present bilateral lower limbs

No h/o numbness, burning,pricking sensation of feet

No h/o loss of sensations ,able to sense floor while walking 

H/o muscle cramps present

No bowel and bladder disturbances

No history suggestive of any cranial nerve involvement

H/o similar complaints 1 year back was admitted and treated for hypokalemic periodic paralysis. 

Not a k/c/o DM, HTN, CVA, CAD, TB, epilepsy, asthma

Personal history:

Pt takes mixed diet 

Appetite normal 

Bowel and bladder movements are regular

Alcoholic since 16 years, 2 to 3 times/week,tobacco chewing since 5 years. 

O/e:

Pt is conscious,coherent,cooperative

No pallor, icterus, cyanosis, clubbing, Lymphaenopathy ,Pedal edema 

Afebrile on touch 

Bp:110/70mmhg

Pulse:91bpm

RS :bilateral air entry present, normal vesicular breath sounds heard 

P/A :soft, non tender 

CNS:

speech Normal

oriented to time place person

memory normal

Higher mental functions normal 

cranial nerves normal

motor

   tone normal in all 4limbs

   power 4/5 in all 4limbs

   reflexes bilateral biceps,triceps,ankle,knee absent

  plantars bilateral flexion

sensory

   fine touch normal

   pain normal

   vibration sense lost in all 4limbs

   stereognosis normal

   joint position sense normal

  

cerebellar signs

  rombergs negative

  able to perform finger nose test

  involuntary movements absent

  dysdiadochokinesia absent

  tandem walking- able to do

no signs of meningeal irritation

CVS

no visible epigastric pulsations

apex beat in 5th ics medial to midclavicular line

no palpable thrill or heave

s 1 s 2 heard,no mumurs

Reports:

Hemogram:

Hb:12.4

TLC:7400

PLT:2.33

CUE:

Albumin:nil

Sugars:nil

RBC:nil

Pus cells:3-4

Urinary potassium :39.9

LFT:

TB:0.85

DB:0.2

AST:168

ALT:232

alkaline phosphate :269

Total protein :6.6

Albumin:4.0

A/G:1.58

RFT:

Urea:32

Creat:1.2

UA:4.1

Calcium:10.2

Phosphorus :6.0

Sodium:142

Potassium :5.7

Chloride:99

RBS:97mg/dl

Urine sodium:273

Urinary chloride:252

Serum magnesium :1.9

Serology:negative

ECG:

2d echo:

Usg abdomen:

 Treatment:

Tab pan 40mg po od

inj thiamine 1amp in 100ml ns iv tid

Inj optineuron 1amp in 100ml ns iv od

nebulisation with plain asthalin(4 respules) 

Inj HAI(8 units) in 25% dextrose/iv/@40 min

bp/pr/spo2 charting 4th hrly

strict I/O charting

Day 2:

No fresh complaints 

O/e:

Pt is conscious,coherent,cooperative

No pallor, icterus, cyanosis, clubbing, Lymphaenopathy ,Pedal edema 

Afebrile on touch 

Bp:110/80mmhg

Pulse:98bpm

Grbs:98 mg/dl

RS :bilateral air entry present, normal vesicular breath sounds heard 

P/A :soft, non tender 

CNS:

speech Normal

oriented to time place person

memory normal

Higher mental functions normal 

cranial nerves normal

motor

   tone normal in all 4limbs

   power 4/5 in all 4limbs

   reflexes bilateral biceps,triceps,ankle,knee absent

  plantars bilateral flexion

sensory

   fine touch normal

   pain normal

   vibration sense lost in all 4limbs

   stereognosis normal

   joint position sense normal

  

cerebellar signs

  rombergs negative

  able to perform finger nose test

  involuntary movements absent

  dysdiadochokinesia absent

  tandem walking- able to do

no signs of meningeal irritation

CVS

no visible epigastric pulsations

apex beat in 5th ics medial to midclavicular line

no palpable thrill or heave

s 1 s 2 heard,no mumurs

Serum potassium:4.8

Treatment:

Tab pan 40mg po od

inj thiamine 1amp in 100ml ns iv tid

Inj optineuron 1amp in 100ml ns iv od

bp/pr/spo2 charting 4th hrly

strict I/O charting

Day 3:

C/o muscle cramps (calf) 

Passed stools

O/e:

Pt is conscious,coherent,cooperative

No pallor, icterus, cyanosis, clubbing, Lymphaenopathy ,Pedal edema 

Afebrile on touch 

Bp:110/80mmhg

Pulse:98bpm

Grbs:98 mg/dl

RS :bilateral air entry present, normal vesicular breath sounds heard 

P/A :soft, non tender 

CNS:

speech Normal

oriented to time place person

memory normal

Higher mental functions normal 

cranial nerves normal

motor

   tone normal in all 4limbs

   power 4/5 in all 4limbs

   reflexes bilateral biceps,triceps,ankle,knee absent

  plantars bilateral flexion

sensory

   fine touch normal

   pain normal

   vibration sense lost in all 4limbs

   stereognosis normal

   joint position sense normal

  

cerebellar signs

  rombergs negative

  able to perform finger nose test

  involuntary movements absent

  dysdiadochokinesia absent

  tandem walking- able to do

no signs of meningeal irritation

CVS

no visible epigastric pulsations

apex beat in 5th ics medial to midclavicular line

no palpable thrill or heave

s 1 s 2 heard,no mumurs

Serum potassium:4.9

thyroid profile:

T3:1.30

T4:8.03

TSH:2.19

Treatment:

Tab pan 40mg po od

inj thiamine 1amp in 100ml ns iv tid

Inj optineuron 1amp in 100ml ns iv od

bp/pr/spo2 charting 4th hrly

strict I/O charting

Day 4:

no fresh complaints 

O/e:

Pt is conscious,coherent,cooperative

No pallor, icterus, cyanosis, clubbing, Lymphaenopathy ,Pedal edema 

Afebrile on touch 

Bp:120/80mmhg

Pulse:71bpm

Grbs:98 mg/dl

RS :bilateral air entry present, normal vesicular breath sounds heard 

P/A :soft, non tender 

CNS:

speech Normal

oriented to time place person

memory normal

Higher mental functions normal 

cranial nerves normal

motor

   tone normal in all 4limbs

   power 4/5 in all 4limbs

   reflexes bilateral biceps,triceps,ankle,knee absent

  plantars bilateral flexion

sensory

   fine touch normal

   pain normal

   vibration sense lost in all 4limbs

   stereognosis normal

   joint position sense normal

  

cerebellar signs

  rombergs negative

  able to perform finger nose test

  involuntary movements absent

  dysdiadochokinesia absent

  tandem walking- able to do

no signs of meningeal irritation

CVS

no visible epigastric pulsations

apex beat in 5th ics medial to midclavicular line

no palpable thrill or heave

s 1 s 2 heard,no mumurs

Serum potassium:4.3

Treatment:

Tab pan 40mg po od

inj thiamine 1amp in 100ml ns iv tid

Inj optineuron 1amp in 100ml ns iv od

bp/pr/spo2 charting 4th hrly

strict I/O charting