Case Report: Rapidly Ascending Weakness in a 22-year-old Man
An otherwise healthy 22-year-old man presents to the ED with bilateral lower extremity weakness ascending to his right upper extremity.
The pathogenesis of HPP is not completely understood; however, alteration in potassium regulation are well documented. Treatment of HPP includes both oral and IV potassium supplementation. Prophylaxis against recurrent attacks has been successful with various modalities including spiranolactone daily and acetazolamide.4 Care must be taken to consider thyrotoxic periodic paralysis, which most commonly presents in Asian men, as hyperthyroid symptoms may be subtle. Treatment focuses on reversal of the thyrotoxic state. β-Adrenergic blocking agents reduce the frequency and severity of attacks and should be started while measures to control thyrotoxicosis are being instituted.4
Before a diagnosis of HPP is made, other causes of hypokalemic paralysis must first be excluded.
Conclusion
This case is important because it demonstrates an unusual presentation of HPP in an emergency setting. This perspective of HPP can help the EP in recognizing and differentiating the condsition from similar disorders.
Dr Orlik is a resident, department of emergency medicine, Akron General Medical Center, Ohio. Mr Kovacs is a student and summer research fellow, department of emergency medicine, Akron General Medical Center, Ohio. Dr Simon is the emergency medicine research director, department of emergency medicine, Akron General Medical Center, Northeast Ohio Medical University.
