Clay ingestion induced hypokalemic paralysis: a rare case report in an elderly female with severe iron deficiency anemia

Hypokalemic paralysis is a rare neuromuscular disorder characterized by painless muscle weakness resulting from low potassium levels, most commonly presenting during adolescence. In this case report, we detail the presentation and management of an 80-year-old female who experienced sudden onset bilateral limb weakness. Initial clinical assessment revealed the absence of reflexes and hypotonia in all four limbs without any gastrointestinal or neurological symptoms. Comprehensive diagnostic evaluation identified severe iron deficiency anemia and an unusual history of clay ingestion due to pica as the underlying causes of her hypokalemic paralysis. Treatment included intravenous and oral potassium supplementation, as well as packed cell volume transfusions, leading to a significant improvement in her symptoms and normalization of her potassium levels. This case highlights the need to consider atypical etiologies, such as pica-induced clay ingestion, in the differential diagnosis of hypokalemic paralysis, particularly in elderly patients with nutritional deficiencies. Early recognition and appropriate management are critical for favourable outcomes.