Hypokalemic periodic paralysis triggered by exertion and cold exposure in a resource-limited Ethiopian setting: a case report

BACKGROUND: Hypokalemic periodic paralysis is a type of periodic paralysis, a rare but life-threatening condition that can cause sudden onset weakness but can be reversed completely with early diagnosis and treatment. Diagnosis of hypokalemic periodic paralysis can be challenging in resource-limited settings where investigations such as genetic testing, Electromyography (EMG) and biochemical tests are not available. We present a case of hypokalemic periodic paralysis in an adult female diagnosed and treated using trigger pattern recognition, basic investigations, exclusion of differential diagnosis and treatment response. CASE PRESENTATION: A case of a 35-year-old Ethiopian female is presented here. The patient presented with a sudden onset of weakness with failure to move her extremities for 1-day duration, preceded by vigorous exercise in her farm land. She had experienced a similar illness a year back in the cold season, for which she was treated and discharged improved. Laboratory results were remarkable for markedly low serum potassium. The patient had improvement after 12 hours of starting potassium replacement. On the second day, the serum potassium was 4 mEq/L, and the patient was discharged from the hospital with no residual neurologic deficit. CONCLUSION: Early diagnosis and treatment of hypokalemic periodic paralysis (PP) is lifesaving, as late diagnosis can be fatal. Therefore, periodic paralysis should be considered in the differential diagnosis of patients with weakness even in adult female patients who do not fit the common demographic. Careful evaluation of trigger factors, previous historical clues, patient presentation and response to treatment can aid timely diagnosis and management in resource limited settings.