Clinical Evaluation of Hypokalemia-Induced Reversible Acute Flaccid Paralysis

Background: Hypokalemia-induced acute flaccid paralysis is a relatively uncommon clinical condition; however, it can be apotentially serious emergency. Early recognition and correction can lead to rapid recovery. The current study was done toevaluate the clinical presentation, biochemical profile, etiological factors, and treatment response. Materials and Methods:This prospective observational study was conducted among 60 adult patients presenting with acute flaccid weaknessassociated with serum potassium <3.5 mEq/L. Demographic profile of the patients along with biochemical investigations andECG were recorded. Neurological recovery was defined as restoration of muscle power to MRC ≥4/5 in affected musclegroups. Correlations between serum potassium, MRC score and recovery time were recorded. Results: The mean age of thecohort was 38.4 ± 14.2 years. Mean serum potassium at admission was 2.4 ± 0.5 mEq/L. The median time to initialimprovement was 6 hours (IQR 4–12) and median time to neurological recovery was 36 hours (IQR 24–72). Admissionserum potassium positively correlated with MRC sum score (r=0.62, P<0.001) and negatively correlated with time toneurological recovery (r=−0.55, P<0.001) and negatively correlated with time to neurological recovery (r=−0.55, P<0.001).Conclusion: Hypokalemia-induced acute flaccid paralysis is a predominantly reversible condition with diverse underlyingetiologies. Lower potassium levels were associated with greater weakness and delayed recovery. Early identification of thecause and carefully monitored potassium replacement resulted in rapid neurological improvement in most patients.